310395_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Water Resources
rality Number - 4 Division of Soil and Water Conservation
� Other Age�y
type of visit: ompli a nspection Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: outine , 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: G r Arrival Time: j 3 Departure Time: FZ l County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Tittle:
Onsite Representative: a/ j "'-� & '_ '-t � `'
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number: 17 ; J-.O
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
to Feeder I
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Layer
-:;'Feeder
INon-Layer— I
Dairy Calf
Dairy Heifer
to Finish
b A io 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,ouit . Ca aci P,o ,
Layers I I
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
01
Wither
Other
Turke s
Turke Points
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No [DNA ❑ NE
❑ Yes a�;0_1_
❑ NA ❑ NE
❑ Yes ❑ No DNA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - jDate of inspection: 11 ! -7
WasteCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET5o ❑ 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 F 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 E rNo❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rTNo ❑ 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 2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ 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
❑ N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
En -'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
0 No
❑ NA
❑ NE
20. Does the facility fail,to have all components of the CAWMP readily available? If yes, check
F24'es
❑ No
❑ NA
❑ NE
the appropriate x.
WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 27(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 ��0 ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: G t
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
[]Yes
❑ No
NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑' 1�~❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes 90 ^ ❑ NA ❑ NE
[:]Yes [:]�o ❑ NA ❑ NE
[:]Yes 0�❑ NA ❑ NE
rWVICWC11111bPUk LU1 INU111C: '� p' ' I"11V11G: < 1 -
ReviewerfInspector Signature: Date: f (rT
Page 3 of 3 21412015

Type of Visit: Q CCopliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: Departure Time: []= County. Z Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: C.-11 rM L,
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
integrator: p
Certification Number: 1 _73 D�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wean to Feeder
Feeder to Finish
Wet Poultry
11-ayer
Non -La er
Design
Capacity
I
Current
Pop.
jjljf­Design
Caftle Capacity
Dai Cow
alf
Dai Heifer
Current
Pop.
Farrow to Wean
Farrow to Feeder
Dry Pioultr,
Design
Ca achy
Current
P,o
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other11
Qther
Turkeys
1 UrKey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ [DNA ❑ NE
❑ Yes 6 ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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 �� LA ��,N 2/
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 MNo ❑ NA ❑ NE
waste management or closure plan?
onmental threat, notify DWR
If any of questions 4-6 were answered yes, and the situation poses an immediate public health o7yr.
7. Do any of the structures need maintenance or improvement?
s ❑
❑ 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 0<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes D
❑ 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?
❑ Y No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �`No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Y 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 b .
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2) _Does record keeping need improvement? If yes, check the appropriate box below.
t/�J Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes [—]No
❑ Waste Transfers
❑ NA
eather
❑ NE
Code
Inspections
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectioW�4o
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 o
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Fa iti Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
YNo❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
ICJ ❑ 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
En No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E�J/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yeso
WU❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any,other comments.
Use`drawings of facility to better explain situations (use additional pages as necessary).
7•J ��� wW�[. ��OS cLFRn�.�,��--� svna� ��.c� SEED �c.,1,l4vC��
t,l((--O �C W W UP Inr' N60 OWii)('P—%1QF1<rfllgll,&( Qt Q61/N41— is/7'-t$ !i%i
,band , 14AO �D) co C I
l
�n DIYS
�PPU27c'4
JS d� ov�i� 1 "lR ilu �'���,oa�� , Rwce pvmPvN� T x}C f6 wywh
9 p 0sfluT&S,
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
CPA �-
Dom joe
,I , Phone��
re: Date: 6
2/4/20 15

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: li r 4 eparture Time: County:{ Region: �1l%
Facility Contact: Title:
Onsite Representative: 6�L 2 Ire, AL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Design Current
I) . P,oul C•_a aci_ P,o -
I Layers I
Dairy Heifer
Dry Cow
Non-Dauy
I Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turke s
Turkey Pouets
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 otber than from a discharge?
❑ Yes �' o ❑ NA ❑ NE
[]Yes ZrNo
❑ Yes J"No
❑ Yes MiNo
❑ Yes K o
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

)Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes pNo ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ---t.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P�Ko
❑ 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
o
VN
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
. maintenance or improvement?
7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 /6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PrNo
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�o
T
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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? ElYes gNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
[FaMity Number: - Date of inspection:'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E fNo ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CNo ❑ 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 R!fNo ❑ 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
[J"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�Vo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
T%No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name: Q��(,Y2� Phone: c5�b
Reviewer/Inspector Signature: C Date: 3 % 7 !Y
Page 3 of 3 2114120il

Facil by NV ber' f
i-Drvision of Water.Q6Aity
i Dtv�sion of Sotl an, Water Conservation
I Otlter`A`geriey
Type of Visit 9tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 4 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: its /fit Integrator: 1,6
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = [ = « Longitude: = ° � i
❑ Wean to Finish
tt ❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
'� ❑ Boars
„Other
" I ❑ Other
gn - Current: Design Current ;
cttyPopulation #Wet Poultry ,;Capacity Population
Non-
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
attle • �:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy_
Beef Stocker
Beef Feeder
Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes rNp [INA ElNE
ElYes o ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection c3 _
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: 7""
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
r
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes FrNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,Fe�o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EI�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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑<o ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2fio ❑ 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 LIONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,[Mo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes .E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J37:(o
❑ NA
❑ NE
Comments (refer to'giiestion #) Explain any YES answers and/or any recommendations or any other comments T
`Use drawings of facility to better explain situations., (use additional pages as necessary) if AAg
t
Reviewer/Inspector Name Phone: 7C 7
Reviewer/Inspector Signature: Date:
12 8104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [?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 ❑ 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
ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Pllqo
❑ 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 �INo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ;3 No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;2-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZI—No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 4�fNo
❑ 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 ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes LNo
❑ 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 _VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ;TNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit OLCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i�6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %Q Arrival Time: ® Departure Time: County: L Region:
Farm Name: /C-4- S ���_ IYl Owner Email:
Owner Name: �.H�I S 1 C� h�E� _� E�] j %� Phone: ! 4)-996 - 4106
Mailing Address: R • LX.) t LLj AMy lc c y-F_/VJ?NS U i t_L lr , %1C C C% CA U 3
Physical Address:
Facility Contact: I Title:
Onsite Representative: CNIUSTORAIM 1AGAT/4
Certified Operator: _C061( 5T o621� ' �C- 14 r l
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Old���
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = f = " Longitude: = ° = 1
r
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Populatian Cattle
Design
Capacity
Current
PapulTH
❑ Wean to Finish
JEI Layer
❑ Dairy Cow
ElWean to Feeder
1 10 Non -Layer
I I El Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Gilts
❑ Pullets ❑ Beef Brood Cowl
❑ Turke s
❑ Turkey Poults
❑ Other Number of Structures:
❑ Boars
Other
❑ 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?
❑ YesNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)q No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
12128104 Continued

eacility Number: J — 3`15 Date of Inspection
Waste Collection & Treatment
4. Is 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 Structure 4
Structure 5 Structure 6
Identifier: 00 a�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes D.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 0 No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes X No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No ElNA
ElNE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy 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 Drift ❑ Application Outside of Area
12.
Crop type(s) Se, a eqL cw�
13.
Soil type(s) jQu 7(Z S4Q) U.0
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
4 No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
�fNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
k No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
�sNo [I NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? El Yes
4No ❑ NA
❑ NE
.Comments (refer to; question #): Explain any.YES answers andlot any recomnendahons or any other comments
Use,4rawings offacility to.better explain situation&juse additional,pages;ai'necessarp):
fir �o yFC G F �69 S (_c.LDc F .5 C.t. u C�� '�? cA+!-j (3(1Z7/UX/ It (�u ; WY fZCC�o�LI�S
,, _ a
Reviewer/inspector Name �} f}/ ES Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 I2/28/04 Continued

4
Facility Number: 3 39 Date of inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. . 0 WUP El Checklists 0 Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
'XNo
❑ NA
❑ NE
❑ Waste Application 1❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑/Alinual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections [] Monthly and I"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
34 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
EfNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
0 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JWNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
12kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Pq No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
z
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes❑
NA
❑ NE
Additiohal'Cotninonts:and/o'r Drawings
(A-) - J
Al19/69
Nlapla I J.
LjJ • � • S<G1V T 7G L� ' Q�_SuLTS 1U1 G3A-EK tAC^T
Page 3 of 3 12128104

Type of Visit JRCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 V 1 Arrival Time: �] Departure Time: County: Q i1 Region:
Farm Name: /C-+ s 4�:qzm Owner Email: Owner Name: �= t-�Q%►�TU(�HE A ���T i-� Phone: q )G-QC?%' d 1 o9(P
Mailing Address: J� �tiZ W c.c A m g Qsj _ �JV/�IV S V I LLE )V['. o��J`I 1 y A `3
Physical Address:
Facility Contact: //�� Title:
Onsite Representative'�.Ltit.T1 S 1C-lC C1U5 �IF,>x�
Certified Operator: CHI-1gT2!�!HEF— 1* • +4,4TH
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 3
Back-up Certification Number:
Latitude: = o = & = « Longitude: = o = 1
Design
Swine Capty
Current
Population
VVet Poultry
Design C►urrent
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
90
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
I
i I
❑ Farrow to Finish
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ^y(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo ❑ NA ❑ NE
❑ Yes Po ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LaccoAt
Spillway?: n
Designed Freeboard (in): 'nn'1{� I T S
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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes {] No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �] No
❑ NA ❑ NE
maintenance or improvement?
J`
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ro No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F� No
❑ NA
❑ NE
Use drawings of facility`to better explain sEtuations {use atidittonal'page"s as�nec�
GET c�� o f cA a BczRTtoN W (F LI-7 wV Q-r Cow -Is S
WISP ► 5 Q�LN� �P lE % Fatz. �E(ZII'►t� Cz�NFwAL
Reviewer/Inspector Name 1yo� >taA/lIC I Phone: j 1-70-t'
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

if
Facility Number: ) —5 Date of Inspection I YJ ! 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists 0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes] No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑,/aste Transfers ❑,4&ual Certification
El Rainfall 0 Stocking G Crop Yield 0 120 Minute Inspections [] Monthly and 1" Rain Inspections ,❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
V 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 property dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 _ - — 12128104

rI
Division of Water Quality
FaNumber `�j� 3�5 O Division of Soil and Water Conservation
- - - OtherAgency
E
Type of Visit ILCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J@ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Q / Title:1
Onsite Representative:�VLT15 69CWICK / �{i215 �' IM-fH
Certified Operator: C u215T0 P>4E (Z-- 4. /J e /4T}{
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =1 =1 11 Longitude: = ° = 6 = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑Non -La ers
❑ Pullets
Other
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population ,
❑ Dairy Cow
E3Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(4 No
❑ NA
❑ NE
❑ Yes
[:*No
❑ NA
❑ NE
12128104 Continued

Facility Number:' I — 3cj S Date of inspection 4.J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure �27 Structure 3 Structure 4
Identifier: 4&WA( C_A t�06N O�
Spillway?:
Designed Freeboard (in): f 6�. 5
Observed Freeboard (in): pit, r �3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA [I NE
Structure 6
❑ Yes
(�No
El NA
El NE
❑ Yes
EYWo
❑ 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 J90 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0No [:1 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 rVi yy No ❑ NA ❑ NE
maintenance or improvement?
Waste AnOication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Xqo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Jam' No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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
G�No
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
9Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
gNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ 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):
1S , NE E1-!,, TO c;T+t F-0GL wE F }bS . OWME L 9#45 5044CCWF 70 W 7114T 5`4(IA1/
Reviewer/Inspector Name MAAfrld C.� 0 1 ,C S Phone:
Reviewer/Inspector Signature: Date: �y b�
12128104 Continued

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

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - —` - OiOther Agency
Type of Visit ? Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Arrival Time: Departure Time: ' County: APG"✓ Region: [W/
Farm Name: Owner Email:
Owner Name: 11`�b�rif /7`G[� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� S Z i� Integrator: 10.4.P.—z f
Certified Operator: y Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 d =61 Longitude: = ° =, = "
Design Current Design Current Design Current,
a Swine- Capacity�`Population Wet Poultry Capacity Population Cattle Capacity: Population:
❑ Wean to Finish
❑ Wean to Feeder
Cff Feeder to Finish
O Q
2, D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other-
❑ Other
❑ La er
❑ Non -Layer
t:
Dry -Poultry .. .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
0-pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ YesZXNo❑ NA ❑ NE
❑Yes
❑No
❑NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes J� No ❑ NA ❑ NE
❑ Yes//ONo ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P 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: W
Spillway?: /2�0 AA,
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 o No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ 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 VrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) _��.�,4 , �
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?
[:]yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA
❑ NE
'ONo
No
❑ NA
❑ NE
Pr No
❑ NA
❑ NE
YNo
❑ NA
❑ NE
PrNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or anyrecommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
A� ,
N/
eovc
Reviewer/Inspector Name' Phone: Z
Reviewer/Inspector Signature: Date:
Pane 2 of3 12/2 /04 Condnaed

tea` . • /1.
Facility Number: = Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
'0 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ef No
�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'0
PNo
❑NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
gNA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,(
p No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
VNo
❑ 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
gNo
❑ 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
[ KNo
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

I
F
Facility Number
(2f Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Y11 3 d(s Arrival Tim,: `l�Q Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner )Email:
Phone:
Onsite Representative: f l-1 tZls 14EM 11 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = f = Longitude: = o = 6 =
Design Current Design CurrentDesign C'urrei t z
Swine Capacity ' Population Wet Poultry Capacity Population Cattle Capacity - Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
h _ -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Co
I I
I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
�6o-0�
Number of Structures ``'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ET/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N El NA
El NE
❑Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
L�No ❑ NA
❑ NE
12128104 Continued

Facility Number: — 3� S Date of Inspection i3 a
r�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A brcr�N i LA (root,/ 1,
Spillway?:
Designed Freeboard (in): I `! . Z Q • Y
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ErNo ❑ 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 eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ��/o
:No ❑ NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes GT�o ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) l�Eft,y-, �q L t-6 ] S Cs o
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
FNo
❑NA El NE
❑ NA ❑ NE
[?-'No ❑ NA ❑ NE
ETN El ❑NE
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):
1. ar-tc- EVE=Nr eN V/0Cz-4L3.OG{
?LGASC—
VW
Reviewer/Inspector Name F .row u o E� Phone: {io, TIC-71 ioS___
Reviewer/Inspector Signature: Date: V/ 13 1 to
n,..,_ 7 _'r 7 V 77/719/Ill rA"r:.,..pd

s
.` Facility Number: 31 — jT,' Date of Inspection 13
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 El Checklists ❑Design El Mans ❑Other
❑ Yes 2No ❑ NA ❑ NE
❑ Yes E 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 I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
]CIA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
PNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ 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
❑'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[, o
❑ 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
_Q No
❑ NA
❑ NE
tf 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
[< N
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
3No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
r to
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (,C_,/ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
V Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 4Q0 Departure Time: County: ivilPLTlJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ���� Title:
Onsite Representative: o4"� TOPly 17 M qd
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = L Longitude: = ° = g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑
Wean to Finish
❑
can to Feeder
Feeder to Finish
I L64oO
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts .
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coul
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
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
12128104 Continued

J
Facility Number: 31 — �'� Date of Inspection EZ75 My
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�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: 0 60'I 1 L A 6-0t) 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [fNo ❑ 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
T Do any of the structures need maintenance or improvement? [YYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E;rNO
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
DNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f
[! No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s) J&.9- ucA ( 14) 560
13. Soil type(s) A t/T 7- I VIL L G �.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[?'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
[,D'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[?No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L]IN o
❑ NA ❑ NE
1.) (A67VIvl VVC
AS SAk� ,rPo-r dAlm6h. 00K-IrTN G, oN GOV4-IZ OA,7,4W
Reviewer/Iuspector Name jo iJ �R n1 EU- =' �� "= Phone: rlpJ Nt, 4' 7 S'
Reviewer/Inspector Signature: Date: S 'a 5 /os
12128104 Continued

Facility Number: Date of Inspection S 05
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EAo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking [I Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CNo
.❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
ElLJ No
,_&(NA
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes -
❑ No
P�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
�lo
❑ 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
E ,xo
❑ 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
ElNA ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
Dlf o
❑ NA ❑ NE
Additional -Comments -and/or Drawings: ...
12128104

Type of Visit O Go liance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other © Denied Access
Facility Number 3 S Date of Visit: i ► a`f Time: c3 6p
O Not Operational 0 Below Threshold
Permitted Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: _ __ b * S F.Aa-* _ County: ntJPLMJ ..... _ ...
Owner Name:
Phone No:
-Mailing Address:
Facility Contact: ___... W W.. » _.. __» Title:._.... _____ _ Phone No: _
Onsite Representative: � �STO PAC ---- M---- Integrator. -------1�_rz,&M
Certified Operator: _ __. .. _» » .»» »,» ,... ,w , » Operator Certification Number:
Location of Farm:
❑ 5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• Du Longitude • ` "
Current : _�
Cattle
••�••�
.:: \ia - L '^.{iV
�ilQliVil-.
—.l.;i
4iL
Wean to Feeder
Layer
Feeder to Finish
2,o&O
Q
Non -Layer
Farrow to Wean
Others
Farrow to Feeder
Farrow to Finish
r:' Total Desy
s _.=1. �' 7
Gilts
�..T�lW
Boars
Mcb
Mes & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�/No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3No
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: . _ _ . _ -- 2— --
Freeboard (inches): _ �b yq
12112103 Continued

>, acility Number: Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes /lic
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �(No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancerimprovement? ❑ Yes N
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 7No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes GIN011. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ FTozen Ground ❑ Copper and/or Zinc
12. Crop type fjeffl- vvp
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 71-50 14. a) Does the facility lack adequate acreage for land application? ❑ Yes b) Does the facility need a wettable acre determination? ❑Yes rN9
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes �No
N
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 10
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 6No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
�-- M� �. ==�� �--�� -•d �;_�:;�. � :-ram �.� ����.-. � ��-..._.� .�-_.
Cow (r�ef`er to gnestran`��) Explaraa� YES�aas�vets andlaraa�yo ar.ariy�at��:oom�ents. �:�_�� ;.�
Use drawer offayTiity to betberexglauar sib. (use' pages as wry.?� Feld Copy ❑Final Notes
�A �vtrr� AkS NAD 1✓d Q&-s 5T4J[.6 Y+NRR.CN 2o6y �co�Ess sw �c�yTavG �ut�G t�RS, .
�q R-ll� A �fl REc�a.oS � Gatsp S }j qPE
HW
r
ReviewerAnspector Name E - -M-R,=
Reviewer/Inspector Signature: Date: ]1

Facility Number: 3 .� 9S Date of Inspection
w:
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ['�No
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 ZV
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rNo
❑ 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 INeVNq
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 7V6
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? [IYes No/
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35) ❑ Yes 0Pio
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and Maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

'
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: I6 O2 Time: / :5-0
10 31 .i S
Not Operational 12 Below Threshold
Permitted D Certified 0 Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: C �}} 17r. r1-\ County: �/ U� r n
Owner Name: C 1-, � ti J l op ti e r A Il e► l 4&14j� Phone No:
Mailing Address:
Facility Contact:
OnsiteRepresentative: _QVVIle✓'
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:iL�.I-
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` � �u Longitude 0 '
Design
Swine Ca aci
Current �ZJWD_
I'.o ulation P,oultr,.y Ca aci
C*urrent Design Current
, 1'o ulation Gattle Ca aci Eo ulation
El Wean to Feeder
(a 0
❑ Layer
C>S 1on-Laver
❑ Other
❑ Dai
❑Non -Doi
Total Design Opacity
Total SSLW
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑ Subsarface Drains Present ❑ La oon Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
❑ S ra Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Qf!d -A% g j
Freeboard (inches): _32—
❑ Yes JVNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes jzfNo
❑ Yes ❑ No
❑ Yes Rl"No
Structure 6
05103101 Continued

t
1
Facility Number: 3 J — 395' Date of inspection tit, 1 d2.
1 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 Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Poonsding ❑ PAN ❑ Hydraulic Overload
12. Crop type �� f ✓h tJ d �► A y �j `'LR ! [� r e1 ;-I
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?
e) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16_ Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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. floes 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?
❑ Yes INO
❑ Yes EfNo
❑ Yes ANo
❑ Yes /ZNo
❑ Yes ONo
❑ Yes 2fNo
❑ Yes 1,-2(No
❑ Yes ONO
❑ Yes ,�No
El Yes - ( No
❑ Yes ONO
❑ Yes ONO
❑ Yes 01No
❑ Yes �No
❑ Yes .2�No
❑ Yes ;2640
❑ Yes JZNo
❑ Yes VfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit.
(ie/ discharge, freeboard problems, over application) ❑ Yes ENo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
I ._..,.-�:. ... a.._.,f L �._ S,.ir.Gte"�,.en 9n.''.''�F�:'F:�d�.`"�C��;"'�35.,ir "; �E. .s'^i...ii�% c »_
❑ Field Copy�� ❑Final Notes
1`t'3 mer4 5 w+cii u ni 44c -AaG f;4 �, Crop , b
Reviewer/Inspector Name J
Reviewer/Inspector Signature:
Date: V 1 t?
05103101 Continued

t
1
Facility Number: Date of Inspection IqN, toZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Oyes ❑ 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 J2�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 ErNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional.Comments and/or DrawinQs:�-
05103101

�brvrsior, of Water Quality
0, DrvWon of Soil "&Water Conservation
_ w
- r� Other Agency
k "
of Visit .aff-Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit •Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Q I irne: Printed an: 7/21/2000
Facility Number r 3
__J . Q Not Operational 0 Below Threshold
[] Permitted Q Certllified r[] Conditionally Certified [3 Registered
Farm Name: � �b S r R
Owner Name: G h r r54 0. lte ✓ Met, q � l " �
............. P -... _..._.......-____........._........_...........I.._............
Facility Contact:
Mailing Address-
_.. Title:
Date Last Operated or Ai bove Threshold: .........................
County: �� . ��'
Phone No:
Phone No:
Onsite Representative:.. ! `f.±�. ...�..`...�............................. .......................... Integrator:-R?!?S7cl.G]Q... -
�T
Certified Operator: ................................................................................................................ Operator CertiFcation Number:..._..............
Location 'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 « Longitude ' 4 44
Design Current
n Wean to Feeder
Feeder to Finish
Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
`f.s� Bgars
Design Current Design Current
Poultry Capacity Population Cattle. Capidty Po elation
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 1[] Non -Dairy
❑ Other I R
Total Design Capacity
Total SSLW
Subsurface Drains Present Lag—n Area ❑ Spray Field Area
❑ No Liquid Waste Management System z
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .........................................................................
Freeboard (inches): 3
5/00
❑ Yes XNo
❑ Yes _gNo
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes 'XNo
❑ Yes INO
Structure 6
Continued on back

1F'aeilit"umber: 31 — 3/-I' j 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, ❑ YesNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 1
closure plan? El Yes �] i`Io
(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 pan 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 r1 lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
12. Crop type "C,
13. Do the receiving crops differ with those i
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
s
to
in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio viQlaiiQns o� dtrf c..... mere Hated during �.... s.... 4 will receive �iti further
....
aboulr this visit. ::: ::: ...... ....... ' .
❑ Yes ❑'Itro
❑ Yes No
❑ Yes 'g(No
❑ Yes 0No
❑ Yes dNo
❑ Yes F�No
❑ Yes ET'No
❑ Yes XNo
❑ Yes �No
❑ Yes,,EdNo
❑ Yes JVNo
❑ Yes ❑'No
[]Yes fi?(No
❑ Yes XINo
❑ Yes 'WNo
❑ Yes 0No
❑ Yes )ZNo
❑ Yes KNo
❑ Yes ❑No
❑ Yes /�No
�d /'e cor� s Are Ve
r a^.e1 j 1<e .-fix `
G=nd Gfd 1.✓et/ 1^�Lor i i1�l� ►''?s? - �e S re yy
p ,� 4s a w4s-/� tArwl sir
yys� eve1'45s ror Grt1CV14"0Ks ��yAe
�eg-rt Z ' 3 • � eV Ca wt,11Z as 4o ke - ►� 0-wovg4e s'a7r1
los e-ve r 6 D d4
Lloq kr cW w kCt,+ 'IS be i'l � pr<a ye4 pr'\ ar- 7d s,�irV � y
s Sa
7
Reviewer/Inspector Name S�Q
Reviewer/Inspector Signature:
Date:
5/00

FacilRy Number: '1 — Date nt'inspectionI%�_ I feinted on: 7/29/2000
+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_,ETNo
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 21'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes,_&No
32. Do the flush tanks lack a submerged fill pipe or a pernanent/temporary cover? ❑ Yes ❑ No
Additional omments and/or rawings:
J
5100

17-
Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit ()Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: fine: ed e7/21/2000
Q Not Operational Q Below Threshold
OMrmitted © Certified 13 �ondjtionally Certified [3Registered Date Last Opera or Above Threshold: ................
S�' � 1
Farm Name: ............ ........................ ........ � !'..+'� ` ,,................. ........... County:....- ..................... ..........
.... ....... ....
OwnerName:.............!!"Y..1.5.....................I.TL-................... Phone No:..............................-..........................-............................,
Facility Contact: .. (�Y i.....-....�itle:......1/.!n�. Phone No : ...................................................
MailingAddress: ...................................................................................................................................................................................................... ..........................
� Integrator ,-.-Onsite Re resentat
Certified Operator:........-.. .+..W.��............ ..... ..t- . .................. Operator Certificationi�`umber: ..........................................
Location of Farm:
it
It Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 i Longitude • t «
Design Current Design Current Design Current
Swine Capaci!j Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 7._ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System
DischarLes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff 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 13WQ)
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? ElSpillway
St`rUCtur � Il Stru -fur i 2 Structure 3 Structure 4 Structure 5
Identifier: ............4:!: .......................................................................................................................-....................
Freeboard (inches): N LLA)
5100
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes o
❑ Yes R] No
Structure 5
Continued on back

Facility Number: Date of InspectionEt� Printed on: 7/21/2000
5_ Are there any irnlffi/etliate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes (LNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of ver application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type � a . S "
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?
Renuired 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'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �'Vo yioiatitjris:vr f decier�... v.� ..noted during his:v.. Yoi} wiii �eceiye Rio f.... �. .
corresptin�ence. about. this visit .. .. .. .. . .
❑ Yes FTo
❑ Yes ;2:�40
❑ Yes �10
❑ Yes E�FVo
❑ Yes dNo
❑ Yes 2No
❑ Yes W10
❑ Yes ONO
❑ Yes 14No
❑ Yes RNo
❑ Yes KNo
❑ Yes l(No
❑ Yes U�No
❑ Yes [p No
❑ Yes No
❑ Yes ® No
❑ Yes WNo
❑ Yes KiVo
❑ Yes No
❑ Yes j 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 necessa ):
1�01I }Yi YV� I� O�YG�lI� AL
�� � ��
6-
� S
a -"-)A C{ tti t� l� �✓�
`NdV
Reviewer/Inspector Name"
Reviewer/Inspector Signature:
Date:

r
Facility Number: — Date of Inspection �filr�
)dor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
, No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
)ffNo
roads, building structure, and/or public property)
24.
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
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
*INo
Additional Comments -and/orDrawings:.- r
F..,
dv6it�\_
J
v'-C ot
S �-
L C 04-
5aAJ
F
� avti 5 �U0�1

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Christopher Allen Heath
C&S Farm
231 Dr. Williams Road
Kenansville NC 28349
Dear Christopher Allen Heath:
31q'r
1 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NaauRAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-395
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal fand industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRRI, IRR2, DRY1, DRY2, DRY3, SLUR], SLUR2,
SLDI, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerel
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

_'. -Division of Soil aod:Water Conservation ,Operation Review A_
_ ;
,,-
O'Ihvision of Soil andyWater Conservation Compliance Inspection_
y - ...
® Division of Water Qu- ty Compliance`Iiaspection
_C _
_. Other Agency Opeatiou:Revrew,r -
IS Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
raw
Facility Number Date of Inspection 10 2 Qrf
Time of Inspection F-W �86' 24 hr. (hh:mm)
® Permitted [3 Certified [3 Conditionally Certified [3 Registered 113 Not OperationalOperationall Date Last Operated:
Farm Name: ...............t.....£...s............County: Af r*►
.............................................................................y:...�...
........... ................................... .......................
Phone No:.......................................................................................
Owner Name: ........................... ! jet
................... . ................... ..................................................
FacilityContact: ..............................................................................Title............................ . Phone No:
MailingAddress: .............................. ...................... ...................................................................................................... ..........................
/. ...............................
Onsite Representative:....c-Lin;S flee... .. Integrator: t'r..........Gt
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
i
..........................................................................................................................................................................................................................................................................
Latitude = • =' 0 Longitude = • 1_.1' ="
Design Current Design,. `Current= Design - Current ;
Swine , Capacity Po ulatioin Poultry. Capacity Population Cattle-
- Capacity Populat
ion.
❑ Wean to Feeder
14 Feeder to Finish
2-060
20OQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
o Number f:Lagoons 2- El Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
�a
_Holdiing Ponds`/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes :j No
❑ Yes 09 No
❑ Yes No
h �a
❑ Yes 8 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes g No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JO No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Cl Spillway ® Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: lgq.w . 01,5(
Freeboard (inches): ............[ ........ I..... .......`�..-23
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — 3 S Date of Inspection 1 Q 2g
6..Aoc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 81No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J4 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9 No
Waste ADnlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
X No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
IM No
12.
Crop type ti S
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19 Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AV,/ -MP?
❑ Yes
K No
Vo yiolatidtis:or• deficiencies were noted diWini # s:visit.' • You :wili•reeeiye tio: further
corres• oridelc' e: abvuf this :visit. :::::...... ...... ..... . ........ . .
r 1 . �__
Comments (referto question #)r- Eiplain any_ YES'answers and/or any recornmenda#ions or -any oilier comments ,
UseArawings of facihty to�better explain situations {use' additionalpages`as necessary)
r—, V GAG. ,-Dr 3 S in 56 o eA
0�4ui►% A' C_Or� off' i c, yo^ de-<;)h -o/ 4ke old 1&9oor. ^,qA key{ ;4
lq. Li AVie,%(ys0 C. q{e flood ro., �a4 da�S �eFore e?vd 60 df�yf
a-14 �,� 41,e dl A� a a ?14 -, a 'A niq 1 �,<;-<.
5"4e_ !caks 900d.
Reviewer/Inspector Name -a
Reviewer/Inspector Signature:
Date: 1612,
3/23/99

Facility Number: —3 �j fate of Inspection ie
1
-Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
$IYes
❑ 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
19 No
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
,� No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
--
bonall ,-omments att or rawmgs:--
3/23/99

Division of Soil and WateraConservation'-.Operation Review
Tex -
[j Division of Soil and Water Conservation Compliance Inspectaon s
bivision of Water Quality ,Comphance Inspection r
a [] Other Agency Operatron.Revievv
WrRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number ► Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Permitted)arCertified © Conditionally Certified Q Registered JE3 Not O erational Date Last Operated:
Farm Name: 7t MMY.---Q+>e.q ....... County:-..-....�.�TQ.�-.F.... ...........................
Owner Name: ................................................. Phone No:..............
FacilityContact:.............................................................................. Title:............... .. Phone No:.....................---...........................
MailingAddress:................................................................j
......................................................� ............... .........................
.............
Onsite Representative: .......5 .' ..�`I.....Q.LC.Q............................................. Integrator: ....... C'A�..`�l......s..........................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
......................................................... .............................................................................. ............... ............................................................ .......... .-...................... .............
i .
Latitude �� �° Longitude
_ , Design 'Current,,Design Current Design CurrentClatSwine Capacity Population'. Ca acity Population
Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean �y
_.
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design `Capacity
❑ Gilts,
❑Boars - - -Total: SSLW
Ler ofLagoons.; �- ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
oltLng Ponds / Solid:Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ONO
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 0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
a'
Freeboard (inches): ......... .......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yeszj� No
seepage, etc.)
3/23/99 Continued on back

Facility Number: �71 — Dale of Inspection i Z
6. 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 Z(No
8. Does any part of the waste management system other than waste structures require maintena6ce/improvement? ❑ Yes [XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �ff No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ONO
12. Crop type + y.a tJ.`� Sa L3 d
13. Do the receiving crops differ with those designated in the Cer ' ied Animal Waste Management Plan (CAWMP)? ❑ Yes VINO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes VNo
c) This facility is pended for a wettable acre determination? WYes ❑ No
15. Does the receiving crop need improvement? ❑ Yes INO
16. Is there a lack of adequate waste application equipment? ❑ Yes IN
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 7No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [�O
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
24. Does facility require a follow-up visit by same agency? ❑ Yes
2k. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes FN
N6.06 afidiis W deficiencies were .h6fed• 8>�WWW this'visit' . Y94 wiii•i•eeeive Rio fbi thgr
co' o ' deuce' ab' A this visit:
Comments (refer to question #): E�,tplaio any -YES answers and/or ally-reco amend" tions or any otlfer comments
Use drawings of facility toW6etterexplain:,situations (use additionalpages as necessary) r
8) SL 4, !lt- a.SE E^X> aV-' Atmav_ -YTi'LL ggJE M WL)R- L1_xN)r_$ . ��P *&t iz7V£ a%jr.
��E - g,4 CrraIGS q>a dt) -' rVc-P�I�sr- � 'Fc��4 A�}� i fay a�t'w:nl`Cr
lz-o a W. nIa TMCE a e -
!Y
�� .IE C�PN eiN sd '.,re �uL1.r s1rr� 6f__5 J&,4r Tt) DtJQ
3p�',39oo rj
Reviewer/Inspector Name
Reviewer/Inspector Signature: ns �. v-+'� Dater Z
3/23/99

� L
FacilityNumber: �
3! — Date of lnspection ']` l
Odor Issues ��
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Oyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes /No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes J No
�A�d`tional Uomments ana w Draw�ngsc
3/23/99

❑ Division of Soil and Water Conservation 0 Other Agency
MDivision of Water Quality
JJQ Routine 0 Complaint O Follow-up of DWQ inspection 0 follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection � 0 24 hr. (hh:mm)
© Registered Certified © Applied for Permit O Permitted 10 Not Operational Date Last Operated:..
.......................
Farm Name: C� County:......[�1'"�
........................................................................................................I... (`t ..
nwnor Noma • C S Nt�nnP vn_ l Vim` O�-as l5
Facility Contact: .......................................... . Title:........................... .. Phone No:
Mailing Address: ...c,- .............. �-.►....... �.C....... 83�i
raj _ t. [.......... .....
Onsite Representative: '.-??r I ,�?�� Integrator: -i...�' l�`-"� ..,,_._
......................... }.............................
Certified Operator:............................................................................................................... Operator Certification Number ..........................................
Lpcaqqn of ff rff.
..... .... ...... ..A .. ..... ..1..... A..............`............... ......i...... .... ............................................................ ..... ..4....... I........ 1. ...... .........
GG L#........................ �s ... ...1?a. .1.....:��.. ..-r. ....Lg.. Q... ►-�, ..� A....... F,
Latitude =• 0' 44 Longitude = • =1 =11
1[)& rt ;,_ Current
Design Current
Design "Current
Svune F Capacity :Paulatton , .<Poultry
Capacity Popula#ton CaEtle
Capacity . Population
❑ Wean to Feeder "''
❑ Layer ❑ Dairy.;
Feeder to Finish �'
❑ Non -Layer I JE1 Non -Dairy I.
❑ Farrow to Wean
,
❑ Farrow to Feeder
❑ Other
u?
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
_
❑ Boars
r Total SSLW
4,
Nuerof ! Holtii Ponds
❑Subsurface Drains Present
❑ Lagoon Area
p Spray Field Area
Dons
�: f
❑ No Liquid Waste Management System
F
. . :
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
VNo
2. Is any discharge observed from any part of the operation?
❑ Yes
Cj No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
❑ Yes
NNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes`
0 No
c. If discharge is observed, what is the estimated flow in gal/min?
1 ^u A
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
4 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
b�`No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
D6No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ONo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
'ZNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
allo
7/2S/97

s
i Facrlity Number: 5
•
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
ONo
Structures (Lagoons.Holding Ponds. Flush Pits, etc)
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: F a
Freeboard(ft): ........... : �........................I .---••-...........................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
9No
12. Do any of the structures need maintenance/improvement?
❑ Yes
CjrNo
(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
j� No
Waste Application
14. Is there physical evidence of over application? ❑ Yes D4No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type r......................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations-or deficiencies:rvere-noted-during' this'.visit.• You.'Will ieceive�it&ftirih_ er:
corrOOOddeince d oath -(his:vWt:• : ; :. _ . .:...::..........
❑ Yes 14 No
❑ Yes U No
❑ Yes O No
❑ Yes GfNo
❑ Yes No
❑ Yes No
❑ Yes j$ No
❑ Yes No
❑ Yes No
❑ Yes ® No
Reviewer/Inspector Name
�2 err-=.... �n..�, , , l
Reviewer/Inspector Signature: Date:

DSWC Animal Feedlot Operation Review KM
'M
1aDWQ Animal Feedlot Operation Site Inspection
10-Routine OComplaint 0Follow-up ofDWOinspection 0 Follow-up of DMVC review 00ther I
Date of Inspection Ig
Facility Number
LP Time of Inspection E!�=24 hr. (hh:mm)
[3 Registered 13 Certified [3 Applied for Permit [] Permitted 10 Not Operational I Date Last Operated: ..........................
count V: .................................... Farm Name: .. .. .... . ...... ... ..... _ . y �
Owner Name:....... ......... . ...... . ........................................... Phone No: ... ......................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:.....................----....---....---------......
Mailing Address: ......... ...... &&J2.4 . ............ ... (-. L,..S Y. 11 LL", f� ... U ............... ..Z
Onsite Representative:.... C'. ........
...,V .44 ...... ................................................... ....... _ .............
Certified . . ................................ Operator Certification Number: ..... ............
Location of Farm:
.......... kj_. ,,. b.m.kA . ..... i. .......
.......................... ................. .................. ......................................................................................
Latitude a =1 i Longitude * �, aif] -I
Design Current
'Swine Capacity Population
El Wean to Feeder
Feeder to Finish
7_06t)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Design Current Design CurrenU
Poultry Capacity Population Cattle Capacity Population
I0 Layer T= I0 Dairy
10 Non -Layer I L I[] Non-Dairyj
I[] Other
Total Design Capacity F-2-c (ro
Total SSLW 2- -1 g I
Number of Lagoons Holding Ponds ID Subsurface Drains =Present ❑ Lagoon Area I0 Spray Field Area
FE17No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 01-agoon E]Spray Field E1Other
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 gat/min',
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons,1holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria ideffect at the time of design?
C�­,
[I Yes WNo
U Yes ER No
❑ Yes R1 No
0 Yes EjNo
0 Yes El No
El Yes SNo
El Yes P No
El Yes 0-No
El Yes ER No
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
El Yes allo
Continued on back

Facility Number: 3 —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
IQ No
Structures (Laimons.11olding Ponds, Flush Pits, etc.1
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
K No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 2- .:..........................................................
Freeboard(ft)' .................................... .................................... .....................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
R1No
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?
KYes
❑ 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 Appljcation
14.
Is there physical evidence of over application?
❑ Yes
EZNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop typed K-n..si...Gl ..................... S+nr` o .�..t a. �!`.... ............ .......... ...
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
NNo
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
li� No
18.
Does the receiving crop need improvement?
KYes
❑ No
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
tRNo
22.
Does record keeping need improvement'?
RYes
❑ No
For Certified ar Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IQ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
® No.violations or de ciencie's.were noted -during this.visit.-:You.wi11 receive no ftirtt er
correspondence about this.visit:-. � ....
Co ntnetrts (refer to question #): Explain any`YES ai steers and/or any recommendations or any,other comments. ,.
Use drawings of facility to better explain situations. (use additional pages as,necessary} j
12. �,fd� �t�r2 spots a•• L tr0� v�ro..Il,�.
6n,I~....,-x_
7/25/97
Reviewer/Inspector Name '94n�rtifi .� Wr
Reviewer/Inspector Signature: f1 o 3 A o Date:

Site Requires Immediate Attenti �Av&
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD - 39
DATE: Z 1995
Time. /
Farm Name/Own(
Mailing Address:
County: -
Integrator: Phone:
On Site Representative: 16b Phone:
Physical Address/Location:
S o� �!z 13aa
Type of Operation: Swine V1 Poultry ' Cattle
Design Capacity: 7 oP Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " 02911 Longitude:2*7 ° L' 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 Oor No Actual Freeboard:Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes Pe
Was any erosion observed? Yes rN
Is adequate land available for s ray? Yes or No Isover crop adequate? Yes No
Crop(s) being utilized: X e k0 ZA 1-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wells. e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
•
spray irrigated on specific acreage with cover crop)? Yes or /No
Additional Comments: L�9tfrod�� �'I%lS S 7"o yJ®�
3�
cc: Facility Assessment Unit Use Attachments if Needed.