310407_INSPECTIONS_20171231

NORTH CAROLINA
,dd�
Department of Environmental Qual

Type of Visit: Q>Co=outine
ce Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Zo Arrival Time: ® Departure Time: County: Region:
J.
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 'iC' t l� fTt' r '�i Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current Design Current
We# Poultry Capacity Pop. Cattle Capacity Pop.
Layer DairyCow
Non -La er DairyCalf
Feeder
o Finish
Dai Heifer
o Wean o.
Z 1
Design Current D Cow
o Feeder
Finish
t
D , P,oul Ca aci l;o Non-Dairyo
1-a ers Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
D<0 E NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No [] NA
Ej NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - 4 % Date of Inspection: - 2 Q
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 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes EnNo ❑ NA ❑ NE
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 EZr> ❑ 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
l l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
7No-❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
��N0 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ffNo ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o 1A
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: a i - t4 A`7 Date of Ins ection: 9 2 ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'lqo--❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L!l o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑i ` l�❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ No NA ❑ NE
Otherlssues
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 facility9 if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
❑ Yes a NA ❑ NE
❑Yes la"' ❑NA ❑NE
❑Yes [3rgo NA ❑NE
❑ Yes [] No D NA 0"NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
,1
Date:
Page 3 of 3 21412015

PC
Type of Visit: O'Com ance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p Departure Time: c 1• County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: } Title:
Onsite Representative: �� i�r { Pa l7G %C
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: (% Z 3 1S
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
lNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
arrow to Wean
2 -00
Z {( Design Current
qwq
D . P,ouItr, Ca acit P,o .
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
'Furke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N❑
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ffNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili umber. - p Date of Inspection: 4 Itt;­11id
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
aiq
❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L3' o
❑ 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
kI No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑-Iqo—
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]'lqo
❑ 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
❑
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2'Iqo__❑
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C!fNo
❑ 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
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ef No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Wumber: IDate of Inspection;
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E 1Vo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-iVo ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ffNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No . ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes J o ❑ 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
2 'l�o ❑ 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
; "o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
%J No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I' I Nc ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
1lovll, YY Vil uIJ�JGV wl 1�au1G. ✓1/� ___`— / !-I1VI1G. i �'� • 1 � � ,
Reviewer/InspectorSignature:Date: /'�
Page 3 of 3 21412015

(Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emertenc_y 0 Other 0 Denied Access
Date of Visit: Arrival Time: © Departure Time:--�--= 1� County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical'Address:
Facility Contact:
Title:
Onsite Representative: <it r t m �r_/ L �-t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
z 3'T
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
III
INon-Layer
_E]
Dairy Calf
,Feeder to Finish
I Dairy Heifer
Farrow to Wean
2oCX%
Design Current
Ca aci Po ,
Dry Cow
Farrow to Feeder
Farrow to Finish
Dty P,oultr.
Layers
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Stream Impacts
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
0
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Wo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Lto Date of Ins ection: t{ r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J N6'
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lf
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 property addressed and/or managed through a ❑ Yes E5No ❑ 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 El"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [J'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F4No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes E:fN—o
❑ Yes Q No
❑ Yes o
[:]Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: jDate of Inspection: s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [314o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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 ETNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
M`NA ❑ NE
❑ Yes C No D NA ❑ NE
❑ Yes ©-No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes El"No
❑ Yes / No
❑ Yes Ej No
❑ NA ❑ NE
DNA ❑NE
❑ 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). .
r6�
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: T(o Irk 13- y
Date: � tL11S
21412015

Date of Visit: ,gyp Arrival Time: O Departure Time: County: f Region:
1
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
8G 1 rd
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: i 7.2 ,fie
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ign
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es 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 ETNo ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes �l4o [] NA ❑ NE
❑ Yes TP'No ❑ NA ❑ NE
❑ Yes 53 No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: t j
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
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 7 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 .6 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
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
[ ] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ETNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 KNo
❑ NA
❑ NE
the appropriate box.
❑WUP [I Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (-D No
23. If selected, did the facility fail to install and maintain rainhreakers on irrigation equipment? ❑ Yes E� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes V
No ❑ NA ❑NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [A No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes 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.
Use drawings of facility to better explain situations (use additional: pages as.necessary).
ry A- N • cS� CC1- ck1l-M as S
S1611Y s sew hj�2�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 07 CJ
Date:If Jf
.3b
21V2Q14

Type of Visit: rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Ri ason for Visit: 0"koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: [�M County: _
Farm Name: --Y ws �� 1 ZOwner Email:
14
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region:
Onsite Representative: Integrator:
Certified Operator: ��� � �j� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wltry
et Pou.
Design Current
Capacity Pop.
I
Cattle
Dairy Cow
Design
Capacity
Current
Pop
Layer
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dr. Poultry
La ers
Design Current
Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes 0 No
[:]Yes VfNo
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

4
lFacility Number: - LID jDate of Ins ection:
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L_! Dan
Spillway?: �c "
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;g 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
0"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Z]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V 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
V' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
PTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VI 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
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V7 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ 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 Rn No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes in No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -140Ffj lbate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VfNo ❑ 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?
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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes XfNo ❑ NA ❑ NE
❑ Yes RjNo ❑ NA ❑ NE
❑ Yes YfNo ❑ NA ❑ NE
❑ Yes ?] No ❑ NA ❑ NE
❑ Yes f� No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes wrNo
❑ Yes �fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
PeCUS aw, ate, h K:
Reviewer/Inspector Name: 1rv� � 00Q z — Phone: �a�
-� 6Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

0
(Type of Visit: %.:Coamoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: \ Arrival Time: ® Departure Time: County: �upLi I�
Farm Name: )� \S i, I L Q A -Mi Cx_ CA21A S )WC Owner Email:
Owner Name: �1� `� 1 �l (.(� R 1 C]C Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: VTN41� integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design C+urgent
Swine Capacity Pop.
Wean to Finish
Desigu Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design C►urgent
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D;, P ultr. Ca aci Plo
Layers
lDry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherNJ
Turkeys,
Turke PouIts
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes JNo [_]NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA []NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

jFacRity Number: J - U Date of Inspection: /
Waste Coilgetion & 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 o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L �.0
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 ONE
(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'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
VVCA, K--
14. Do the receiving crops differ from those designated in the CAWMP?
IS. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Q WUP ❑ Checklists ❑ Design 0 Maps ❑ Lease Agreements
❑ Yes MNo
❑ Yes 0 No
❑ Yes �No
❑ Yes t
oYeso
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A, No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis 0 ❑ Soil Analysis V.ste Transfers
❑ Rainfall ❑ Stocking ❑ /'p Yield Q t20 Minute Inspections Q Monthly and I" Rainfall Inspections
22. Did the facility fail to ins all and maintain a rain gauge? ❑ Yes CNO
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E] Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: g
24. 4d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA XNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes �QNo [] NA []NE
the appropriate box(es) below. �iT
❑ 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:
0 Yes
❑ No
NA
NE
[] Yes
No
tA NA
❑ NE
[] Yes �No
Yes ko
Yes t6 No
El Yes 4No
[] NA NE
NA ❑ NE
[] NA [] NE
[] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes 10 No NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes Po NA NE
34. Does the facility require a follow-up visit by the same agency? Yes o NA NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments;-.,
Use drawings of facility to better explain situations (use additional pages as necessary). :.
-- Alf � �o?`� of c90 10 C'kc
► L cA�� w 1 9-6 C0�tw — L-.m L-E_ c W-AS) IV, 5 T
CON F ! C'tA 01 C_ AC-T)U C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: 3&Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: .Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: 5 / Arrival Time: ® Departure Time: County:
Farm Name: ,L( Q RTi�-i G� �IqQ (� S 1ii� G Owner Email:
Owner Name: tR�/ IL DA`-��� Phone: '9)Q—
Mailing Address: IL950 NG l_Aw 0 S 9<3%liQL1A / YC oa / S
Physical Address:
Facility Contact: Title:
Onsite Representative: V�>(} 1 �n I (.D f }7QJ CiC
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certifi` ytion Number:
Certification Number:
Longitude:
Region:
Design
Swine C►apacity
Wean to Finish
Current
Pap.
Design C►urrent Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dairy Cow
Non -La er Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
D , P,oult . C*_a aci_ P,o ,
Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes *
[—]Yes [—]No
[:]Yes [:]No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilf Numb r: - Date of Inspection: S / /
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: Laimg
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ` No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [[[[ � No ❑ NA
❑ 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):
UNt �i cc
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 5No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
E]WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ 1�ste Transfers
❑ Rainfall ❑ Stocking ❑ op Yield Q 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No
❑ NA ❑ NE
C] Weather Code
[] Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

FaciI4 Number: I Date of Ins ection: f
24.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application).
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes t> 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 Vz No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other cornmenmz,-
Use drawings of facility to better explain situations (use additional pages as necessary).
SC�u CC,e EXq,--+tQY cA�-'JL DOi3
CQ
CgL,j A,47►� "t(AE ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: S ��
2/4/2011

Division of Water Quality
�l� acility Number 3 Ty Division of Soil and Water Conservation
1Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine Complaint
Follow up Referral 0 Emergency
Other ❑ Denied Access
Date of Visit: Arrival Time: f S Departure Time: County: hyAPLl N Region:
Farm Name: J� I r��ATa I C}C �_A2MS , A C . Owner Email:
Owner Name: & LL � N N %1LPA� 1 C� _ __ _ Phone: [phone],91 „
Mailing Address: )tp rC'rWit 50'�)_ t' 1V,%V6uA 1C 0O Q
Physical Address:
Facility Contact: �( Title:
Onsite Representative:
Certified Operator: :}Q I2I'--. F. 1(0LRQ t QjC_K,
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Ope,20e2fication Number: a 3
Back-up Certification Number:
Latitude: [= o [= A = Longitude: = ° [= i = i1
Swine
Design Current
Capacity Population
Wet Poultry
Design
Capacity
Current
Population
Design
Cattle Capacity
Curren#
Population
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean
Farrow to Feeder
Q0
Dry Poultry
❑ La ers
❑ D Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Beef Brood Co
❑ Turke s
urke Poultser
ffither
Other,
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes INo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: — G Date of inspection
..:Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA . ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (—A646AJ
Spillway?:
Designed Freeboard (in): 1 q • 5
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.) j��,
6. Are there structures on -site which are not properly addressed and/or managed El Yes L�1 No [I NA El NE
through a waste management or closure plan? J �
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 ONo ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑NA ❑ NE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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) S G E\��
13. Soil type(s)-�jL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes tNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes X No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ElNA ElNE
18. Is there a tack of properly operating waste application equipment? ❑ Yes1:0 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers�and/or any recommendations or any other comments.,.
Use,. drawings offacility .to better explain: situations (use: additional pages as,necessary)
a
Reviewer/Inspector Name
-1 Phone: q10 --i'(v 47W
Reviewer/Inspector Signature:
Date: U 6
Page 2-of 3 12128104 Continued

Facility Number: -3 f �/6�-
Date of Inspection 'I I"r
"Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
4No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
X'No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists0 Design ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
��o
[INA
ElNE
0 Waste Application ❑ Weekly Freeboard ElWaste Analysis ElSoil Analysis ❑aste Transfers
❑>Wnual Certification
0 rainfall ❑ Stocking ❑ ¢fop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IgNo
❑ 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 fait to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes IgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�hTA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
YXNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
0
ElNA
❑ 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
o
❑ NA
❑ NE
Additional Comments and/or Drawings::..
AL
��e_ —.�1A5 P3cc--)V paw J
AV
5cpto P61(���Lwa��
A . dw ,LU,A. -40 cou&iZ
1N orolo
i�W)0 ! .
__J -
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit vcgoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (j Arrival Time: — Departure Time: C] County: LiAJ Region:
Farm Name: W% c p 7p icr, PPSLm S I)il C. Owner Email -
Owner Name: jjp q U 04M l c_j) (z_(CK Phone:1�91 �
Mailing Address: } P5�fic
46 NOu 4 . / Y� �U �` s
Physical Address:
Facility Contact: �/ Title:
Onsite Representative: Si!A. ub F. i� i L p 4 zz i C.IC
Certified Operator: A 1�� r I (=�7eI
Back-up Operator:
Location of Farm:
Phone No:
Integrator: p
Operator Certification Number: J �aS8
Back-up Certification Number:
Latitude: 0 0 [= , „ Longitude: = ° = ,
Design Current
Swine Capacity Population Wet Poultry
Design
C**apacity
Ourrent
Population
Design
Cattle Capacity
C►►urrent
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
&000 0C> Dry PoWtry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Gilts
❑ Non -Ls ers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
El Boars
❑ Turkeys
Other ❑ TurkeyPoults
❑ Other ❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

` Facility Number: — y0
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
❑ Yes No
❑ Yes ❑ No
Structure 4 Structure 5
El NA El NE
El NA [I NE
Structure 6
Spillway?: p
Designed Freeboard (in):
Observed Freeboard (in): y
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 ONo ❑ 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 ;I,�1 No [INA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes YANo ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes KNo ❑ NA ❑ NE
❑ Yes A No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
El NA El NE
❑ 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) aC__ P S G
_
_ —
13.
Soil type(s) A ! d A
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 ,4 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes J�[No
❑ NA
❑ NE
18,
is there a lack of properly operating waste application equipment?
❑ Yes,)QNo
❑ NA
❑ NE
'Comments (refer to question #) Explain any YES -answers and/or any ecom_mendax"ho "s or any other comments. "~
Use drkwings of facility to,better"explain situattons.- (use additional "pages as oec ssary):�
Reviewer/Inspector Name I in t Phone: (41Q —�i�3on�
Reviewerllnspector Signature: Date: y Uh/Q�
12128104 Continued

Facility Number: % — Date of Inspection r
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 XNo
❑ NA
❑ NE
the appropriate box. 0 WUp ❑ Checklists ❑ DesignMaps
❑ p El
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
10No
Q Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ /aste 'Transfers �nnual Certification
El Rainfall El Stocking 0 Crop Yield ❑ 120 Minute Inspections [11 Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes qNo
❑ NA
❑ NE
- 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes No
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes '❑ No
XNA
ElNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes )kNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 9No
❑ 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 ,�J No
[I NA
El 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 K o
❑ NA
❑ NE
Addit,oval,.CommentsdaadlorDrarvings:
�.A Jk
Jg 1
�P �
FX(�IMENj
12.12&04

Type of Visit N Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit QfRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 114W Arrival Time: © Departure Time: County: U ✓ Region:
Farm Name: _ � lS '*-> lei L D A TaA CX C- R2m INC. Owner Email:
Owner Name: ��LSZi� �QHR! '� 1 L�r(�TQ [ �1�_ Phone:
Mailing Address: IS C C�u13 �fZ EIYAJVS'U) L-E IVc ag3y9
Physical Address:
Facility Contact: I Title:
Onsite Representative: ?>A I IL 1 C- pg 12i C.IC
Certified Operator:
Phone No:
Integrator:
Operator Certification Number: at
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [ o [ , F--I „ Longitude: = o ❑ , =
Swine
Design Current
Capacity Population
Design Current Design Current
Wet Poultry Capacity Population C►attle Capacity Population
❑ Layer ❑ DairyCow
❑ Non -Layer ❑ DairyCalf
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
JA Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
acoo
Dry Poultry
❑ La ers
❑ DairyHeifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Turkeys
El urkey Poults
ther
❑ Boars
Other.
❑ Other
❑Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes X No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

t
,- Facility Number: 3 - Flo Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes I$ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: L "/V
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
0
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 19No ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes tNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 WindowElElEvidence of Wind Drift El Application Outside of Area
12. Crop types) y�.MU_ti A (6 1 3 0L 91P iA]
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
3No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
A "`- ". ol_S C (LE+! 7-
Reviewer/Inspector Name R- S Phone:
Reviewer/Inspector Signature: Date: ZQQ%
Page 2 of 3 12128104 Continued

•' •Facility Number: 1/64-1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10No ❑ 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. ❑ W`UP 0 Checklists ❑ Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �] No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ baste Transfers ❑ yfinual Certification
0 Rainfall 0 Stocking [D Crop Yield © 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
ym No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A4No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
50 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
%,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
El NA
El 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
29,,io
❑ 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
f K.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V o
❑ NA
❑ NE
Page 3 of 3 12128104

4 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,0 Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g O Arrival Time: Departure Time: C unty:
Farm Name: Owner Email:
Owner Nama• PhnnP-
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:Z,Q
Certified Operator:G�i���7_Gf�
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: 1�!
Latitude: [—] o = ' = « Longitude: = ° = ' = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

r
Facility Number: — d Date of Inspection Lb/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesNo
❑ 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:
l
Spillway?: No
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
El 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
[I 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)
4. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Y s 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 Q Application Outside of Area
12. Crop type(s)
13. Soil
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
!LJ No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
/�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
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):
Age" N&gofo Game 6g-�Fo O/L,
A
Reviewer/Inspector Name Phone: � /V
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspectiony�0 '
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
t the appropirate 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 t" Rain Inspections ❑ Weather Code
❑ Yes No El NA ❑ NE
El Yes //❑ No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
;dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ffNo
A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
gN.
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,ICJ 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
;dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
J6
�> a
A
,_c�N� 12rz8104

a
Facility Number
(Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !l !Lo Arrival Time: ® Departure Time: County: DLIPLZJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: 3AZR.4 1CCl_P-Ca.rG(c. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 6 = & = O Longitude: = ° ❑ S ❑
SA
Design ,Current: Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity 'Population1� Fri
1
Other
❑ Other
❑ Layers
❑ Non -Layers
Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Calf
Ll Dry Cow
❑ Non -Dairy
❑ Beef Stocker
IL I Beef Brood Cowl I 1
Number of Structures: ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
El No
❑ Yes L'I 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?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: tA160o'J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3K
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V(No
❑ Yes d'No
❑ NA ❑ NE
El NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El,.
Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElE Yes
,,�
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 Drift ❑ Application Outside of
Area
12. Crop type(s) 13 (Gl S G b
13. Soil type(s) A vb 1V 4A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1[3No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WXo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ
❑ NA El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
CJ 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):
�•) UPO i STDc,I:T�/G• 9660"5, X� (),rrNG• GoMWEA- ..U1/WV2A-Y GCc 4RWV4 L-
`
r�icavL kt7L E�6.-}� .
Reviewer/inspector Name �_Towj f"AaW � �� Phone: d 71 - 73 y?
Reviewer/Inspector Signature: Date:
Page 2 of 3 + 12/28/04 Continued

Facility Number: 3 — 0) Date of inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. LI Yes ❑ No ❑ NA ❑ NE
❑ Waste Applica � n El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
El Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes EX/No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LAN
❑ NA
El NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes❑
;No,
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
!�'N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
(J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[!] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
El� Yes
l No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

(Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '�� �0 Departure Time: ; County:
Farm Name: �Q G Owne. 17mail:
Owner Name: i0 �G��Tit�C o!� kzvpp "Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �z5h--Z,<o �GroA7/Lt �
Certified Operator:
Back-up Operator:
Location of Farm:
Region:
/��f0&2kjPhone No:
Integrator: (-[i.R5
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= I= Longitude: = o= i
Design. Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Ogg 01)0
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design . Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: © 11
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 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ YesyNo ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
1
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: ;iY
Spillway? o
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑Yes /No
❑NA ElNE
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 2fNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes No
X
❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drifl ❑,Application Outside of Area
12. Crop type(s) �_ i-/ ,04 �flli� Q-
13. Soil type(s)
r /
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:]
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments {refer to gnestton #) Exp.Iamt any YE54answers andloranyAr tort to dattons or anyfother comments f
°Use drawings of facility to better espla�n"sttuattons (use addtttonhl pages;as�necessary} �x
/5>
nl�r o �,•�� G�:}-,ry_ C7 / �,�/�. 1 r,✓ Lz ��� �•4 s /boo,,✓
MfaG 7,aaz1,
q10 -'alto -77&*
Reviewer/Inspector Name j Phone:
Reviewer/Inspector Signatures Date: IZ
12128104 Continued

Facility Number: — Date of Inspection / d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /11,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 ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PdNo ❑ 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 A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IV No
/VNo
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ 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
No
/[
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
10No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
X No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Commeiits and/or Drawings
12128104

(Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation j
for Visit Qf Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit: I
Permitted [3 Certified [3 Conditionally Certified 0 Registered
Farm Name: `tJ' L
Tune:
p Denied Access
IO Not Onerational O Below Threshold
Date -Last Opera or Abo a Threshold: _.._
County: -------- ..._
Owner Name: _ . _.. _ . _ _ _ . _..... _. Phone No:
Mailing Address:
FadHtv Contact: __ . _ - -- Title: .
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator. (CI�Zg�IQ/Iis
Operator Certification Number:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ' < 46 Longitude • 4 Du
- Design
=.Current Desega
Current _ Des,ga Current
Swinepaci
pd' �on, Ponitry;�
rpo' oti`.. . .Cattle Po aoa =
Wean to Feeder
1
�
Layer
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [I Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes OrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [I Yes ,j No
Strucpre I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility, Number: s �7 Date of inspection
5. Are there�any immediate threats to the integrity of any of the structures observed? Cie/ 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 maintenanceJimprovement?
8. Does any part of the waste management system other than waste structums require maintenance!'improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste App§cation
10. Are there any buffers that need maintenanceltmprovement?
11 _ Is there evidence of over application? If yes, check the appropriate box below.
❑ ExcessiveePPPonding ❑ PAANN% ❑3Hyd1raulic Overload 0 Frozen Ground /❑ opper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues ,
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ZNo
❑ Yes PINo
071 es 7�o
❑ Yes dNo
❑ Yes gNo
❑ Yes P'No
❑ Yes XNo
❑ Yes [-No
❑ Yes ,I -No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,3No
❑ Yes _E1110
❑ Yes �2Wo
❑ Yes -Of40
❑ Yes .2<o
❑ Yes
�; )- Ea�m�y'�YFS aastivers_ r any,. , _ or.anp outer camp. $,� .
Fuss ara� ol=faaTrty3w�b�er acp� s�atiaats. {tee �1 pas;ttary� ®❑ Wield copy ❑Final rotes
�2a
OIG��r��
qe' a
Re-Aewer/Uspwtor Name .. ;�
Reviewer/inspector Signature: �! Date: 7 d
12112103 Cowed

Facility Number: 3 — Date of Inspection
Rectuii•ed Records &_Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ;3'110
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 J::iQo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fE'flo
❑ 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 _Q-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
J__lvo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
:QNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
_'Erko
28. Does facility require a follow-up visit by same agency?
❑ Yes
O'No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Rio
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
�0
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required farms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form +
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit JaTompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine C)Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility_ Number Date of Visit: 2a pZ Time: 25
Not O erational 0 Below Threshold
Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: J-237
Fin �� County:
Owner Name: -Ba ;.--A _ Poi G �11 Phone No:
Mailing Address:
Facility Contact: Title: l/ Phone No:
Onsite Representative: '�©� " S' B °r' �, TT K h `` �'� , M44 r' 4'�—I ntegrator: 13r r' LV "x!' O�% 6a` r a 11.`%
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C]0 0" Longitude 0 0�
-Desr n Current T Derr n Curreni �D Current
>; . _ g K
S,vtne ," Ca achy PQ iilstrorl - Pouttr Ga 'apty Po elation Cattle = Cs" stti ;Po istittsan
❑ Wean to Feeder -w ❑ Layer = ❑ Dairy
❑ Feeder to Finish ,. ❑ Non -Layer 42-7 ❑ Non -Dairy E
❑ Farrow to Wean _ -
❑ Farrow to Feeder `- ❑ Other z
❑ Farrow to Finish Total Design Gapaciri
❑ Gilts
❑ Boars ZetillisSLW
qzp
Number of Lagoons e ❑ Subsurface Drains Present ❑ La oon Area ❑ S ray Field Area
sHolding Ponds I:SoLd-:i raps N� as ❑ 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)
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 pins storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: !
Freeboard (inches): S
05103101
❑ Yes �,ffNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes_/ No
❑ Yes '0No
❑ Yes _J2`No
Structure 6
Continued

Facility Number:
Date of Inspection f3 Zl� li
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?
❑ Yes XNo
❑ Yes .�TNo
❑ Yes .,TNo
❑ Yes ONO
❑ Yes 21"No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
2TNo
11. is there evidence of over application? ❑ Excessive Ponding
[I PAN ❑ Hydraulic Overload
❑ Yeso
12. Crop type _B"'_ r r' V^ r; rGZP �r-t �1 /1 Grai --'
C7 ra Ze 70 e , sA
IN
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes _21—No
14. a) Does the facility lack adequate acreage for land application?
14 L e P S14,lk
. ❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Awes
0i0
c) This facility is pended for a wettable acre determination?
`S
❑ Yes
❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes _L3No
Required Records & Documents
17- Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �2No
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�10No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not.in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'ONO
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes JZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit? ,�
(ie/ discharge, freeboard problems, over application) ❑ , Yes 2I No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes ZI-No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes L3No
0 No violations or deficiencies were. noted during this visit. You will receive no further correspondence about this visit
-
Comments (refer to quistiosi #) Explaw , ui atiy M:ai sanovor;any recommendafions or arty otiser comments.
.UseArawiii gs of facility to better explain sitttatiotrs.'(nse:addt4onal pages as necessary) µ❑ field Coy,"
v ❑ Final Notec ;
Tilc jr4,611l4 S_L 4? tld t74VC q l+vc �i6�e GiL�P� q�c�er►-�aitR t'p�'L
-PC r'for"'ed ai e�-�ravP�i %-t
_j✓1
15. 4 ?V I';eld A eed s
(�Ve,-A-
T
Reviewer/Inspector Namead/'ii✓,1:�l h r I' - - -
Reviewer/Inspector Signature: Date: 20
05103101 Continued

aJ
acilih Number; 31 — Q Date of Inspcctimn
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 Zo
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 ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesPT�io
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
0510.3101

• Division of Water Quality -
Q Division of Soil and Water Conservation '
0-,Other Agency - -
Type of Visit-,RFCompliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit IcarRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
i��• I ,_-, [)ate of Visit: J5 Q I Time. I3�.p Printed on: 7121/20t)0
Facility Number �
Q Not O erational Q Below Threshold
Permitted © Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ................
Farm Name: .....B•r7 ..' �. R 1 �'t C...T. �"'r M �� J-nL.'....... County: U............................................... r+n.....................
r..... ... `....... .........
1J. ,
Owner Name:01't^G.......K • �d}��' r Gk............................................ Phone No:.....................................................................................
FacilityContact:.............................................................................. Title: ................................................................ Phone No:
MailingAddress: ....................................................... . ............................................................ ..................................................................................... ..........................
Onsite Representative: .... !L� ....f..'.ttp��r'iG�� 1eh►4:4�rt�Tntegrator:....!.....s...df...��'p.1!'�11�................
Certified Operator:
Location of Farm:
Operator Certification Number:
,08wvine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �•� Longitude �• �� ���
Design_, Current Design Current Design. Current
:Si..
0- Poultry Capacity ,o ulation Cattle Ca ac- , Po llation a
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean ZA TU
Farrow to Feeder ❑ Other
Farrow to Finish Total -Design Capacity
Gilts
Boars Tow Ssm
N*y ❑ Subsurface Drains Present ❑ 1�g^�n Area ❑Spray Field Area
Ponds / Solid Tina log ps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes XNO
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �Vo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes )2rNo
c. If discharge is observed. what is the estimated flow in gal/min? n /rA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes )ZNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes "FrNo
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 YfNo
Structure I Structure 2 Structure 3 Structnre 4 Structure 5 Structure 6
Identifier:...............�....................................................... ................................... .................................... ....................... ............. ........... .........................
Freeboard (inches):
5100 Continued on back

j Facility Number: 3 — 40 1 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, ❑ Yes RfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ZNo
(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 VTo
& Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,EfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZE1No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �,Z No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes,,ONO
12. Crop type get'^0dA Grace Sri 1l �_ra% D��se_ed , Corr, , 41 hear�gegnl-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ 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 ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes 16No
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.)
Yes ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 33No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes J'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes FfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`? ❑ Yes EfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
No Molatiods ot. deljcieli. '.. were noted during this.visit. - Y:ob will-feeeiye rio further:
corres idence: aho' llf this visit
Explain any YES answers and/or any
ia((t Lies beZ61 S19r#4 ELi� .-ji, ber.�,VG{A aS off' �P�i f ��1.5 yEA/'.
vi l eiv0iy i5'Pro tessi.N 1Al l() rrGa�•�►rheLtd a e¢P 4h.-f ;erld
AL
rot+;hel' G1�+ 4ekeel Zjf? COW!re4;4 o►1 AnA prv-'Le & raf,.dl e-ovee'tLy
,,r A, fil � 1 1 J
—rile ve�e��-�; b:s� g ��ss cn �e✓� ��I f l a9 oo)i is elaoA cave A9 efPj6
YOWL-r's, 5004 ward- fe Fc�c= �;-tl � Gro�3 � q r,d reeo-dr ire Lve1 i ke;4.
7 —
I
Reviewer/Inspector Name _747 C t, /R tl ►. S_�., ,. _=_ .__ ... ...__� Id
Reviewer/Inspector Signature: _ _ Date: 0 5100

Facility Number: 3 f — Qlr Date of Inspection Printed on: 7/21/2000
• Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 6t/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 9No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Ycs"�JNo
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 ZNo
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 EI'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )7ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional'Comments and/orDrawings:
i
5100

JOLDivision of Water.Qualrty.
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit '39 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
Permitted [3 Certified © Conditionally Certified [3 Registered
FarmName: ................................................ .�..............F.................................... I....................
Owner Name: ... — ` ► ✓ J` ' 1 p't
Facility Contact:
................. Title:
MailingAddress: ...................................................................................
Onsite Representative:.,+,!`,4 �' ! � - ' Llt
....................�..............................
Certified Operator;,,,,,,,,,,,,,
Location of Farm:
O Tune: � Printed on: 10/2612000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: D-ll- jP. %-? N.
Phone No:
Phone No:
Integrator: �% ! r0 /,Y►
.-....1...............
Operator Certification Number: ..........................................
r
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' ��� Longitude �49
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
Farrow to Wean 2-DDD
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ID spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ;Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZTNo
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 ;R No
c. If discharge is observed, what is the estimated flow in gal/min? 11
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes jjrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )EI No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .6 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier :.................
................... .................................... ..................... .............. .......................... .......... ............ ........................ ....... I............................
Freeboard (inches): If Z
5100 Continued on back

Facility Number: 3'1 - Date of inspection I
I Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XrNo
seepage, etc.)
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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ge f Y" t4zi 9-t itos..-.G 11 Gnq 1 C.-M udA G-•az e C en-" I W Gje
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW' MP)?
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?
N,0Molati6iis:or• deticiendb,9 •were notes• d&iiid this:visit= :Y:oo will-t•eeeive iW further
Torres ondeike. albouti this visit: • • ..................... •
❑ Yes XNo
❑ Yes 9 No
❑ Yes M No
[]Yes 129 No
t❑ Yes / No
l7� VSVh^eiss
Yes` ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ;WrNe
❑ Yes I!fNo
❑ Yes 15ONo
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes 1KNo
❑ Yes fiD No
❑ Yes J No
❑ Yes No
❑ YesNo
Commnts e(refer to'question #): 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)•
I3 . We,.4e ' 141, s6w-�•rs A-c t tf 9A z;s k/t/ bt4 ••Field ;.Ax beer, j -,--c ed
Se >Ore Fitts-4 ie14 prgt�1ee Alice.
d
14- We#otble gc,e-r delern oo­�.4 ar
00kq.y 61 va,rel( ee c,-crio;r•e . 1 /et pp_- h ej.j alre- PPe oV4.4c/y � jGlill-�
4A%-,d Use AGrCGc e� Irv-, r„�a�e �`�xn a+�,]�IQ-Z �� • fire �aarp( r�Gc�r�{s
St v to h a ti� i h ✓1 a g a s -� �e t!e 1 e ct h d �U r r ,'ears h e. Fie' AG be, _ry re k�%'
RcUV,r•a4e r-Ica�d S. Be sure 4o -�r'a� der �1�12"� reeorJe�
Reviewer/Inspector Name�r� h (^ JG► �"`%}�j �.�r
Reviewer/Inspector Signature: Date: /Z Pilea 5100

I~aOffity Number: 31 Q Date of Imspection Z Printed on: 10/26/2000
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 Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes -J�(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 XNo
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 51No
Additional Comments and/or rawin _ -
.................
�yop.� A.
�'pl I '-t� seP sQ Z?19 sire xe t +rr��3
hr;-� i GiGi I S o-/ a! i �-�r ah o;r, a:x, R- 7-. r s .
Iv � e ire s aY-? 1, 1-'.) err -fo f
r t? Gerd IN beevi m4de� A95AF.
5100

Facility Number Date of Inspection 121111001
Time of Inspection 1 O-?6 24 hr. (hh:mm)
E3 Permitted E3 Certified Q Conditionally Certified 13 Registered10 Not Operational DateLastOperated:
Farm Name �4 r`-.. County: --•--Dur. 1.....................................................
Owner Name :......... ..... ......!..'........-..-------G----------------- Phone No: -------.-............
Facility Contact: ........
Title:................................................................ Phone No:
MailingAddress: ......................................... .......................................
Onsite Representative:...��'.no{ tC . j .q'�'Gk.J..v.'. `"�.�..-Ut�1 fad Integrator: gs!.o�.!�..f..°�...�ar �.}.t.�..............
.............. ............
Certified Operator:
Location of Farm:
Operator Certification Number:
r........................................... •-------------------------------------------------- --------.-.......................................................................---.....................-.......-.-.--...---.---.---.--.---..-......................., .
Latitude Longitude �• �� ��= —
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry -?Ca acity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer IM Non -Dairy
❑ Other
- _ - Total Design Capacity
Total SSLW
Number of Lagoons ns Presnt
_ ., ❑ Subsurface Draie❑V. Lagoon Area 10 Sprav Field Area
Holding Ponds /Solid Traps _ _. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El Spray Field El 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 ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboardfinches): ................................... ................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
Structure 6
❑ Yes ❑ No
Continued on back
3/23199
1

F chit; dumber: -3 - yo7 Date of Inspection
-6. Are theta structures on -site which are not properly addressed and/or managed through a waste management or
�Jbsure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level.
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
U-NA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' Rio yiglatigris :or def ciencies were jnQted di irig this'visit. • .. u will •r. eeeiye rid furthk
cor'resparidence: agouti this visit.. -
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes C9 No
❑ Yes ❑ No
❑ Yes ❑ No
Comments -(refer to question #}: _Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to beEter eYpiain situations {u'se additional pages as necessary):
Syr�ec�.'o� covN4uo4ed as a Follow-u1 J, o-F--�l�e 2/16/oo oiiSckarg c--r1a,.14
}nsroc ci-� ems► .
2. („�as�c Ol�xc�ar�co! F,-ow� r�or4YF;e1d arre� Pull l7 (Wh;C'k krol 0i dv1)'egkrors0VX
2/ 8/0o n d 2/10/6o o-' Sq) goo 9c,llorls eacA. W,,s4c- d.'seJ L4,9c4 ew,•
i+7Fo POt�dWrn�j ci�kGk �tla„�cl SW IILH. Lj&S4e -Falrowcd d^q.'-%,R,5e ra+k and do-.rckaf5td
fa co-1 vnn'%"'e_d ¢rl bv�r"l of S�o�k:.vc��� W,,,4e Q.,s o6rerved c,(;tch�,` �
ln}-a S+�r� �n�t�ec�d Grrek durd.J� ftt,,S t^-f pr. s 4e rc/',cse�taa
-1, btocL, ovtna►ned l✓ v�q cZvid .rprcLr 1"c)u•`A-irar•� +l-)6crkary ovifo sfi^a,tr�`;eiof,
-Tkcse- Gic4;on3 Wc!'C 4akc.,. WV - I V41 4,1 '5-,vtt ple.s b O;cjvres t,,,cre J kkcrl..l —
Reviewer/Inspector Name ,5 4�' K C LV
Reviewer/Inspector Signature: Date: 5/
3/23/99

Type of Visit 0• Compliance Inspection O Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine 0• Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number" 31 407
Date of Visit �000 Printed on: 3/23/2000
0 Not Operational 0 Below Threshold
ll Permitted M Certified 0 Conditionally Certified E3 Registered Date ]Last Operated or Above Threshold: .........................
Faro, Name: J1U.JQpa1rirkExran.9.Jnc .......................................................................
Owner Name: R,E jrjj....................................... 1011,11rkk.........
Facility Contact:
Title:
County: ILupru............................................... WiRla.........
Phone No: .......................
Phone No:
Mailing Address: 165Q.5,.NC.5f1l.Hwy............................................................................. MagmU.N.0 ....................................................... 2$453.............
Onsite Representative: ........................................................................................................... Integrator: . .................................
Certified Operator: Batxdl................................... Kilpatriclt....................................... Operator Certification Number:.1723.8 ............................
]Location of Farm:
® Swine ❑ Poultry ❑ Cattle Latitude 34 • 53 30 K Longitude F-77--1 • F 55 00 u
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes D No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(inches): .......................................................................................................................................................................................................................

)Eaieity NuVber: 31-407 Date of Inspection 2/10/2000 Printed on: 3/23/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (let trees, severe erosion,
0 Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4fi was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance./improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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
Reauired 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.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
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, frecboard problems, over application) ❑ Yes ❑ No
23. Did ReviewerlhMector fail to discuss review/inspection with on -site representative? 0 Yes ❑ 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 AWMP? ❑ Yes ❑ No
-NO'-i7iola6briii rir:dEfrciericies•tvere:rioted'du' ng this •visit:: u' Wi7l:receive no fiift ier
• �'AT�'PC•i�fliifl PH A�lAi�f *hit•i7i. a7-.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hunkele (DWQ) received a discharge complaint on this facility and referred it to me at approximately 5:00 p:m on 2/10/2000.
(Greer-DWQ) got to area of complaint at approximately 5:30 p:m on 2/10/2000 and found the dithes at Hwy 50 and SR 1141 (Stocking
lead Rd.) filled with waste. It was getting dark by the time I found the discharge and I was unable to really get a good
lea as to the point of discharge. I felt sure that the waste was more that likely coming straight off sprayfield beside ditch filled with
taste, although I counldn't see (due to darkness) how far or from where waste was flowing. I did take samples and took them
lab. I did report back to facilty on next morning and met with Stoney Mathis - DWQ, BOC (Jimmy Vincent), and Mr. Kilpatrick for
other investigation.
Reviewer/Inspector Name
.lie. .

O'Division of Soil and Wa'tei-i'—onser vatton. Operation Review=
_. 13 Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality'
,= Compliance Inspection
- 0 Other.Agency - Operation Review
J(PRoutine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number j U-7
Gate of Inspection j 9
Time of Inspection 24 hr. (hh:mm)
Permitted Jp Certified [3 Conditionally Certified © Registered 113 Not Operational (Date Last Operated:
Farm Name. ........ ``� .L� , ••--- County:.... i.�0�.............
OwnerName: .........................1.�4tiCi1i1�...........----...---.................. Phone,\o:.........................................................---.----.......---............
Facility Contact: .............. .... Title: ................................................................ Phone No:
Mailing Address:....... ...... Sa ..N ...................................... .. t
Onsite Representative: ............. ......... �..................................... . Inte�v! &. .+
Certified Operator: ................................................... ............... Operator Certification Number:..........................
Location of Farm:
Latitude Longitude 0• ��°° _._._.
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Zp p
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity 200a
Total SSLW
Number of Lagoons 11ASubsurface Drains Present ❑ Lagoon Area jolSprayField Area
Holding Ponds / Solid Traps JEI No Liquid 'Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gallmin'?
d. Does discharge bypass a lagoon system?
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes [� No
❑ Yes
IP No
❑ Yes
[0 No
N Ilk
❑ Yes
No
❑ Yes
No
❑ Yes
P1 No
❑ Yes CgNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............4 (� ..
......................................................................................................................................................................................................
116/99 Continued on back

Fadility Number: 31 q07 I Date of Inspection
5_-Ame 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 raintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
3 9 �
❑ Yes 3 No
❑ Yes W3 No
❑ Yes ® No
❑ Yes JV No
❑ Yes 19 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ERNo
i. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen I ` ❑ Yes ® No
12. Croptype .......` Y.Y (1ti .... i`°"j T..#Jr...3.......................C(LI`la'1........................
YP ..........�.Q►'Y�.�..i.? ...4G� cn-.�.................. i �.............. �. t SY
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0- N.o.vio'lati'ons-or. deficiencies .were noted. d1&ing.this'visit:. Y'oti will.recceive nog furilier . -.
correspoiidehee' about; this visit.; • ' - ' - , - - - - - ; •. -. •. -. •. •. • : •. • : •. • ... -. •. • ... •. •. •. • : •. •. •. • ... •. -. •. •
❑ Yes [YNo
[VYes ❑ No
❑ Yes CONo
❑ Yes VNo
❑ Yes t9 No
❑ Yes [N No
PYes ❑ No
❑ Yes rtn0i No
❑ Yes R No
❑ Yes A No
❑ Yes FNo
❑ Yes U[}No
Comments (refer to"question Explain any YES answers arid/or any recommendation -So r any other comments.
Use dfawings^of facility to Better explain situations. (use additional pages as necessary)
parr.. w,k( b� i t.eSe bJl4 duct mires `�r tmi&s5 . � . Allawi.A cA he roy�d,(, J -
-31L3/ah . 4 L M 1 Z a of +OiW( Amity its ta. L A.e1J it W;Li . CLO1
i9. �— romct N spaUI� fo. � 611ta M_ �.. stt�v +nca,rr�s . `j�.� b{u� uk v,a�e pu`"'�
�w 1c-e t "k{-OV16 Sca t"J�wv�l eo,fcula�,
L_a_ G uyvels C rV'OU fJ L10— ` oil- Cw. p�� y�q;eDf �pY7►ll. At IIU�1
�icv i Slno ✓�� e 1~; ti '�e 1 W Up.
Reviewer/Inspector Nameyt�
Reviewer/Inspector Signature: - Date: ���jAq I1/6/99

Division of Soil and Water Conservation
0 ❑ Other Agency
sy. a RDivision of Water Quality "
110 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 7 Time of Inspection d 24 hr. (hh:mm)
E3 Registered [A Certified © Ap-{plied forPermitPermitted Q Not Operational Date Last Operated:
FarmName: ................ .......kW� a.....Ry.�................. ....... .... County: �i .................................
Owner Name: ...................... L--\M .............. � � 5...................................... Phone No:.....(_%0).z' q..I.T............................................
Facility Contact: .... Title:
........................................................................................................................................ Phone o:...................................................
MailingAddress: ....... 4..b........ ....... ....... 5�............................................... .............. ........................................yS.........
Onsite Representative: ........�if-A.......... 1��.1.��'�Y��IS............................................. Integrator:.......�S................................................
Certified Operator:.............................................................................................................. Operator Certification Number:.................
Location of Farm:
.f l....Y `.Sc..... i¢5...... �...._.... '.1�.... A r.. p:..? ....tr.� ...... vl4.r.. ,q..........sZA i.. i :.....................................................................................
..................... ..... ........................... ................... ...... ................
Latitude ' C 0" Longitude • 4 «
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Pj No
2. Is any discharge observed from any part of the operation? ❑ Yes [P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 53 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes W No
c. If discharge is observed, what is the estimated flow in gal/min? M A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 10 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require COYes 10 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes UP No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes. O No
7/25/97

1
Facility Number: 31— qo-+
`+ 8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
V) No. '
Structures (Lagoons.11oldinQ Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (fr): ........... ...19....... —.......
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
[�j No
12. Do any of the structures need maintenance/improvement?
j Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
i No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff enteringwatersof the State, notify DWQ)
15. Crop e tr,............................................................
P tyPx.TrU.s�A-........5.�.. i�rn.........:QYh.......[.�ii............�5}
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
tR�No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
P No
18. Does the receiving crop need improvement?
❑ Yes
P No
19. Is there a lack of available waste application equipment?
❑ Yes
�RPNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
ID No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
C]•No: :violatioils•or deficiencies-were,noted-during this'. visit.-YoiU4i11 ikei fv_e-no.furitier-:-
eorresp0Odeh0 6houf this:visit
i: Kv V-� `t A�c� t S Te_r "C� .j ocz C-{tas :y\ W3 k . �k_ 41 COA 5lnmt, "..I ! 0, �r a� n � ► �c .
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7/25/97

Routine 0 Complaint 0 F'ollmv-up of DXA10 ins
Facility Number 3I 1i17
1 Foll(Pw-up ofDSWC review 0 Other
11
Date of Inspection 1/29198
Time of Inspection 15:55 24 hr. (hh:mm)
0 Registered ® Certified [] Aj)plied for Pe.rrnit MPermitted 113 Not O erational Date Last Operated:
Farm Name ..... County: D.uplitt!....................................
•.................................................................. .FBd.�,tl��ttitcJi..>:.arz»s..l�lr...............' !;?..........
Owner Name:BAitrld....................................... Kilp."Itrick ................................................. Phone No: 29.6:4991.4w)..29.5-0,501W. •........
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 1CS[4.5..[C..611..11tx�.............................................................
Onsite Representative:...........................................................................................
Certified Operator: Rai rd.F................................. Kilpatrick.-....................
U►cation of Farm:
M agna Ha.. N.C....................................................... 28453 .............
... Integrator: .....................................................................................
Operator Certification Number:-1223.8.............................
?at�xa>xt av�st.sxtic.af.k tEy..SQ. ap.p.rttion ilr.N-n......................................................................................
............................................................. ............................................. ......................... .................................... .............................. ............. ..................................... I .........
........
Latitude 34 • 53 30 k Lon; itude. 77 • 55 4 00 ..
General
1. Are there any buffers that need nurintcnance/improvement? ❑ Yes ❑ No
2. Is any discharge obsen=ed from am° part of the opet:!tion`? ❑ Yes ❑ No
Discharge origii!f!l�tl tit: ❑ 1.agoon ❑ Spray Field ❑ Other
a. if discharge is ob etz ed_ eras the :_rJtt � attce man-made? ❑ Yes ❑ No
h_ Udischarge is obstnved, did it rcz i1 SmI—jec Water? (TF%-cs, noli€i• DWQ) ❑ Yes ❑ No
e. If discharge i4 c i!so! ved, „fir::::, tilt estimated floxv in galhnin?
d. Does discharge I;_ pass a laL..5n : vstcm? (I f ,not 1fy DWQ3 ❑Yes ❑ No
3. Is there evidence of past discharge from an), Dart of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of tlic State other than from a discharge? ❑ Yes ❑ No
S. Does any part of the waste nranagQment systtn! (other than lagoons/holding ponds) require 0 Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with :uw applicable sethack criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator- in reslionsible charge`? ❑ Yes ❑ No

Facility Number: 31-407
8. Are there lagoons or storage ponds onsite which need to he properly closed? ❑ Yes ❑ No
Structures (Laaoon.s.Ho1dinfr Ponds. Flush Pits, etc. i
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure 1 Strricturc ? StrUClLrre 3 StruClnl'C 4 Structure 5 Structure 6
ldcnti f icr:
Freeboard (ft):................................ .....................
10. Is seepage observed from an%, of tllc structures? ❑ Yes ❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes' ❑ No
12. Do any of the structures need nlaintcnance/improvement`? ❑ Yes ❑ No
(If any of questions 9-12 was ar).cwercd yes, and the situation poses an
immediate public health or environmenlal threat, notify DWQ)
13. Do any of the structures lack adequate mininwin or ma.\ nnnn liquid level markers? ❑ Yes ❑ No
Waste Application
14. Is there physical evidence of over applications') ❑ Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notily DWQ)
15. Crop type............................................................................................................................................................................................................................................
16. Do the receiving crops differ with those design.rted in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of Mdcquate acreage for land application?
18. Does the receiving crop need improvement?
19_ Is there a lack of available wa.te .L j)j)hCation eyuipmerrt?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to diSCrss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilrfies Oniv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which c.rrlse noncompliance of the Certified AWIAP?
25. Were any additional problems nolcd which cause noncompliance of the Permit?
30:vititatio,ns_or,,d,, i,icrrcic�s:�verc�:rrntecl:ctu>r-itiig this:visit.: You•Wif],r1',eeive-nofu. er•-
• . � :eor:res:poudei�ce alivir t flt is:visit:.:.:.:::.::::::..:::.:.:::::.::::.......... .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: q

❑ DSWC Animal Feedlot Operation Review
UDWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Con!Elaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other l
Facility NumberI L
Date of Inspection lE
{
Time of Inspection =En 24 hr. (hh:mm)
Registered © Certified ® Applied for Permit E3 Permitted E3 Not Operational I Date Last Operated
Farm Name:.- �..1.. .a�- r i-.t. ...... .!^'' .. i , [..,........ County:.... ....cx%......... .. ......................
.Wl..��..
........ ....
OvimerName- ...Stls..t.,r..;L........................ ....Y—I.IT .L..�................. :...a..c.p2-st....- 0 ... ..............
Facility Contact: .............................................................................. Title:.........
Mailing Address: ... 1.1.5 Q........M.c...... 5 Q....... ..&........ ..
Onsite Representative:.... 0•t .✓� K-.i..�..y�
CertifiedOperator:......................................................... ...............................
Location of Farm:
Phone No:
.......................
Integrator: ... &-1r A--W-y.&.......................................................
Operator Certification Number ,----.-"I'P I.......
......S.Q.x..BA"o—.3.A....rR............
.....-.mil . ..X'±-� .....�.1� .l .1.......................................................................................... .
Latitude ' £ 44 Longitude • `
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design. Current
Poultry Capacity Population Cattle Capacity, Population
❑ Layer ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity,
Total SSLW
Number, of Lagoons Molding Ponds `lam f Subsurface Drains Present JJKLI,agoon Area JIR Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need tnaintenancelimprove men t? ❑ Yes IM No
2. Is any discharge observed from any part of the operation? ❑ Yes NNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed. did it reach Surface Water? (If yes. notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gailmin? -- N i4
J. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ®'No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 54No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 19.No
7/25/97 Continued on back

r Facility Number: -
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 1RNo
Structures (Lagoons,[fold ine Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure fi
Identifier: It.. Js..........
I
Freeboard(tty.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes E(No
11. Is erosion, or any other threats to the integrity of any of the structures observed? X Yes ❑ No
12. Do any of the structures need maintenance/improvement? ,.Yes ❑ No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes XNo
Waste Application
14, Is there physical evidence of over application? ❑ Yes OkNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .S.a-. .......................... Lo,r..a t...---.._...,a..is..)-a r ................10 ......... r.e .........S...........1 �. .L.r`
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes XNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
FqNo
18.
Does the receiving crop need improvement?
aYes
❑ 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
J$No
22.
Does record keeping need improvement'?
❑ Yes
[R No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
R1 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
IQ_No
0- Nwviolations or. deficiencies were- noted during this'visit. You.will receive iro further
correspondence about this'visit.,
Caimments (refer to question #): Explairi.any YES answers and/ any recott mendations=nr any niher comments:
Usedrawings of facility to better explain situations. (use additional pages as necessary
a } _
tl .'t2 . S6 w�J �' bI i 0 ,.ti W RJ emend p �-C_Q'r` _'k iw F-q 0 0 W." .,. W
ILL Q I� w�i- a I i b a.v��, a �S a� w.a l 1 S 1•►.o v Lot
► $ W e Y 1'- o c.a Y,�. e-t�� .na- a d3 i w L o y b e-�,-,1t '
�� / , �; p o s t � b i.e .
a4 iJ a �+ w o b Q. t T WI I I e { e. -- t '�o r r� L (a..�d vv r !��` qo-�►-�
VOrLO' V
Reviewer/Inspector Name ,
Reviewer/Inspector Signature:
7/25/97
Date: t o 1 -7 I F -7

Facility Number:aE- 407
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: ID, 2 9-9 CO" ram`
Time: 1_ 1 0 A
General Information:
Farm Name �� N -�_ - V , I jQ 8-f k,E G (c County: _DVP 1,.,o
Owner Name: i&T RP,rc- Phone No: ZSG •��
On Site Representative: IM-0071 Q it € V. S f�-A-r94 Cam- Integrator: _X-A62.�.rtS _
Mailing Address:
Physical Address/Location: IUG
Latitude: 1 1 Longitude: I 1
Operation Description: (based on design characteristics)
Type of Swine No of Animals Type of Poulny No. of Animals Type of Cattle No. of Animals
U(Sow CVO #❑ Layer U Dairy
❑ Nursery a Non -Layer ❑ Beef
❑ Feeder
OtherType of Livesrock Number of Animals: 4 Z3,79 Pi -51 e4s
Number of Lagoons: r (include in the Drawings and Observations the freeboard of each lagoon)
Facility ection:
Lagoon
Is lagoon(s) freeboard less than 1.foot + 25 year 24 hour storm storage?:
Yes ❑
NoiZ
Is seepage observed from the lagoon?:
Yes ❑
No 0
Is erosion observed?:
Yes 0
No ❑
Is any discharge observed?
Yes ❑
No 0
Q Man-made 0 Not Man-made
Cover Crop
Does the facility nerd more acreage for spraying?:
Yes ❑
Does the cover crop need improvement?:
Yes ❑
No ❑
( list the craps which need improvement)
Crop type: r Acreage: i� o
Setback Criteria
Is a dwelling located withiri 200 feet of waste application?
Yes ❑
No Q
Is a well located within 100 feet of waste application?
Yes ❑
No IN
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
NO2
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes ❑ No 9
AOI — January 17,1996

_ Nfaintenance -- - - - - -- -- - - — -- - - - -
Does the facility maintenance need improvement? Yes a No 0-
Is there evidence of past discharge from any part of the operation? Yes A No G
Does record keeping need improvement? Yes Q No 0
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 4 No
Explain any Yes answers: C&,k— r _ Zee
-r_..A 7 R.as � d1 _ �i ,��, �..vu.C�s a..K.0 ���� �. � S-�r�►.. �.�.� i
---�-
t Y►, r�s..�2 if 1.5�,^, �� �s
.-
-
cc: Facility Assessment Unit
Drawings or Observations:.
Date: --25` (o
Use Attachments if Needed
AOi -- January 17,1996

Site Requires Immediate Atten ' 1 Facility No.�
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm
t S Pji Farm Name/Owner: {�LrW, Q t rA I I
" y a -�'
Mailing
County:
Integrator. ., Phone:
On Site Representative: t_ A rVAL Phone: a
Physical Address/Location: c ie:o _ f !� 4 rJ x o;;2 m, L-0.
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' 3 (� . " Longitude:_° Elevation: Feet
Circle Yes or No
---Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) s r No Actual Freeboard: 5-Ft. Inches
Was any seepage observed from th agoon(s)? Yes o>o Was•any erosion observed? �or No
Ts adequate land available for spray? or No Is the cover crop adequate? Yes or
Crop(s) being utilized. -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(_&;�
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 oVe
' If Yes, Please Explain.
Does the facility maintain adequate wmanagement records (volumes of manure, land applied,
spray irrigated on sped is acreage with cover crop)? Yes oig
Additional Comments: 62r, c- =�? L !a.)-eot V1
Inspecto-Name�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Aoo l
'95 10:05 P.02/08
995
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