310438_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

7
Type of Visit: 0 7Routlne
cc Inspection Q Operation Review D Structure Evaluation Q Technical Assistance
Reason for Visit: Q Complaint ❑ Follow-up Q Referral a Emergency 0 Other ❑ Denied Access
Date of Visit: z+ r Arrival Time: Ua Departure Time: P County: I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _ ► C Cl s Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
—T
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
DairyEEJ Cow
Dairy Calf
Wean to Feeder
Non -La er
D . Aoult
Layers
I
Design
Ca aci
I
Current
P,o
ceder to Finish a ti r?
q
Dairy Heifer
Da Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischnrizes 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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes 0- oT _ DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[a Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ETNT
❑ NA
❑ NE
[] Yes
[o
❑ NA
❑ NE
Page I of 3 21412015 Continued

►.
/Facility Number: j I - L.l 3 J l {Date of Inspection: 3 /nh
� 7 j
Waste Collection & Treatment
4._Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3 o
❑ NA
❑ NE
Of
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N❑
❑ 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
n 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 hreat, 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 5 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 Zf No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
E� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EN o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6 No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements El other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[] Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Q 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 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: jDate of Inspection: -7 F
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Fa'1To_�O NA ❑ NE
21. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �a1 0 0 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 N❑ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []-%'A ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No 0 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
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ 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?
u: fg.: s.r � ;..
ReviewerlInspector Name:
c'_ /� P9-�
ReviewerlInspector Signature: V___Z
Page 3 of 3
❑ Yes [�rN ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes ❑-lo ❑ NA ❑ NE
❑ Yes [5No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: f 49 71(7f ak
Date: 3 z ( / 7
21412015

U Division of Water Resources
Wacility Number - ® d Division of Sol] and Water Conservation
Q Other Agency
Type of Visit: C pliance Inspection 0 Operation Review D Structure Evaluation ❑ Technical Assistance
Reason for Visit: ❑ Routine ❑ Complaint Q Follow-up Q Referral 4 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 61 11 C 0 S�, �, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 74!� 3 k—
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
ceder to Finish o I Poo
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
ether
L
ayer
Pullets
Pouits
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation;'
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E rNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Plumber: -Y 2 Date of inspection:
WAste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FrNo
❑ 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: 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z_ L
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
01No
[ ] NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[.-14o
❑ 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 ALIplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff�No
❑ NA
❑ NE
maintenance or �mprnvement.
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 [D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E] lvc ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EJ'No ❑ NA ❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes []� No
❑ NA
❑ NE
Reauired_Records
& Documents
19.
Did the Facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes YNOo"'
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Q—' es -❑ No
❑ NA
❑ NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis oil 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 `rNo
❑ NA
Di NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: 31- ❑ate of inspection:
IN
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
�' o
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Ej`NA
❑ NE
Other issues
N
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[I]
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:)Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/E] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�T]No.
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E No
❑ NA
❑ NE
Comments (refer to.question'ft Explain any,Y.ES`answers�and/ore'anyradditional'reciimmendat ous':or;any`otl7er;:comments
..g , - r4�i:�•.$.::d,Fs�' .s;�. t•F ,Ld4'x.
Use drawings of facility to better ex lafr .situations (use'additional 'ages;as.necessar }: ,= ; I .fir J�
FC( /-A — ( C) A /T S `J fl ° `
L lr 5C, C Sas' ere or .�& �0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L` G 1�-) d . '0a L.L I/ (a n r, CV--
Phone: T 10 7 f lA T3'{I
Date: �c
21412014

i
1� 3
1� B
� G-
S
RECEIVED/NCDENR/DWR
M
Operations Section
Wilmington Regional office

ror.-I 1 6-�l
NCOA&CS Agronomic Division Phone: [phone]
Webake: www.nagrVovfagronomil
Report No.
FY16-SL017997
�: ~ `
Client: Costin Farms
Adviser:
Predictive
L
Coatin Farms
a Soil Report
Mehlictl-3 Extraction
312 Blackmore Rd.
Mrsaw, NC 28308
Sampled County: Ouplin
samprrq: R"Wvwa=
11124/2015
ComPWW. 1211812015
ram:
Links to Helnfuf Information
SIR
8amplelO:D1A,
Recommendations:
Lime
Nutrients Iblacre)
More
"
Crop
(tonstacre)
N P2O8
KrO NO S
Mn
In
Cu B
Inkrawtion
Lime History:'
1 -Cam, grain
0.0
120 - M 0
10 0 20
0
0
0 0
Nate: 3
2 -Small Grain (SG)
0.0
80-100 0
10 0 20
0
0
0 0
2=23
Test Results (units - W1V in glcrn� CEC and Na in mooll00 ems NO3-N In mgldma .
Soil Class:
Mineral
FIAM WN EC BS% AC PH
134 lid
Ca% Mq%
Sd
Mn4 Mn-All M"12
T.n4
Zn,IU
Cue No ESP 884 NO3I.N
0.18 1.13 I.2.6 71 08 6.1
61 73
44 13
23
34 36 29
61
81
62 0.1
4
Sample 10- A EB
Recommendatlons:
Lime
Nutrients Oblecre
More
TV
Crop
(Wnslacra)
N P2O5
K20 Mg S
Mn
Zn
Cu B
Information
Lime History
1-Com, grain
0.0
120 - 160 0
0 0 0
0
0
0 0
Note: 3
2- Smali Grain (SG)
0.0
00-100 0
0 0 0
0
0
❑ 0
Nate: 3
Test Results (units - WN In glcrrr ; CEC and No In megr109 cnrx M03-N in mgldrA:
Soil Class:
Mineral
HU% WN CEC BS% Ac pH
P4 K4
Cs% Mg%
S4
Mn4 Mn-All Mn-Al2
In4
Zn4U
Cue No ESP SS4 H03-H
1 �7
0.22 1.25 ; M2,5 67 0.8 6.1
155 80
39 12
26
48 45 38
55
65
s0 0.1
4
Sample IOteti y
Recommendations:
Lime
u ' is jiblacre)
More
xr
7
crop
{tonslacrei
N Papa
K20 Mg S
Mn
2n
Cu B
Informatlon
Lime Hlst»ry:
1 -Cam. grain
0.0
120 - 160 0
0 0 0
PH$
0
0 0
Mote: 3 Not% 33
2 -Small Grain (SG)
0.0
80-100 0
0 0 0
PH$
0
0 0
Noig: 3 Nate; S
Test Results (units - WN In gfcO. CEC and No in mW00 cmNO3-K in mgldmaJ:
Soll Class:
Mineral
HM% WN CEC 9S% Ac pH
P4 141
Ca% Mg%
S4
Mn-I Mn-All Mn-Al2
In4 r
Tn-At
Cud No ESP S34 NOrN
0.22 1.27 2.a 78 0.6 6.6
106 92
48 13
26
44 35 25
47
47
51 0.1
4
North Cartel ina
Reprogramming of the laborstoryinforrnaborn-management system that makes this report passible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Ii�1)5
Thank you tar using agronomic services to manage nutrients and safeguard environmental quality.
- Steve ftx

NCDAR¢SAgronomic Division Phone: {9191733.2656
Webslts: www.ncagr.govlagronomil
Report No.
FYIGSLO17997
Costin Farms
Page 2 of 4
Sample lq . y10
Recommendations:
Lima
Nutrients Ib/acre}
Mom
Crop
(tonslacre)
N PION
K20
Mg 8
Mn
Zn
Cu
B
Information
Lime History:
1 - Cam, grain
0.0
120 -160 0
0
0 0
pHS
0
0
0
Notc: 3 Note $
2-Small Grain (SG)
0.0
80-100 0
0
0 0
pHS
0
0
0
Note:3 hLgLeLl
Test Results [units - WN In
lltom ; CEC and No In moW100 cma NO3-N in mgldrrM:
Soil Class:
Mineral
HM% WN CEC 89% Ac PH
P4 K4
Ca% Mg%
94
Mn4
Mn-Ali Mn-Al2
Zn4
Zn-AI
Cu4
Na ESP
SS4 NO3-N
0.18 1.26 2.8
79 0.8 6.8
90 106
43 16
28
43'
34 27
53
53
53
0.2
7
Sample 10- 1 H
Recommendations:
Lima
Nutrients (lb/scra)
More
Crop
(tonslacre)
N P206
KZO
Mg S
Mn
Zn
Cu
B
InfonmMon
Lime History:
t-Cantaloupe/Melons
0.0
60-80 0
180
D 20
0
0
0
1.0
Note: 6
2-Small Grain (SG)
0.0
80-100 0
90
0 20
❑
0
0
❑
Note•
Test Results [units - WIV in gkvn� CEC and Na in megM00 cmz NO3-N In mgidnr):
Soft Close:
Mineral
P•r
HMSO WN CEC BS% Ac PH
P4 K4
Cast, Mg%
S4
Mn4
Mn-Ali Mn-Ai2
Zn4
Zn-Al
Cu4
No ESP
684 NO3-N
D.27 1,2DAAJ
68 0.9 5A
124 24
44 19
21
49
39 39
106
106
92
0.1
4
Sample IDezk
Recommendations:
Lime
Nutrients (Iblacre)
More
ff.
Crop
(tonslacre}
N P205
K20
Mg S
Mn
Zrt
Cu
B
Infomfation
Lime Hlatory:
1- Com, grain
0.0
120 _ 160 10
0
0 0
pH$
0
0
0
Note: 3 Nate:
2-Small Grain (Sr.)
0-0
80-100 10
0
D 0
pHs
0
❑
0
Nate: 3 N te:
Test Results [units - WN In
gfwtr3 CEC and Na In meg1f00 cm} NO3-N In mgldnA'
Sall Class.
Mineral
HM% WN CEC 138% Ac PH
P4 K4
Ca% Mg%
S4
Mn4
Mn-Alt Mn-Al2
Zn4
Zn-Ai
Cu4
Na ESP
884 NO3-N
0-32 1.23 ti 3.6
85 0-B 6.B
80 134
50 16
30
61
45 38
91
91
90
0-2
8
Sample ID; 429 "r
Recommendations:
Lima
Nutrients (Iblacre)
More
Crop
(tonsfacre)
N P205
Kz0
Mg S
Mn
Zn
Cu
B
Information
Lime History:"
1- Corn, grain
0-0
120 -160 30
0
0 0
0
0
0
0
1Va1e: 3
2- Small Grain {SG]
0.0
80-100 30
0
a 0
0
0
0
0
Net&A
Test Results (units - WN in glemIL, CEC and Na in MW00 Cnlr NO3-N in mgfdM)-.
Sail Class:
rAineral
HMS'. WN CEC 88% Ac PH
P4 K4
Go% Mg%
S4
Mn4
Mn-Ali Mn-Al2
Zn4
Zn-Al
Cu4
No ESP
S34 NO3-M
0.71 1.23 4.2
80 0-8 6-5
49 180
44 14
36
45
37 30
53
53
69
0.2
5
NCDAWS Agrorwmic ONIslon Phone: [phone]
Website: www.ncagr.govlagronomil
Report No.
FYI"I.017997
Castin Farms'•+
,a
Page 3 of 4
SamptelD C
Recommendations:
Lime
Nutrients(Iblacre)
Mars
`A
Crop
(tonslacm}
N .. Pzas
K20
M9 S
Mn
Zn
Cu
B
lnfmmadon
Lime History,
1 -Cam, grain
0.0
120 -160' 60
0
0 0
0
0
0
0
How-
2-Small Grain (SG)
0.0
80-100 50
0
0 0
0
0
0
0
Note,3
Test Results [units - WN in glcmx CEC and Na in megn00 crnt Nos-N In mgidnTj-
Son Class:
Mineral
HM% WN -I CEC 138% Ac PH
P4 1i-1
Ca% Mg%
84
Mn4
Mn-Ali Mn.AI2
Zn4
Zn-Al
Cue
No
ESP
S84 NO3-N
0.71 1.14 /74.0
82 0.0 6.4
37 183
47 15
30
47
39 32
45
45
78
0.2
4
Sample ID: 4
Recommendations:
Lime
Nutrients Ib)edej
More
Crop
{tonslacre)
N P205
Kz0
Mg S
Mn
Zn
Cu
B
information
Lime History:
1 -Corn. grain
0.0
120 -160 40
0
0 0
0
0
0
0
Note: 3
2- Smaa Grain (SG)
0-0
00-100 40
0
0 0
0
0
0
0
t: 3
Teat Results [units - WN In gfcnA. CEC and No in meg1100 cma NO3-N in mgldno).
Sail Clans:
Mineral
H18% WN CEC BS% Ac PH
P4 K4
Ca% Mg%
13.4
Mn4
Mn-All Mn-Al2
Zn4
Zn4U
Cu4
Na
ESP
S54 NO3-N
1.08 1-09 5.4
76 1.3 60
44 185
46 13
29
80
53 46
101
101
158
0.2
4
Sample ID E' •
Recommendations:
Lime
Nutrients (WRO e)
I More
a
Crop
Ponsiacre)
N Pxk
Kz0
Mg S
Mn
Zn
Cu
B
IM%wmatlon
Lime History: '
1 -Corn, grain
0.D
120 - 160 0
0
0 0
0
0
0
0
Nate: 3
I
2 -Small Grain (SG)
0.0
80-100 0
0
0 0
0
0
0
0
Nate: 3
Test Results [unita - WN In
glcmj; CEC and Na In mW00 cma M03-N in mgtdrra.
Soil Class:
Mineral
HM% llWlV CEC RS% Ac PH
P4 K4
Ca% Mg%
S4
Mn4
Mn-AN Mn-Al2
Zn4
Zn-Al
Cu4
Na
ESP
984 NO3-N
1.74 1.04 7.3
86 1.0 6.5
76 120
64 13
38
75
56 48
170
170
240
0.2
3

s
U
NCDASCS Agronomic Division Phone: [phone]
Website: www.neagr.gov/agronomi/
Report No.
FY16-SLOO9312
-
Client:
Costin Farms
Advisor:
Predictive
Costin Farms
Soi I Report
Meh fich-3 Extraction
312 Slackmore Rd.
Warsaw, NC 28398
Sampled County: Duplin
Sampled: Reaahmd:
1011412015 Compww:
10/2712015
Farm.
Links to Helpful Information
Na
Sample ID: 13a j
Recommendations:
Lime
Nutrients ilia/acre)
More
0
Crop
(tonsiacre)
N P205
K20
Mg S
Mn
Zn
Cu
B
Information
Lime History:
1 -Small Grain (SG)
0.0
80-100 40
0
0 0
0
0
0
0
Note: 3
2-Soybean
0.0
0 40
0
0 0
0
0
0
0
Nate: 3
Test Results [units - WN In glans; CEC and Na in meo00 curl, NO3-N in mgldm4J:
Soil Class:
Mineral
HM% W1V
CEC BS% Ac pH
P-1 K4
Ca% Mg%
S4
Mn4 Mn-All Mn Al2
Zn4
Zn-AI
Cu4 Na
ESP
SS4 M03-N
0.41 1.141-i.
3.2 77 0.7 6.0
42 105
48 13
29
39
33 33
fit
fit
74 0.2
6
Sale ID: ��3b
Recommendations:
Limo
Nutrients (lblacre)
More
t:.,
Crop
(tonslacre)
N P206
Kz0
Mg S
Mn
Zn
Cu
B
Information
lUme History:
1 -Small Grain (SG)
0.0
80-100 80
0
0 0
0
0
0
0
Note: 3
2-Soybean
0.0
0 80
0
0 0
0
0
0
0
Nate: 3
Test Results [units - WN In glans; CEC and Na In meg1100 cm3; NO3-N in mgld"ft
Soil Class:
Mineral
HM% WN
CEC BS% Ac pH
P4 K4
Ca% Mg%
S4
Mn4 Mn-All Mn ►412
Zn4
Zn Al
Cu4 Na
ESP
SS -I NO3-N
0.97 14'7
5.6 80 1.1 6.0
26 161
53 12
34
38
32 32
88
68
164 0.2
4
.Sample ID: L 3p
Recommendations:
Lime
Nutrients (Iblacre)
More
j
Crop
(tons/acre)
N P205
K20
Mg S
Mn
Zn
Cu
B
Information
Lime History:
1 -Small Grain (SG)
0.0
80-100 60
0
0 0
0
0
0
0
Nate 3
2-Soybean
0.0
0 60
0
0 0
0
0
0
0
Nate: 3
Test Results (units - WN in glans; CEC and Na in megM00
cm3; NO3-N in mgldmsJ:
Soil Class:
Mineral
HM% WN
CEC BS% Ac pH
P4 Kd
Ca°% Mg%
S4
Mn4 Mn-All Mn-AI2
Zn4
Zn Al
Cu4 Na
ESP
SS4 NO3-N
1.37 1.06
6.2 79 1.3 6.0
31 166
53 13
32
34
30 30 •
88
88
164 0.2
3
North C.Irulina
�-
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Trox

NCDASCS Agronomic Division Phone: [phone]
Website: www.ncagr.govlagronomil
Report No.
FY16-SL009312
Costin Farms'r'b
Page 3 of 11
k
ID:1b
Recommendations:
Lime
Nutrients (lblacre)
More
,!!Tvfi
Crop
jtonslacre)
N P206
KzO
Mg
S
Mn
Zn
Cu
B
Information
Lime History:--
1 -Small Grain (SG)
0.0
80-100 0
10
0
0
0
0
0
0
Note: 3
2-Soybean
0.0
0 0
10
0
0
0
0
0
0
Note: 3
Test Results [unites - WIV in glenrl; CEC and Na in megl100 cm', NO3-N In mg/drift
Soil Class:
Mineral
HM% WN CEC BS% Ac pH
Pd Kd
Ca% Mg°%
Sd
Mn-I
Mn-All
Mn Ai2
Znd
Zn-AI
Cud
Na
ESP
SS4 N0"
0.32/.1.17jA�73.0
73 0.8 5.9
127 78
48 12
30
31
29
29
55
55
47
0.2
7
Sa pie to: �l c j
Recommendations:
Lime
Nutrients (lb/acre)
More
�1
Crop
(tonstacre)
N P205
K2O
NO
S
Mn
Zn
Cu
B
Information
Lime History:
1 -Small Grain (SG)
0.0
80-100 0
10
0
0
0
0
0
0
Note: 3
2-Soybean
0.0
0 0
10
0
0
0
0
0
0
Note: 3
Test Results [units - WN in glernrl; CEC and Na In meg1100 cM3. NO3-N in mgldm3j:
Soil Class:
Mineral
HM% WN CEC BS°% Ac pH
Pd Kd
Ca% Mg%
S4
Mn4
Mn-All
Mn-AI2
Znd
Zn-Al
Cud
Na
ESP
554 NO3-N
t
0.36 1.18'' . f ' 3.1
78 0.7 6.1
142 74
54 13
33
41
33
33
69
69
50
0.2
6
Sample to:, j1d.1
i
Recommendations:
Crop
Lime
(tonslacre)
N P206
KzO
Nutrients (lb/acre)
Mg 5 Mn
Zn
Cu
B
More
information
Lithe History:
1 -Small Grain (SG)
0.0
80-100 0
30
0
0
0
0
0
0
Note: 3
2-Soybean
0.0
0 0
30
0
0
0
0
0
0
Note: 3
Test Results [units - WN in glcm3; CEC and Na in meg1100 cm3; NO3-N in mgldnr):
Soil Class:
Mineral
r
HM% WN CEC BS% Ac pH
Pd K-i
Ca% Mg%
S-i
Mn-I
Mn-All
Mn-Aix
Znd
Zn-Al
Cud
Na
ESP
SS4 NO3-N
0 1.23 1 3.0
72 0.8 5.9
132 59
51 12
27
38
32
32
78
78
45
0.2
7
mple to: 'lea
Recommendations:
Lime
Nutrients (lb/acre)
More
IN, cl
Crop
(tonsfacre)
N P205
K20
Mg
S
Mn
Zn
Cu
B
Information
Lime History:
1 -Small Grain (SG)
0.0
BOA 00 0
20
0
0
0
0
0
0
Note: 3
2-Soybean
0.0
0 0
20
0
0
0
0
0
0
Note: 3
Test Results {units -WIV In glcnr3; CEC and Na in meg11DO cmz NO3-N in mgldrrft
Soil Class:
Mineral
HM% WN CEC 85% Ac pH
P4 Kd
Ca°% Mg%
S-i
Mnd
Mn All
Mn-AI2
Znd
Zn-Al
Cu-I
Na
ESP
SS4 NO3-N
0.32 1.24 2.9
73 0.8 5.9
172 64
50 12
29
42
35
35
8a
80
47
0.2
7
13,

l%
__"
NCDABCS Agronomic Division Phone: [phone]
Website: www.ncagr.gov/agronomi/
Report No.
FY16-SL009312
Costn Farms
Page 2 of 11
W., )z w
S mole IM 3dt
Recommendations:
Lime
Nutrients (Iblacre)
More
'Vr
Crop
(tonslacre)
N Pros
K20
Mg
S
Mn
zn
Cu
B
Information
Lime History:
1 -Small Grain (SG)
0.0
80-100 90
0
0
0
0
0
0
0
Note: 3
2-Soybean
0.0
0 90
0
0
0
0
0
0
0
Note, 3
Teat Results [units -WN In glcm;; CEC and Na in megM OO cm? NO3-N In mgldrn ]:
Soil Class:
Mineral
HM% W/V GEC BS% Ac pH
P4 K4
Ca% Mg%
Sd
Mnd
Mn-All
Mn-AI2 Zn4
Zn-Al
Cu-I
Na
ESP
SS4 NO3-N
1.02 1.07 5.8 81 1.1 6.0
21 165
55 12
30
34
30
30
115
116
359
0.2
3
Sa 'pie ID: 3e
Recommendations:
Lime
Nutrients (lblacre)
More
7 �
Crop
(tonslacre)
N P205
K20
Mg
S
Mn
Zn
Cu
B
Information
Lime History: by
1 -Small Grain (SG)
0.6
80-100 80
0
0
0
0
0
0
0
Note: 3
2 -So bean
0.0
0 80
0
0
0
0
0
0
0
Note: 3
Test Results [units - W!V in g1cm3; CEC and Na in meg/100 cmt NO3-N in mgldnr):
Soil Class:
Mineral
HM% WN CEC BS% Ac pH
Pd Kd
Ca% Mg%
S-I
Mnd
Mn-Ail
Mn AI2
Zn4
Zn-AI
Cu-I
Na
ESP
SS4 NO3-N
1.19. 1.05 5.3 73 1.4 5.6
23 107
53 10
39
35
31
31
100
100
217
0.2
4
S pie ID: 3f
Recommendations:
Lime
Nutrients (Iblacre)
More
rrvrx
Crop
(tons/acre)
N P206
K20
Mg
S
Mn
Zn
Cu
a
Information
L€me History:
1- Small Grain (SG)
0.6
80-100 44
40
0
0
0
0
0
0
Nate: 3
2 Soybean
0.0
0 40
40
0
0
0
0
0
0
Now 3
Test Results [units - WIV In g1cm3; CEC and Na in meg1100 cart NO3-N In mgldmsJ:
Soli Class:
Mineral
HM% WIV CEC BS% Ac pH
Pd K-I
Ca% Mg%
S4
Mnd
Mn-All
Mn.Al2
Zn4
Zn-AI
Cu-I
Na
ESP
SS-1 NO3-N
1.14 1.04 6.0 77 1.4 5.6
42 49
60 14
45
39
33
33
ill
111
180
0.2
3
Sarnple ID: 39
Recommendations:
Lime
Nutrients (Iblacre)
More
Crop
(tonslacre)
N P205
K20
Mg
S
Mn
Zn
Cu
B
Information
Lime History:
1- Small Grain (SG)
0.8
80-100 0
70
0
0
0
0
0
0
Nate: 3
2- Soybean
__TG'_
0 0
70
0
0
0
0
0
0
Note: 3
Test Results [units - WN In glcO; CEC and Na in meg1100 crn3; NO3-N in mg/dnr):
Soil Class:
Mineral
HM% WN CEC BS°% Ac pH
Pd K-1
Ca% Mg%
S-1
Mnd
Mn-All
Mn-Al2 Zn4
Zn-AI
Cud
Na
ESP
SS -I NO3-N
0.22 1.21 2.6 49 1.3 5.0
71 34
33 10
28
33
30
30
40
40
76
0.1
4

Ct.(ii V
t
Is
r G-
Jr ��
RECEiVER/NCDEHR/DWR
M
Operations Section
Wilmington Regional Office

-r
1 aciliSty Number W -
C0 Division of Water Resources
D Division of Soil and Water Conservation
0 Other Agency
L/
Type of Visit: Com ' nee Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: aRoutine Q Complaint Q Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: A fap Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �J r + C4 S� �� Integrator:
Certified Operator: Certification Number:
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
eeder to Finish �] D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
ury rouury
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets,.
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Ileiter
D Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ErNo ❑ NA ❑ NE
❑Yes
❑N❑
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes <No❑ NA NE
❑ Yes �No ❑ NA ❑ NE
Page I of 3 21412015 Continued

11
Facili Number: - Date of Inspection:
W ste_Collection_&_Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
Spillway?-.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ 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 environm;TNo
I threat, notify DWR
7, Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes E"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E!J'N❑ ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required huffers, 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
flare 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 N -
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes Ff"No ❑ NA ❑ NE
the appropriate box,
❑ W UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [] Other:
21, Does record keeping need improvement'? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. 1fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facill Numher: 31- ❑ate of inspection:
24�Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [7�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q NA ❑ NE
Other Issues ,
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [E N❑ ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
[�] 1Na
❑ NA
❑ N E
❑ Yes
ESNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
E2(No
❑ NA
❑ NE
... _..... t......, .... -I F........
Reviewer/inspector Signature: Date:
Page 3 of 3 1141265

Type of Visit: C Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: f0 Routine 0 Complaint ❑ Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ! Departure Time: iX7 County:. a Region: �.
Farm Name: ; 1k CahnI� I Owner Email:
Owner Name:
Mailing Address-
. Physical Address:
Facility Contact: Title:
Onsite Representative: �I—b-rYv\ CdL Y.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:1�
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
nt
Design Clirp,",
Cattle Capacity ,
DairyCow
Wean to Feeder
Nan-I.a er
DairyCalf
Feeder to Finish
4
DairyHeifer
Farrow to Wean
Farrow to Feeder
Dr. l?aultr.
Design
Ca acit
Current
P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes 0N❑
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

t
acilit Number: 07, jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9TNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VrNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: —� �_ l� ■
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PrNo
❑ 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 KNo ❑ 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 ;ffNo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z'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
/ZNo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
;a 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
�ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
e
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
;ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2rNo
❑ 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
No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes'
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly Fnd V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeili 'Number: ILi jDate of Inspection: - �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes idNo ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONO ❑ 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes JZ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes tf No
❑ Yes Y No
❑ Yes WIo
❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.� a
.� ` ..
■ 21412011

Division of Water Quality
Facility Number ®- ® Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: OTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: _ Qlftoutine Q Complaint Q Follow-up p Referral Q Emergency Q Other Q Denied Access
Date of Visit:
Arrival Time: j�'�
Departure Time: 1p
County:
Farm Name: W,
&M
Pi
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Phone:
Title:
Certified Operator: e Alwvvti AZV\ -SIC
Back-up Operator:
Location of Farm:
Swine
Vean to Finish
Veanto Feeder
eederto Finish
arrow to Wean
arrow to Feeder
arrow to Finish
Boars
Other
Other
Latitude.
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity, Pop.
Layer
Non -La er
Pullets
Poults
Design Current
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?
Longitude:
Region \rij m—
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes dNo ❑ NA ❑ NE
❑Yes
No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
NE
[—]Yes
M—No
❑ NA
❑ NE
❑ Yes
C!rNa
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g f 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: Lewnrd�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): % LV
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ZrNo
❑ 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
[�t 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,
ZjNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[UNo
❑ 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
[ rNo
❑ 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
[�rNo
❑ 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
2f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[?No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
a No
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[7rNo
❑ 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 Ef No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes 2rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;KVo ❑ 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 ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �iVo ❑ NA ❑ NE
Other Issues TT
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ff 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
dNo
❑ NA
❑ NE
permit? (i,e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z 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
rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FXNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C2rNo
❑ 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).
�aqwvv
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�p�
Date:
21412011

Division of Water Quality
PAciiity-Number 0 Division of Sol] and Water Conservation
❑ 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County Region:
Farm Names LLS ►1I� 1 �� Owner Email:
Owner Name: ] 1 (rt,� A fYl Phone:
Malling Address: 11 rc), I c.PC4CmoQF_ 96 s7`+ s 3
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: '?D IL:&=
(fO S7`/►,V
integrators�
Certified Operator: V`� i
M �dS%% --T
T
..]�.
Doi
Certification Number:
1 � �7$
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
[other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and. Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field [] Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE.
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA NE
Page l of 21412011 Continued

Facilit Number: - Date of Inspection: 9j
Waite 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (P��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L/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.) �4
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 tNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 X'No ❑ NA ❑ NE
Excessive Ponding ❑ HydrauIic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Q 1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
tNo
❑ NA
❑ NE
the appropriate box.
Q WUP []Checklists 0 Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ V�ste Transfers
[] Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes "'gNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes M No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Q
Facilit Number: - Date of Inspection:
24. ,did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] 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 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 0�►
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.c., 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: TTT[[[
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 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 apy,other-comments.�6'� ' I.y.
Use drawings of facilityto better explain situations use additional pages as neecssa k="'' " a'
319119
ay
3 �
I g/411
�.4
50l11
aO//
u
'b(AE
Reviewer/]nspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone: 9 10
Date: �1��l
2/4/20I1

Type of Visit Compliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit'jb—Routine Q Complaint Q Fallow up O Referral Q Emergency a Other ❑ Denied Access
Date of Visit: 11I Arrival Time: Departure Time: County: u N Region:
Farm Name: I L _ C 0S J /A/ Owner Email:
Owner Name: i L_Li Q CYl CoS7J Al Phone:
Mailing Address; Cffiy._C i` 8 LL=19Q S N(2,
Physical Address:
Facility Contact: Title:
Onsite Representative:C5-'/'A/
Certified Operator: _ `A2 .j L L1A ' . (24�-151) lq
Back-up Operator:
Phone No:
Integrator: [�
OperaT for �] r#ification Number: 19 (DIS
Back-up Certification Number:
Location of Farm: Latitude: = e = i =,, Longitude: Q ° = g = «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
❑ La er
ElDai CowWean
❑ Dai CalfEj
to Feeder
❑ Non -La er
Feeder to Finish Q
ElDai Heifer
Farrow to Wean
DrPoltr
ElD Cow
Farrow to Feeder
1El—
❑ Non-DairyFarrow
to Finish
❑ La ers
ElBeef Stocker
Gilts
❑ Non -La ersEl
❑Beef Feeder
Boars
Pullets
❑ Beef Brood CowElTurke
s
en n❑Turke
Pnuets
❑ Other
❑Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
[I NA
[I NE
❑Yes
[I No
❑ Yes Nn ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
pad�e j of 3 12128104 Continued

Facility Number. —143&1 Date of Inspection =p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Struct re 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 ofany of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks))
9. Does any part of the waste management system other than the waste structures require 0 Yes No ❑ NA ❑ NE
maintenance or improvement? j
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesA
No El NA El NE
maintenance/improvement? .
11, is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift [:]Application Outside of Area
tr
12. Crop type(s) _ �/�-'1 { �7 S�& ._
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El NA El NE
'gNo ❑ NA ❑ NE
No ❑ NA ❑ NE
jNo El NA ❑NE
o ❑NA ❑NE
i''-.�:�.-f4 •�i�+Y',�i'r19•.':,�..Y.'R3 �'•'riS,��i'4i�z�h:�. .�� ..
Ciimments`(refer to question #): Expla1n=any.YLGS answers•;and/nr"an�kkrecommendation
s'or any other comments; 5.
&' m7•: .a :ii'}', f:.*&' �wS.rsa�3tFli 1• ..., r...- I � •�
use.drawin'gs offacility fo:hefter.explain situations.'(use.additionai.pages asLnecessary):4:5'„9 grga
i
Phone: qlU` AmmReviewer/Inspector Name
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

■ i 'r
Facility Number: i ­L454 Date of Inspection I S
Reguired_Records &_ Documents
19. Did the facility fail to have Certificate Of Coverage & Permit readily available? ❑ Yes XNo ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA ❑ NE
the appropriate box. J ,
El WUP El Checklists ElDesign ElMaps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )kNo ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Ahnual Certification
0 Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections [E Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �No
ElNA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pennit?
❑ 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
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
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)
\\\`�No
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
Addi#innal Comhrterits'andlor Drawin s: :'s .3;, " �'' "
Lo 3.
,1117�1,0 0.93
�195110 I. a .Q
I��t�rao�v Qua %01_ —� I
Page 3 of 3 1IZ128104

Type of Visit Compliance Inspection O Operatlon Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoutino O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 f Arrival Time: ® Departure Time: County: Ll Region:
Farm Name: 1LL CdS i1N�+ Owner Email:
Owner Name: � t LL! 19 fYl ST//u Phone:
Mailing Address: 6LRCY- FOR E CA-'-_)N-SAt A31 /�. 9$3C)-4S3 o
Physical Address:
Facility Contact: Title:
Onsite Representative: _V-)ILL n j /,A/
Certified Operator:. U --)1 L A A n_�S CQ5 T 1 AI
Back-up Operator:
Phone No:
integrator:
Operator Certification Number: IgLsla„_
Back-up Certification Number:
Location of Farm: Latitude: = o = 1011 Longitude: = ° 01 = «
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Poputation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder I
JEJ Non -Layer I I
❑ Dairy Calf
® Feeder to Finish Q 1
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
El Farrow to Finish
El I.
Layers
❑ Beef Stocker
Gilts
❑Nan -La ers❑
❑ Beef Feeder
PE]Boars
Pullets
❑Beef Brood Caw
❑ Turkeys
other
❑ Other
❑ Turkey Pouets
❑ Other
Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
*No
��,��,
❑ NA
❑ NE
Discharge originated at: [I Structure ❑ Application Field [I Other
\\\\\\
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: Bate of Inspection ! 1 1C]
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 8—No ❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'! ❑ Yes ANo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes INo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes XkNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No ❑ NA ❑ NE
11. Is there evidence of incorrect application? if yes, check the appropriate box below, ❑ Yes No ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic OVCrload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop typeC �
s) (e_1,1 U,3i4e01 e— r-3_ �
13.
Soil type(s) ..NQ Iq
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 9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes ANo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes )F4
❑ NA
❑ NE
Comments (refer. to.ggestioa #]:. Explain uny YES. answers:andlor ;any: recommendations. nr an other comments. '
Use drawings of.facility to'better explain situations,.(usc ai dd tonAl pages as necessary] � ,,
Reviewer/Ins ector Name "`
='f `` ` i :; _.. Phone: p
Reviewer/Inspector Signature: Date: !r)11[)
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
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps ❑ Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
[l Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑/nual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and V
Rain Inspections []
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes]
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
bid the facility fail to have an actively certified operator in charge?
❑ Yes
X 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
• 1
3 l .
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
kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'No
❑ NA
❑ NE
w , 00'a .
Additiogaomments apolor prawings:
UcQho / . �s J. I?
TV401 /
12128104

Type of Visit W Compliance Inspection 0 Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit O1 Routine a Complaint Q Follow up Q Referral Q Emergency D Other ❑ Denied Access
Date of Vislt: Arrival Time: ® Departure Time: County: Lj.A/ Region:
Farm Name: 2 ) A+ �—�.LL C0571 r Y Owner Email:
Owner Name: L_,l IA.....S7Ilti% Phone:
Mailing Address: ) oL f2� L f)C_C 9_E pRJS l9 W _ ■ ■ t'` ���
Physical Address:
Facility Contact: Title:
Onsite.Representative: 2_1 L, L_ CCY571 IV Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 00 0 9 = If longitude: ❑ o =1 = fl
Uesigrt Current Design Current Design Current
Swine Cap iac ty Population Wet Poultry Capacity Population Cattle Capaci#y Population
❑ Wean to Finish
❑ La er
❑Dai Caw
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Dairy Heifer
❑ Dry Cow
Feeder to Finish
Ury Poultry°
La crs
❑ Non -Lavers
❑ Wallets
❑ Turke s
❑ Turkey Poults
❑Other
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
JO Beef Brood Cow
Number of Structures:
❑ farrow to Finish
❑ Gilts
❑ Boars
ether
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ Nis
h. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (]ryes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
y
-Na
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'ANo
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12/28/04
Continued

Facility' Number: �> I--4jl3'd' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i►'t 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: �� (W A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes % No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes DINo ❑ 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 C4 No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box beIow. ❑ Yes
4Na
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ ❑utside of Acceptable Crop Window ❑ Evidence of Wind Drift [:3 Application Outside of Area
12.
( �
Crop type(s) � fy S � > LA:�) t4
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
4 Noy.1❑
NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
0No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
U.No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? El Yes
�No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
14 No
❑ NA ❑ NE
Reviewer/Inspector Name ! § ' `` ` } Phone 4!/�y
Reviewer/Inspector Signature: Date: �Q9
Page 2 of 3 12128104 Continued

i
Facility Number: 3 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�dNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA ❑ NE
the appropirate box. El WUP 0 Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA ❑ NE
[l Waste Application [] Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑Waste Transfers
❑ nnual Certification
[l Rainfall 0 Stocking 0 Crop Yield 0 124 Minute Inspections 0 Monthly and I"
fain Inspections
0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
I'mNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
`7 No
ElNA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
❑ Yes
1ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
AN❑
❑ 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
0 No
❑ NA
❑ NE
E
Page 3 of 3 1228104

Facility Number 3 l 3
Division of Water Quality
a Division of Sail and Water Conservation
Q Other Agency ;.
Type of Visit & Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine ❑ Complaint p Fallow up Q Referral Q Emergency d Other ❑ Denied Access
Date of Visit: i lfa Arrival 'Time: �} oo Departure Time: County: )�(kj?u Al Region:
Farm Name: -.-_--. _..- _.___ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: [� Title:
Onsite Representative: 1 �1 LL _ CD57/^f„
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Rack -up Certification Number:
Latitude: [= a 0 f =« Longitude: = a 0, 0 11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Reeder to Finish OY�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[--]Boars
Other
❑ Other
❑ Layer
IEJ Non-Layet
Dry Poultry
Lj Layers
N on -Lavers
Pul lets
❑ 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?
17esign Current."..'-`
Capacity Population rs;
❑ Dairy Cow
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2• Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
m
El Yes ®No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N.No
❑ NA
❑ NE
❑ Yes
25 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 1 'a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: wGaw _.�00w,�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
� No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
� No
❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�qNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Froxen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > IW/o or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application Site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1� 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
KNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 6PJ 30W F (4V - C_L Phone: 910—'j9i[o - 43a1
Reviewer/Inspector Signature: ` Date: t-f 6
12128104 Continued

li acility Number: ( —y i Date of Inspection 1 �tti a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KA No ❑ NA ❑ NE
the appropirate box.
ElWUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
5Q No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
,� No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
LN No
ElNA
ElNE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
k3No
❑ NA
❑ NE
❑ Yes
M No
El NA
El NE
❑ Yes
Q No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $ Routine ❑ Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 217 O Arrival Time: p.7..5 Departure Time: 1 ' d County: &Ut0&Z1L) Region: _ W■'AC d
Farm Name: �d5 r�� Owner Email:
Owner Name: (�tJLG��}�y} t��STi►! Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No!
i
Onsite Representative: re- _0S7-.1+ly „ _ Integrator: +Q06L
Certified Operator: ;tL _�dS.T�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = g = Longitude: = ° 01 = ff
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
❑esign
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish Q d d
❑Dai Heifer
Farrow to Wean
Dry Poultry
❑ Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Outer
❑ Turkey PuuIts
❑ Other
❑ Other ::jNumber
of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
vNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3 _
12128104
Continued

Facility Number: 3
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
Identifier: a0-1 1 W Z
Spillway?: d �4
Designed Freeboard (in); .5 r� 5
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes XNo
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement`?
❑ Yes
❑ NA
❑ NE
K Do any of the stuctures lack adequate markers as required by the permit?
'0No
❑ Yes 5�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
X
ElNA
ElNE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop types) L.a2►�I - W.E,4 7. �pS��F_Ar1.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`?
�z
❑ 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 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):
/�/,Q AL
140L
.�. 6/�✓� 2.y-�� I�}►Prx� Z5 l�t��� � z�T��nJ+�D �.s�,�A-f �Ecas ��°riF�J
Reviewer/inspector Name .- Q Phone: 4
Reviewer/Inspector Signature: Date:
Page 2 of 3 12 8/04 Continued

'L
J
r
Facility Number; Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[] Yes ONo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WLTP [I Checklists [I Design ❑Maps ❑ ether
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes b No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZN❑
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes X90
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes PrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Y(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes zNo
❑ 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 nonnal?
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 ONo
❑ 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 to No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
❑ NA
❑ NE
Additional. Comments and/or Drawings:
�,� �•�,P "�61: owzo
AL
152e
n►i�7F �r�� P[.E ��/J
Page 3 of 3 12128.104

L
f Visit P Compliance Inspection Q Operation Review Q Structure Evaluation a Technical Assistance
n for Visit 95Routine Q Complaint Q Follow up Q Referral Q Emergency d Other ❑ Denied Access
Date of Visit: / p Arrival `t' e: + Departure Time: I I. I J13^L County: Region: 46wQ
Farm Name: Owner Email:
Owner Name: &Izznz Phone:
Mailing Address:
Physical Address:
Facility Contact: A
_ }Title:
Onsite Representative: Z-/—L
Certified Operator; 6ze i- /_�24
Back-up Operator:
Phone No:
Integrator: 1&6e�4W ga.-W
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = j =4 Longitude: [� ° = j = ff
Dcsign Current Design Gurrcni Design Current
Swine . ciity Population Wet Poultry Capacity Population Cattic Capacity Population
❑ Wean to Finish
1 110 Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Caw
Number of Structures:
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean
Q
Ury Poultry
❑ Farrow to Feeder
El Farrow to Finish
❑ La crs
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Boars
❑ Turkeys
Other ❑ Turkey Po its
❑ Other ❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

a
Facility Number: —yap Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?: 4Z2 A10
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It. 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 > 1 d% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
11
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
17No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
JZNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendationsor any other Ycomments r
Use drawings of facility to better explain situations. (use additional pagers. as. necessary)t:..; :. ;: •: f
s
20) 6�0.V7' ua 54"S t9,C 90 73WInYP 2��tr� , r�� crl'- K 6&41j-7,C_,,2 2
�j-� of �rlJIUL/Z � ZF.S CfiG � � � I'-!J/1rr'1 �rt11J ;Ze ZC!-AC'0`' �f�G�rBRgTTp�
Reviewer/Inspector Name �� Phone: /
Reviewer/Inspector Signature: Date: 3
Page 2 oj'3 L.-I 12128104 Continued

Facility Number: YERR Date of InspectionQjJ
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El other
2 L . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
eNo
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�2fNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ 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
[l 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
V(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
o
A
ElNA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
i No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12129104

Type of Visit �X Compliance Inspection Q Operation Review Q Structure Evaluation a Technical Assistance 1
Reason for Visit Routine Q Complaint a Follow up Q Referral Q Emergency Q Other ❑ Denied Access I
Date of Vklt: $ QS Arrival Time: rls Departure Time: ; a County:
Farm Name: �� Owner Email:
Owner Name: ZZ&n�� Phone:
;Flailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� �i.�i� Integrator:.c4iv4:51_5
Certified Operator:
Back-up Operator:
I.,ocation of Farm:
Operator Certification ;~lumber:
Back-up Certification Number:
Region:
Latitude: = ❑ = t Longitude: = ° 0' E]
Design Current Design Current
Swine Capacity Population Wet Poultry C4pacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1,240 So
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
b. Did the discharge reach waters of the State'' (If yes, notify DWQ)
Design Current
Capacity Population
[]_pal
Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number. of.5tructures:
d. Does discharge bypass the waste management system? (It'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 ZONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
IoNo
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NF
1212&104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �No❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: •�
Spillway?: _ Iva /Vy
Designed Freeboard (in): Jl
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
IZNo
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 ZNo ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PrNo ❑ 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 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 109% 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)
1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determinations[] Yes
ONo
❑ 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
fioc 2f mil-- 6�2 Z r�n1 NSF ,
Reviewer/Inspector Name �- - ^f -- - �- T - - `"" ` �It7"-3g
°=' Phone:
Reviewer/Inspector Signature: Date:
1212814 Continued

,1
Facility Number: Date of Inspection
Required Records &_ Documents
19, Did the Facility fail to have Certificate or Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? Iryes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility rail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problerns noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead anirnals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the tirne of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Qua[ity representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
WfNo
❑ NA
❑ NE
❑ Yes
PIN
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
/2fNE
❑ Yes VNo
❑ NA
❑ NE
❑ Yes �No
❑ NA
❑ NE
❑ Yes VNo
❑ NA
❑ NE
❑ Yes 10 No
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

— F'! •!i� :'f-••
t u .:.I. :.t ...::I:.:.'•.. u: I:: �'i.°s3 ij!��; ;:;':(#[;<. : I# •.g.::;
1. 1't {
, .::. ...i ... .,. ..... I � (� �rriF1"i.:'4'i:y'f,.
r.. ! F:.::�.,. .:.. ,. t ..�. er. ..! ... �,r:.:.... ..r ..,F•: ' '`i�. � . i . ;.�."=
,A r., 'I �:�, ... .;�,: :VLF A e .::.. .i;� :y.. `l
.. ..,..: o-� , .f, ..a.. .. � � ,3$!i'.... �. 1...-�'li..::�i�i•' tvt��:.:. .:
A.`
.{. t „r:ek� � ::.i, •' :�;1�.;
u a
r i.�.,.1 f lN1 s ..�. k.• 1 �•rf::. .. .• .: .5:.. :'1`� s:E•::' •si5...
' It :. ....,:. •. ...
li
rr .. 4. ?F..�t�t� I •. ..,IL .. 'I�L�.: �,r �r .�..:.� :�:&_'•� �n;::: i,r:?:: i�-i?r •�:;t; ;: •:
Type of Visit9Compliance inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit A!f Routine Q Complaint Q Follow up Q Emergency Notification Q Lather El Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
PermlttedXCertiiied 13 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Threshold: ........ ....
FarmName: ......63M.L, ................................................. ].......................................r.. County:......... 1,t� V....................................
Owner Name:
Phone No:
MailingAddress:................................................................».........t............................................................................................................................
Facility Contact:
Title:
Phone No:
- �n
Onsite Representative:...... ....... c S 1 zl)....................................................... Integrator:..._.... ................ .......
CertifiedOperator: ................................................... .. ..... . .......... ..... .............. . .................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle [3 Horse Latitude r' �� �« Longitude r �4 «
• r'E
Design'
1 ` {jGuirrentl �' ' ;' Design.
H'i .
'� : Current '' `' ° e .•
Design, urrent ;
C
Swine a aci
C
f:Po ulation.i; rPoultry; c
x. Cii a i
l Cattle
isPa u atioiri:'. :�..
Ca aci "Po'ulation'''
Wean to Feeder
74,
❑ Layer
I
❑Dairy
:E
eerier to FinishFlo
❑Non -La er
Non -Dairy
Farrow to Wean
❑ to FeederOther
r,
�Farrow
3 u
..
,
S
❑�il
Farrow to Finish
..T� ji �- -IHC. fl.:: yr;., it' .,
';
F�;; i
t i? ..i.... 1 ::' ` ' 'il i' Ij i3.
tg
a a
Desi n i
i
:?
❑ Gilts
ryry,' r. .It �l Ml '' y:�r:
'
gtyTotid
•C,
Boars
�'t :. ; Er
= ` ; . ='!jt bta155LW '
•!�
iNtim6i of Lagoons'�'�i..E :
. It
`E!dr•E?.li ! ..
Discharges & Stream lImea_c_ts
I . Is any discharge observed from any part of the operation?
❑ Yes 21"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 gaUrnin?
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 Be'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [INo
Waste Coilection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Rf Ro
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. I.................... _......I. ............ ...... .... ...................... .......... ................................... ..... ....»...... ............ ...t....................................
Freeboard (inches): 0 c7L3
12112103 Continued

Facility Number: 3 1 -- Date of Inspection
I ZNo5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes io
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Cj4D<
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Ld0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level M Yes Leo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 04
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes PNo/
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 01 Sw Fe SGU E CO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14, a) Does the facility lack adequate acreage for land application? ❑ Yes z
b) Does the facility need a wettable acre determination? ❑ Yes
Mvo­
c) This facility is pended for a wettable acre determination? ❑ Yes ;N7o
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Air Quality representative immediately.
&WgPS 4 kv m zrw Goo❑ SHOK,
00 04-_� L-lrA D AVv4mE%b V Er►17 To
� ����r� • Le ash At�I�EEr�1E
LgoAtcz C•Q®r ` rc—wo (��
;ary):,%R ❑ Field Copy ❑Final Notes
tJSc- 0E t;6q was &ca r�
W rrI q AYv YV 6,� t7 Nt W—r
CA Lt:m "rtz>a tb ► E DaN� t¢ Y Z�4, i ao q
»-
Reviewer/Inspector Name;~m., .xi'I�,t ::.,..
,: ii.i�xx
Reviewer/Inspector Signature: Date: 13 0
12112103 Continued

Facility Number: —1„1 Date of Inspection CI 114 (J
V
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
o
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L.Ro
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
/No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Z<O
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑Yes
Yes
,.,.,,�
t_7<o
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
LTNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
:N9
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
0 Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MIN;
32.
33.
Did the facility fail to install and maintain a rain gauge?
facility
❑ Yes
rNo
Did the fail to conduct an annual sludge survey?
❑ Yes
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit P Compliance Inspection Q Operation Review ❑ Lagoon Evaluation
Reason for Visit J6 Routine Q Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: TF
Time:
tin Below hreshol
Permitted Certified 0 Conditlonally Certified 0 Registered pate Last Operated or Above Threshold: j
Farm Name: ��LL 05-771li 1' 1 County: .91P`=7 f'j
OwnerName; "I_,4 [�5�2�J . r�R • Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _Vaillji&�
Certified Operator:
Location of Farm:
Phone No:
r
Integrator: LL LS
Operator Certification: Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 e ° 0 L° Longitude a 6 I� 96
J Wean to Feeder
Feeder to Finish
12 boo❑Non-L
�U Laver
Farrow to Wean
Other
] Farrow to Feeder
Farrow to Finish
Gilts
] Boars
No I.iouid Waste
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 dischargc is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area lU Spray Field Area
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteColl& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (incites):
❑ Yes ❑ No
❑ Yes P No
❑ Yes XNo
❑ Yes 91"No
Structure 6
05103101
Continued

1 . %
Facility Number: — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
II
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
No
(if any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8, Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
14, Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ HydrauIic Overload
❑ Yes
ZNo
12. Crop type 0
11 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 crap need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
HUuired Records,& Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ 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 ordesign?
❑ 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?
(ic/ discharge, freeboard problems, over application)
ElYes
VTNo
23. Did Rcviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
�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
gNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
S ­."RA.-Ri
Comments -(ref, io gtiestion #): Explain any YES nnswers.andlor.any, recgmmendutipits or-„anygo cr:comments ; < ;: A. _° ;;^ _?
'Use drawings of facility to better explain situations. (use additlekiikpag,yyess as�ynye�ee�ss�ay�iy}; i Field Copy Final Notes h `
.E9�
�} G�� 00tj IRr�)C►es 4I.� A66c-ffo 14R110 S1!f 77
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �-
05103101 Continued

Facility Number: 3� — Date rat' luspection
Odar Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes INO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes No
28. Is there any evidence of wind drift daring 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 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.)
Cl Yes No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
Additional omme,nts o an r' rngs: w ;r
....,v.raw
. ... ''d••.* r "t'� 'i: `t:�.'�C tea.:
A
I
QA a64ft - ��� l �,E,Q /�aD
.�lj ;fir

Facility Number I)ate of Visit: ® Time:
Q Not Operational 0 Below Threshold
)dPermitted 13 Certified '[] Conditionally Certified E] Registered Date Last Operated or Above Threshold
FarmName: ........ gil.�.... si .Lk\............................................................................ . County:.... ��.41.............................. ......................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................... ......................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ............r�...---....�.�.............................................................................. ..................................... ............... .L .._....................... ..........................
Onsite Representative: 1� .�4^!.. Integrator: .... ���D�J..................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 46 Longitude ' 4 44
Design Current Design: Current, Design Current-',.
Swine Capacity PopulationPotrcapacity ulation Catte y Capacity Popiislatian•
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrclw to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons. Subsurface Drains Present ❑ Lagunn Areu IC3.9prayFieldAreA
Holding Ponds 1 Solld.Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4No
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
e. II'discharge is observed, what is the esti[Ttated 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
0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
❑ Yes
It No
SL1'UCtUrC 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................ ...............................................................................................................
Freeboard (inches): q0 3C
5100
Continued
on back

f
Facility Number- — Date of Inspection
Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
b. Are there structures on -site which are not property addressed and/or managed through a waste management of
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify ❑WQ)
7. Do any of the structures need maintenance/improvement?
10/26/2000
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 C
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?
(icl 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?
(iel 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?
yi0lp i0s.ojr• deiFic�Oct. v► re .n. 00t fig tb s.v�s�t; Ya> ;w'iii eetriye ti hit' '0r;
comes o deike' about: this visit:
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ Yes J No
Yes ❑ No
❑ Yes VNo
❑ Yes 4 No
❑ Yes fq No
❑ Yes t "No
❑ Yes f No
❑ Yes No
❑ Yes WNo
[]Yes KNo
❑ Yes XNo
❑ Yes XNo
❑ Yes ONo
❑ Yes [ INo
❑ Yes 0 No
❑ Yes No
Cl Yes No
❑ Yes O�No
❑ Yes P4 No
Comments (refer. to question #); Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
pd,+ A Qt. tip " we—i a,,_ �• �ces1 �,. 1,,�j
V C e-" ft-14, G44 "[61
V .��Q � ��►� s ; 1 5�►��� �-- �--Pei-�,.�� �-��5 � _...
a a o►-.r
Reviewer/Inspector Name �A
Reviewer/Inspector Signature: k _ _ Date: 5/00

r _
Facility Nurnber: ' — '1 Date of Inspection printed on: 1/9/2I101
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 9Yes ❑ 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 FNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Vj 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 RNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes dNa
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 gNo
AdditionsUConarnents An or; Drawings:
5/00

d :0 Division of Soil and Water Conservation - Operation Revie►v
��0 i�vision of Soil andWater Coinservation - Compliance Inspection
. n. ivision of Water Quality
Compliance �1;nSpect7UTl � .
)i 0 Other Agency Uperation Ri view:,r k
outine _ o'm laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of inspection
Time of Inspection =44i ' 1AJ 7A hr. (hh:mm)
0 Permitted © Certified [3 Cppditionally Certified 0 Registered 113 Not O erational Date Last Operated:
Farin Name:rll'i.. �— [ ounty 1�..............1121.1�........ .... !
Owner Name: ............................................ "
ame:.................................................
........................
................................................ Phone No:.........
- ..............................................................................
Facility Contact: ...... /...... o.;s, r ......... Title Phone No: ............ -- ....... . .........................
Mailingaddress................................................................................................................................ ............................. .......................... ........ ...........
Onsite Representative: X//
... Integrator: .................. �
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude ' 1 ;4 Longitude �7 • 4 46
Design Current. Design Current ... Design Current
Swine, Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ''Total Design Capacity
❑ Gilts
t
❑ Boars Total SSLW
Number of Lagoons
Holding Pondsll Solid Traps ��
• :.
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Arcs
❑ No Liquid Waste Management System
❑ischarg & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kNo
Discharge arininatcd at: ❑ Lagoon ❑ Spray Field [:]Other
a. I! discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
K 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
N❑
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
�No
Structure I Structure 2 Structure 3 Structure 4 structurc 5
Structure 6
Identifier: (6 IA-,. ) LAB',!
00, s,
r
Freeboard{inches): ............3Z...................3V....... - ......... .......... .......... ....:.............................................. ...................................
............. .............. I.......
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
�No
seepage, ate.)"
3/23/99
Continued on hack

Facility Number: — Date of I nspection
6. Are there structure. on-s to which are not properly addressed anchor 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require main tenancelimprovement?
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 ofAver application? ___ ❑ Excessive Ponding ❑ PAN
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?
Recluired Records & Doctiments
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility tail to have all components of the Certified Animal Waste Management Plan readily available?
(iel Will', checklists, design, maps, etc,)
19, Does record keeping need improvement? (iel 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'!
(iel discharge, freeboard problems, over application)
23. Did ReviewerlInspector 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?
f tfependOO *OrLA �ipte� ¢gtring �:h�sy s}t; Yop: iij•>�0 lye no #`u�t�t�r .:
corres Qfideh&' ut. abbthis Vislt. '
❑ Yes tNo
❑ Yes
❑ Yes fo
❑ Yes § ()
❑ Yes �o�
❑ Yes )KNo
❑ Yes XNn
El Yesl,12r.14o
❑ Yes .RNG-
❑ Yes �No
❑ Yes �,En-.
❑ Yes P�,O_
❑ Yes es.@ IVY
❑ Yes g,—
❑ Yes JR•No
❑ Yes NO
❑ Yes 5410-
❑ Yes 'No
❑ Yes ® '""No
El Yes
��
Comments (refer toquestinri`#),iExplaii'any:;YES,answers atdlorany.:recommeridatiois dr'tiiny.otizer,comments .
Use;drawings off facility;to'hetter,explaineA uatians: (use'additiogtisl:pages'as'riecessary}: ,. ir;r• `,''�1 r►: r `+
r. 6z5,gn is ►�G,� 5�rvLy t'�Cvr- �y 10,411 J-- e /1 oc rt,o5 e k*ae
41,1
�F r L � �0 � �-J
j G�i �q.�c.�_ . L��a �-I `c.�+�-•� r,W�y I G �aJc� ow Cr.r,� .
Ayw/�,/
1 I
Reviewer/Inspector Name 6
i r �r.'•f �,;.f _
Reviewer/Inspector Signature: td ��ate: % fJjj/J
IV

Facility Number: — Date of Inspection
Qd6r Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead: animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes OCNo
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes rYNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �'No
6's.7/ -
fl - �"7
(�2) C
Vt ttj 'l 5
iQ-
WO
(L
00

Division of Soil andWater Conseirvation - Operation Review
Q Division of Soil and Water Conservation' - Compliance .Inspection
® Division of Water Quality.,, Compliance Inspection
© Other Agency - Operation�Review ` . r
Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection � Z
Time of Inspeclion Q l3 24 hr. (hh:mm)
01 Permitted 13 Certified 0 Conditionally Certified 0 Registered Not Operational Date I.stst Operated:
1
Farm Name: ......�.:.� �... ��S.I.!.rl..........�..�. County:.... .!l .rill ........................................................
. rr
OwnerName:........ +..�. l.t. f^""!........................... `r..'............................................... Phone 1Vn:.......................................................................................
FacilityContact: ................. ..............................................................title:................................................................ Phone No:...................................................
MailingAddress; ......................................................................................................
Onsite Representative: .... .......'.+.�. ! .................. Integrator: .G aura 1 r s...... ... .................. ...........................
........-r..S�..:?'T.! �................................... ...... 1, ....{..
Certified Operator:
Location of Farm:
Operator Certification Number-.
Latitude ' 6 :i Longitude • 6 64
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
91 Feeder to Finish
30y-p
Z p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gills.
❑ Boars
Design Current Design Current
Poultry. € elipacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
t
❑ other
Total Design Capacity
Total SSLW
�,''Niumbeir of Lagoons 10 Subsurface Drains Present ❑Lagoon Area IS Spray Field Area
Holding'Ponds 1 Solid Traps n . ❑ 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?
h. 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 gallmin?
d. Does discharge bypass a lagoon system? (If ycs, 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 ] Structure 2 Structure 3 Structure a
Identifier: 01 A M Q 1
Freeboard (inches): 35 3
r
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
"I14
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes ® No
Continued on back

Facility umber: -3( —4f 36 Date of inspection
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?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Ar)nlication
10. Are there any buffers that need main tenancelimprovement'?
11. Is there evidence of over application'? ❑ Excessive Ponding El PAN
12. Crop type Cdn>n , W L,eeH , Sc4 ben 1�5 , Ta be cC a
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'?
lb. 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?
(icl WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel 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?
(icl 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?
a violA E911s •a- 0 ficie'noes -"re p004• ootl ig 4bis* visit; :YOO will •rebeiye ijQ flitthO
co, fires• 6 ideirce' about: this 'visit.'
❑ Yes 19 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
X Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes 21 No
❑ Yes J9 No
❑ Yes ® No
❑ Yes Jj� No
Conin.ii* (refer fu.guestinn #):: Explain any YES`answers and/or any'recommendations ot< any other comments:
Use drawings of futility to'hetter:'explaiinsituuations.' (weaddiitional pages Ias necessary):
dvcvey 1iG�t410V, of1 i�7.0 16S CNI ( lOl lnt Gdrrt Clear Oki PVit 1r
g. rek,- ,rX .Z
�1�lZ`2 far r'eco o(e_A roll 19 c'S 11AViry 2 5 tj�c.r r r , 6v4 ,AS4e P1,n
Aeaslo,x 1 s4- Full 19 Z. LCV-rS, -TL
Pnr-}•ty resol4et-A trt UtiEY Ct1 1 r■ i�L lOY1 M" ke Tvee 4nl"4 QC_Ci-1 jcs 4,n TW'21f
^'+ct �C1� Iry�eer,�.f in wAsFe plan / , rrr'9o��r'p►'► r�es�`9n for ear+, Pull.
rtrw. si-�e i5 ih rood C.and��ier�i i�r. Ge5.4in Q6viotft�y �kcs Pry=oil
ReviewerlInspector Name it ,'
S o inGW�i'f „L ' {
61`''i�• Do
ejr;,,2v3 i
Reviewer/Inspector Signature:
Date: 1-2-1 z
lei et
3/23/99

FacilityOumber: 31 --470I Date ref nspeetion 1 Z
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Vi 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
CR No
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
® No
Additional Comments and/orDrawings:
3/23/99

01[] Division of Soil and Water Conservation ❑ Other Agency
H .,.i:
El
Division of Water Quality
Routine Q Com lain( O FolloH-u of DW ins ection Q Follow-up_of DSWC review 0 Dther
Date of Inspection Sr Q
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered IM Certified [] Applied forPermit© Permitted 0 Nnt O erational Date bast Operated:
FarmName:...........i.�,�......... �1"1t�............ t::P nx�-s............. County:.... In ..................... .................... ... ....................
OwnerName: .............. ........ I .... .......�S,t►�,....�..�.]1C,.............................
Facility Contact:
Title:
Mailing Address; _.3'..14..........Ual.wk ....,..9l:.................... .. ' .
.....................
Onsite Representative+:'..,...N.4.+...........
CerrtiCed Operator;,,, S S �
.......I�.t'�. is ....... � ,Tr :.........................
Location of Farm:
Phone No:...... ?.E�Q �..�i ��......................... I ....... .,. —
Phone No:
............NLI..................................... . 7�4.$�.,....
r I, "
Integrator ...........i-,.�4.Y.Yal fs....................................................
Operator Certification Number;,..,., , .4�, �=,..........
Latitude 0. 4 ®4a Longitude ®• ` ®"
'gR: i ' ' ..:..nrren sign Current Design : Current
Swine "',.; Cn acit Po ulation Poult Capacity Po ulation Cattle
p Y" .. p rY P Y p Capacity . Prspulatian
Oil Wean to Feeder
Layer ❑ Dairy
Feeder to Finish I0 Non -Layer 1 ❑ Non-Dairy
El Farrow to Wean
1 ❑ Other
El Farrow to Feeder
❑ Farrow to Finish ' Total'DeM n'Capacity,`
❑ Gilts
❑ Boars . TotaI.SSLW
.. ... _. .. .... S: ... ...,
"`: Number of L goons'°I.Holdin7g Ponds z i Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Luid Waste Management S stem
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes MNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Q1 No
c. If discharge is observed, what is the estimated flow in gaVmin? Al IN
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes N No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 151 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 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 ( No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number, 3
8.
Are there lagoons or storage ponds on site which need to be properly closed'?
❑ Yeti
No
Structures il,ay;oons,llolding fonds. Flush flits, et�j
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure. 3 Structure 4 Structure 5
Structure
6
Identifier: ti 8 -
e........................t............................................................................................................,...........I.........................................
Freeboard (ft): ............2.`.0.. ........................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yeti
No
l [.
Is erasion, or any onher threats to the integrity of any of'the structures observed?
❑ Yes
No
12,
Do any of the structures need maintt n;tncelimprovemcnt?
Yes
❑ Net
(If any or 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 maxintum liquid level markers'?
❑ Yes
No
Waste Application
,
14.
Is there physical evidence of over application? f
❑ Yes
P No
(If in excess of WMP, or runoff entering; waters ofthe State, notify DWQ)
15.
Crop type..........LDf.V\.............. dJ k................!S[,. �zk .:..... I ...... I ....... .
16.
Do the receiving crops differ with those designated in the Animal Waste Management Phan (AWM11)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yeti
,No
18.
Does the receiving crop need improvement?
❑ Yes
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?
J
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
No
Eor Certified or Pennitted Facilities only
_
23.
Does the facility fail to have a copy of the Animal Waste Manztgetnent 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
0 No violations or deficiencies were note'd-during this. visit. ,You.wi11 receive no further
correspntidence 0o4t this.visit:
Gotntnents,(refer to question #} Explain any YES answers and/or ariy recommendations or any uther'citnmentsi i'";i;„:P i';
U�6 drawin s'nf fucilit 'tp bitter explain u o ( t : g vsit ati . ns. use additi seal pages as nL'L'eSSarV
ee. ..- .] .. , .. I}
Cr0ScoK ewrc.S On i nvujr JikL, a� did �c�t3ffh sWd L, 4,-1W w 1fk t
PP
RS
4 7 A a�
OtAn
Si �" Vj� ar
Z�� I� rint`Sl+il �i✓[ CQ►+��pi+ta U Cdl �"it�
tic
a rrri i S
� 0
�O k 5k; IT
fa.vt~. EaD-S Yo -
7/25/97
Reviewerllnspector Name A.
Reviewer/inspector Signature: ,r„5 J f 1AIn, Date: SfZy�q�'

LM
DSWC Animal Feedlot Operation Review
, DWQ Animal Feedlot Operation Site Inspection4-1
10 Routine 0 Complaint 0 Follow-u t of Moinspection 0 Follow-u of DS%VC review 0 other
Date of Inspection to -7
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered P Certified 0 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
Facto Name:.... �en............0........ ....... �.r.........rrGYilltr.... County; ..... ]lpi■....................
.....................
Owner Name: ...... W.A.ki r&........�'h!s.....r...l!=........................................................ Phone No:.... ................................
Facility Contact: ..... �.�:fiyxYl....,.. ,. A ....r...J r............ Title:.........DL,)fx.......................................... Phone No:.� 14�... .� 3...........
INlaiting Addre.ss:....31z........... V ......... ..................................................... ..... Nfc.l iujo..... N L............................................. .a.-9.X........
vttsite Represent:tti►e:.`.-.I'Vi�.�.il l+7......l�yQ.Sr.!....5�r!............................................ intcl;r:stE►r:...... 1tt Q..I..................
.......... ............. .................
Certified Operator :....... lN.dix'ldt"........ J.r p r ....... ................... Operator Certification Number .........................................
Location of Farm:
rr: .. ran....... .. ( 3 .� Cpxm .........-F.. .
Latitude ' 1 4� Longitude 0. 0' it
Current
ropuuttton
❑ Wean to Feeder
50 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
---------------------
Ih:sign. Current
Poultry Capacity Population
Layer
❑ Non -Layer
Cattle Capacity Population
❑ Dairy I �d
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
_=:'''Number of Lagoons 1 Holding Ponds Subsurface Drains Present ❑ Lagoon Area spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need cnaintenancelimproventem?
❑ Yes
A No
2. Is any discharge observed from any part of (lie operation!
❑ Yes
® No
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharg,c is observed, dill it reach Surface Water? (ll'yvs. notify Ili' Q)
❑ Yes
[A No
c. [1'discharge is observed, what is the estimated flow ift gallmin?
A
d. Does discharge bypass a lagoon system? df 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. Ones any part of the waste management system (other than lagoonslholding ponds) require
❑ Yes
[KNo
rttaintenanceli mprove ment'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
® No
7. Did the facility fail la have a certified operator in responsible charge?
❑ Yes
to No
7/25/97
Continued on buck

r. r
Facility Number: 3
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
EffNo
Structures La goon~ 11oldin Ponds F ittsh fits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JN No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: L iaO."
...............
Freeboard(f t):................................. ............................................................................,....................,..............................-....,....,....
10.
Is seepage observed from any of the structures'?
❑ Yes
JS No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
K 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 ❑WQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
CKNo
LVaste_ Application
14.
Is there physical evidence of over application?
❑ Yes
04 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............................ ia1j"LLx.�............ ....... cam .... ............... ..---.............................................. :.....-..............
.........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
,® No
18.
Does the receiving crop need improvement?
❑ Yes
I&No
19.
Is there a lack of available waste application equipment?
❑ Yes
KNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -Site representative?
❑ Yes
No
22.
Does record keeping need improvement?
[9Yes
❑ No
For Certified or Permitted Facilities Onl_x
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
1,5d No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
PL.No-violaitions or def dertcies were noted during this'visit.- .You will receive no further
carrespondebu about this'visit:
Coinments (kfer to question #.): Explain any YES answers andldr, any': recommen'dations or. any other comments.
'e"arawin s :. of fa ility tobetter eiiplain:situations. (use tadditional:pages as nec4 sae
.
.::Y ................. g
........
Iz. ' n, atkJ; [4 wpm of I &5,w #I !4vulJ 6ovw J. Eros , or, ere& o4mtno I n 0 lac �e Sy)V()(d `
toe- P Q ��w i �k G& 1aJ YI'fSt✓ AJ, r& l-c S P4S Of6 1L 110�ScOhS fS�np cl0 sae mec d ed•
zZ-U�,hw trill 50,Mn b Gcl'>QI`1�S i5� SptoA LIn ttYti Ae+ Pfkh, y-aloe I 1a�co(x IYj Silk!
Y
7/25/97
.....:......:......:: i......,:.. i. .. �. .-.... -. ... .... ........ ...... .. ...., µ...... .... .... ......
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,,;��. .,, �� ,rl � Date: 1012-1 Ag I