310475_INSPECTIONS_20171231

NURTH CAROLINA
Department of Environmental Qua!

Date of Visit: Arrival Time: ,vc Departure Time: ► County: ! r•1 Region:
Farm Name: j�G�Gfg. 41 vWd t4)s F;v-ems 164-7 -- Owner Email:
Owner Name: _ 45, .&"SSG Phone: RECEIVED/NCDENR/M
Mailing Address: _ _AAR-3-412
Physical Address:
Facility Contact: S pia �� G-.a ✓C4 r `^ Title: MMM oneons Regiona{l Office
Onsite Representative: Integrator:
Certified Operator: �L `5�` 4W (0-L
Back-up Operator:
Location of Farm: Latitude:
Certification Number: ""` d�
Certification Number:
Longitude:
!Design
Design
Curr�eni
CurrentHamm
C�rent
Design
Swine
Capacity
Pop.
Wet Poultry
Capacity
Plop.
Cattle
Capacity
P�O�p.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Eby
(Flo
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
lh. 1',oulta
Ca aci
I'o .
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [E No ❑ NA F] NE
❑ Yes ❑ No C:f-NA ❑ NE
❑ Yes ❑ No ❑'KA ❑ NE
❑ Yes ❑ No
❑ Yes �o
❑ Yes f] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acuity Number: 31 - Lf7.$ Date of Inspection: a_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Zpkr---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No [b-4 ❑ 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 ED W ❑ 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
-[T No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[T] N
❑ 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
[ 1q-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. E] Yes I34o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy 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
-_`, :S
12. Crop Type(s): _ _ _ �lJ VAA4 6 Y
U � t
13. Soil Type(s): ( C,.0 OcUr
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
0 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-into
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a-N-o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
❑-Iq-(-)
❑ 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
[2-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail -to install and maintain a rain gauge?
❑ Yes
[!fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili 'Number: -q7S jDateof Inspection: 4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-N—o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [D-N6 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 0-1qo_ [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3"lq-o E] 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
E] N
❑ 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
[�]'I Igo
❑ 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
❑-I1_o_
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3'IQo
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
©'go
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E! f:No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
n ariv,V C•Aiicwarc sindMr.:arik
[(,
o 1-A W-1s4t: 617 C�`
3p�-Egs c
Q{�1 .C) Phone: 10- 13--3.] `l
< Date: L( I
21412015

t ype of v istt: Ap t ompuance inspection v vperauon tteview V ntructure r.vaivanon V i ecnntcai Assistance
Reason for Visit: JErlkoutine O Complaint O Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: (L Z Z Arrival Time: I Y.'O d Departure Time: County: j� Region: C_4,jZ&
Farm Name: &=r L >- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Toe L -ram
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design C►urrent
Swine C*apacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
C►ettle
Dairy Cow
Design
C*apacity
Current
Pop.
Wean to Feeder
]Non -Layer
Ell
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,Ouit ,
Layers
Design Current
Ca aci P.o P.
Dry Cow
NonmDairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Tarkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 5'No ❑ NA ❑ NE
❑ Yes -EfrTlo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes -Er'No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E j-No
[:]Yes E�-No
❑ Yes D-lqo
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 3 1 - 4 f r` Date of Inspection: Z
Waste Collection & Treatment
4. Is storage cap6k.ity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [TNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 520
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C:jNo ❑ 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 2-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
T Do any of the structures need maintenance or improvement? ❑ Yes 12 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E:J No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA
❑ NE
FNo
❑ 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? D Yes ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VT 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? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
T�IVo
❑ 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
ZNo
D NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
VNo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facilitAout of compliance with permit conditions related to sludge? If yes, check 0 Yes C2rNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes pr& 0
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comm6ts (refer W4:deiti6fiV).&Mp'lain any;YES�answers;ai t
1t y SgA.jt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑ Yes PfNo ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
[] Yes VfNo ❑ NA ❑ NE
❑ Yes p4No ❑ NA ❑ NE
❑ Yes d o
❑ Yes VNo
❑ Yes YNo
ct r U� n pouf s
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
Phone: ,`73&-7�
Date: 2 2Z
2/4/ 015

Type of Visit: AirCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Okoutine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied,Access
Date of Visit: Arrival Time: all Departure Time: " 0 M County: —'Region:
Farm Name: R-ee4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
Certified Operator: I '
—�-TT
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
NA
Design Current
Wet Poultry Capacity Pop.
Layer
: 'Dairy
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder'
Farrow to Finish,''f
Design Current
Dr, P,ouItr. C•.a aci P,o
La ers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
,
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
JZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9
jNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

# q_6, I
Facili Number: Lol s Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
,E!1'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L 4--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2rNo
❑ 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
VfNo
❑ 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 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
ZN
❑ 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 FZrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes 0"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZO'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
V No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available7 if yes, check
❑ Yes
2�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
[DNA
❑ 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
ZrNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J?fNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility umber: jDate of Inspection: ,
-
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes X 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 boxes) beiow,
❑ 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 PRiNo ❑ 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 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:
7�
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes OP
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes VNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F o ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or an other comments.
Use drawings of facility to better explain situations (use additional pages as necessary}.
Reviewer/inspector Name: Phone:
Reviewer/inspector Signature: Date:
Page 3 of 3 21412014

Date of Visit: ® Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 14 " �` Integrator:
41
Certified Operator: 15o4 .SLAkr Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current Design
Current
Swine Capacity Pop.
Wet Poultry C+apacity Pop. Cattle Capacity
Pop.
Wean to Finish
La er IDairy Cow
Non -La er I Dai Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
22 Cow
Farrow to Feeder
P,oultr, C•_a aci P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
I
113cef Feeder
Boars
Pullets
IBeef Brood Caw
Turkeys
Qther
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes FTNo
❑ Yes 21'No
❑NA ❑NE
❑NA [3 NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: P31 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
St ru t e 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
D 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 r] 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 27No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes 2�"No
C] 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
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes en No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L3'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [21No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. D Yes ErNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 211 0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;;5 No 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 to provide documentation of an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes Or No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z 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
;Z 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
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
JZ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pagesasnecessary).
i h C�
lL _
Reviewer/Inspector Name: �M� 1� Phone:
Reviewer/Inspector Signature: _ Date: 5 '
Page 3 of 3 21412011

3
Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: VRoutine O Complaint O Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: �t-""-J Arrival Time: Departure Time: County: County: u �� Region:
-t'
Farm Name: �-�A- Mr= gbot a S f--Aam $ ! 4 of Owner Email:
Owner Name: CUFt&% - • � ` IC— Phone:
Mailing Address:
Physical Address:
5TA� + '�S00.4NcN_�W VS-EuGAv,LLr _NC &?31
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design C►urrent
Swine Capacity Pop. Wet Poultry Capacity Pap. Cattle C►apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
1p
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Iggsign Current
Dr. P.ouItr.., Ca aci P.o ,
D Cow
Non -Dairy
Farrow to Finish
ILavers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �( No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facisli Number: jDate of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tN
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yeso ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 'I P
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): tQ Co
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ANo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes )�No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? )A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): SG it P-)
13, Soil Type(s): 6 U 1 Lt-E (t v24C70L_L4,3
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 o
❑ 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 X No
❑ NA
❑ NE
the appropriate box.
[]WUP OChecklists Q Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes - No ❑ NA ❑ NE
E] Waste Application [3 Weekly Freeboard [•] Waste Analysis ❑ Soil Analysis ❑ W,&e Transfers 0 Weather Code
[] Rainfall ❑ Stocking II/Op Yield [] 120 Minute Inspections E] Monthly and V Rainfall (Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: Z 1 - Date of Inspection: V1 t'
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 f
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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
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? ❑ 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 kNo ❑ 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 ex lain situations (use additional pages as necessary).
cw.A• I
ail rt- 3.3 a �
iresl�I�� 1 S ��` •
❑ Yes MNo ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes 1p No
❑NA ❑NE
❑NA ❑NE
❑ Yes �p No ❑ NA ❑ NE
10,96/7 9.3 '�)-3
(,•NC-aj-�, C,? for ao19 (31 C.c4(Q�+PA L4�-6caKbI _ LA-VLL C-1c-
1M.S 0 tMFI)C�-SWLr 01CACT/U(
Reviewer/Inspector Name: Ammtfw Cq/ E S Phone: 216 11(0 43 91
Reviewer/Inspector Signature: GU/7V::> Date: f (zo[
Page 3 of 3 2/4/2011

Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: NLRoutine O Complaint O Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: V66Zc a ADCx�S j7AGLMS 14 Q Owner Email:
Owner Name: y-c�C Ire S E z aLkS r_' Phone: 1 is — Q �9 _3 S y 3
Mailing Address: SS MNU4 &E W-QU 1 LLB %UC
Physical Address:
Facility Contact:
Title:
Onsite Representative: Y'0'i &La Sw I T It Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
VI'et Poultry
C•apacii
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
-pni Cow
Farrow to Feeder
Dr, PYoultr,
Ca aci
Peo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on —Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Pouets
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page l of 3 21412011 Continued

Ftacili Number: 1 - L-J S Date of Ins ection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Suture 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 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? T�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application 1
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes hhJ No ❑ NA ❑ NE
maintenance or improvement? 77��
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground [3Heavy 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): ) )tom
13. Soil Type(s): AA 7 u 1 c_t F C Td Lc t S V JV
14. Do the receiving crops differ rom those designated in the CAWMP?
❑ Yes
No
�C
❑ 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
JkNo
❑ NA
❑ NE
the appropriate box.
QWUP []Checklists []Design [] Maps []Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f�5No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis G Soil Analysis ❑ W/ste Transfers
❑ Rainfall ❑ Stocking ❑ �op Yield ❑ 120 Minute Inspections Q Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
[] Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Acility 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VkNo
❑ 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
jj No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
i�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 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
V1No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Efo
❑ 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). ~. ;
,c �? - J)Nz T p►�r+�i� '3131/ 1 t S rr - '/o
A-C.0ugCF d F SAM?CS CRLC_ Foi_ MGfL& TOAN"� O F_ c-1 0,&E
LOOK-INTO A ?t c- K� '3oM E u M r
w. A. r d
�f��lld 6.S . I
�1MS y-©1C�f�G?Ic��
Pcc.l,'((r 64-CT l9-9-9, `b� 1C_��- UPDA7r= iRR-QS wow WEc, W,j4. AafUV6P
r-6.EC' w��>�I1'�� O N C(w1',om1Ak& AS X&OL&N D L �Ac �n��— �3t�c; �r�+ �MPKOUEt�
g AOIC f -0 0r_/,x/r "T_rE f?-
Fecw j- 1L r (;: L a 5 NEED PrL,1 TTL& V-" 66n C0N 1 " Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/loll

Type of Visit ix,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit N� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: w yb " U Arrival Time: �0 Departure Time: County: t-f Region:
Farm Name: 2=67C� l t IC''ia�oW� 1`f�� �� l�at Owner Email: p
Owner Name: Zuqus' 1`�I,-�S� Phone:
Mailing Address: NCN P_d e C—LkL61. i LLr /U C QRS
Physical Address:
Facility Contact: Title:
/
Onsite Representative: .�o G� rV l
Certified Operator: vN L. L- r Fi?—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
toorope`ratCertification Number: 1 �
Sack -up Certification Number:
Latitude: = 0 = Longitude: 0 ° = ` ❑
Design Current
Design Current
Design Current
Swine Capacity .Population
Wet Pou75—a c I NVA Population
C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑ Dairy Calf
Feeder to Finish
(ag
E]_Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑Non -La Non -Layers
❑ Pullets
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
❑Gilts
El Boars
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other I I
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 ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �(No ❑ NA ❑ NE
❑ Yes ;allo ❑ NA ❑ NE
12128104 Continued

Faty Number: — rj
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I of
Spillway?: a
Designed Freeboard (in): f,
Observed Freeboard (in): z-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes $No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes
XNo
,No
El NA
El NE
El Yes
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑YesNo El NA [3 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes *No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) sG &_(46?)
t3. Soil type(s) y(A7(,t1U1L.LC-
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
;�o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations
or any other: comments f
Use drawings
of facility to
befter explain situations..(use additidnaik,pages^:as necessary):+
_
�, .. ', v�;
,I;.�-. ¢ a:�i6r ��..a�.
//��
W . 4 '
P_e l
{�(j
Q"_"
•
5/1gjxf
3. C =-- >
3. 1
a/l(Of o
I.5
). y
111951bq
/ V
i, 3
'gpv-�
1, 4
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

i
Facility Number: — LP Date of Inspection !0 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
0 WUP El Checklists El Design (] Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis [l Soil Analysis ❑ Waste Transfers ❑ An/lual Certification
0 Rainfall ❑ Stocking ❑dop Yield [3 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
oElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes�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
No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yesf
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�Wo
❑ NA
❑ NE
A. dditional Comments and/or -Drawings s �, , ", ;z•t� � 's �' . t t . � f � # f��
wa¢Xl,v6 OR R_0516AI 5 e07S O IV
�T TUS act ► �R 1
QPDHTf ?iAm plAC - )j�Cgo ?P V7-E R OU 1
j (ZQoK_&^/ - cjq LoINC C fLC;5 JOA1 - P(-cASe PIX
I 1 01 1c �-r Gc.C)S
Page 3 of 3 12128104

Type of Visit tDkCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit `Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 4 � Arrival Time: ® Departure Time: n� County: L N Region:
Farm Name: E.E•Q/� ! 'rlE�(LJ- -��,�g ��iCZ f� g °E o� Owner Email:
Owner Name: Phone:
Mailing Address: 1LIPs8 PAsT(Ak�__ Q,2AivC„y -GZd G—cticAUlr1.E �C S
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 i = Longitude: = o = t = 4i
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
C•apy Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish
(q
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
❑ NE
Discharge originated at: El 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
1No
❑ NA
El NE
other than from a discharge?
Page 1 of 3
12128104
Continued

acility Number: — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N 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: Q
Spillway?: p
Designed Freeboard (in): 19. S
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes *o ❑ NA ❑ NE
(ic/ 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 W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D§No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S G Let 6
nn)
13. Soil type(s)
I uc—: YAC-70
oU
14. Do the receiving crops diffff er from those designated in the CAWMP?
❑Yes
kNo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONO
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] yes
[� No
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
t8. Is there a lack of properly operating waste application equipment?
❑ Yes
ONO
❑NA ❑NE
El NA ❑NE
El NA El NE
[I NA ❑NE
❑NA El NE
C{apmments¢�{re%r�ytaueshon#)ggj Exlplain anly"p��YalvS answeyr�s a,n�d�/or any re�cypmmen�dyations or any other comments.
U,((sI��e,,,vadrawengsiof f,yacyf�iyty�to better�exppl�ain ¢syitu7ation_s(puse�addittonal pages a_s necess�a4ry);;
(A013
191IDg I,�
Reviewer/Inspector Name �' )N ES' Phone:
Reviewer/Inspector Signature: Date: /09
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. El WUP 0 Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ /aste Transfers
❑/nnual Certification
❑ Rainfall ❑ Stocking ❑ /op Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections 0
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
[XNo
❑ NA ❑ NE
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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ( No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
A Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
0 NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
Cl Yes
P�No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
Additional Comments and/or Drawings: .
ASCa u ouT o 1C. Zest6NAT1on!
1 q . No cvtE C'-�Q��m i w j �. cc�R-DS - W ILL
wj mE Never wCC)k
VAULC,fi IM.Paoucp �, K��.p IT ulp.4`
snip L�L SPA) dW gAeK-5106 a F c,4GOo/v I ^
. i-Cyjs E IS ac)1 NC; To u 50rv- E- 361b C� N THE AjzFA
sood
Page 3 of 3 12128104

Division of water Quality
FactlityAumber ��S 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 4
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
ORoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ""µ= Arrival Time: ® Departure Time: County: "kpRegion:
Farm Name:
OwnerName: � G LxS -GL SF —
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 i �;
Certified Operator: N Lk rr R
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: 1-�y1 `4
Back-up Certification Number:
Latitude: = o = d Longitude: = ° = 6
Design Current Design.. Current Design Current.
Swine Capacity Population' Wet Poultry Capacity Population Cattle Capacity :Population
L❑ Wean to Finish_
❑ Wean to Feeder
Feeder to Finish (09
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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?
❑
Daia Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

1r
Facility Number: —
Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: � ( —H Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): VQ p�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Z No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? XYes ElNo ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [I 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 E] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
)qYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
go No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ 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)::.. `
GET bee4l I-AG0a/V
Se41W SOME t�tRJ 7a t-ILuw- ou.r- 0014 (ac P12- c0m"V6 FQc�an
N�Eh ro Mow P CkS[ - aF \K�wGL 4-6-M�'UF_ SM-1Urr
e 9-Q51Qnlpy 64Cr-.S r= o� jff�5 r-
Reviewer/Inspector Name I R C t A G R.Phone: Cj/� ip— 3 d7
Reviewer/Inspector Signature: Date: &
Page 2 of 12128104 Continued

1
L
Facility Number:—W51Date of Inspection `(Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [I Design El Maps El Other
A Yes
❑ No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1�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 Codc
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
'VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ 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
qNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )n No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
44 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
ONo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
26 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
4No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
. CCWT'D
NGrcl'�' rtC�h Ion
x( VAA ,I✓ 5 (' - I a A( r et�'
M p W t X 6 7n ALL© L►, ] g s�M DrQ
6 e-7 c) F CrJG
Co coPc� GF Av6l A&AN41- 570C-Vft//('
50-kW-AS we_o � u� �� C� 3.5�
5t✓LLIDGI<SUtU6 AN(TyEF- 7�t
EF ?Hr4 WA S A PxQBLi; #A, 6 AHL� OF- '7Hf ,DA:7*
w
Page 3 of 3 1Z28/04

• 7 ivision. of Water Quality
Facility Number �� 0 Division of Soil and Water Conservation I
0 Other Agency
Type of Visit )oTompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit I•Routine 0 Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 6 a Arrival Timis; Departure Time: County: Region:1AP,*
Ar
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ew
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
PI ne No:
Integrator
Operator Cert ication Number:
Back-up Certification Number:
Latitude: 0 0 = i = Longitude: = o = t =
Design Current:. Design Current Design Curre
Swine Capacity Population Wet Poultry Capacity Populati06 Cattle .Capacity :`Populat
❑ Wean to Finish ❑ Layer
El Wean to Feeder ❑ Non -Layer ry
eeder to Finish _-
❑ Farrow to Wean
u rarruw Lu reeucr
❑ Farrow to Finish
❑ Gilts
❑ Boars
,Other
❑ Other- - - — - - - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
[IT rkePoults
❑ 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?
Dai Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
'.I
❑ Yes G No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
El Yes
❑No
❑ Yes
�a`No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

,jFacilir'y Number — Date of Inspection i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �L7=
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
ElNA ElNE
(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
jP'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
fL] 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 ElNA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Winfiiq)v 0 Evidenge of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
R,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;2No
❑ NA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ;Z 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):
A,
Reviewer/inspector Name _ Phone:
Reviewer/Inspector Signature: Date: / d
Page 2 of 3 12MI04" Continued

S
)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 13'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 rainbreakers on irrigation equipment?
V- 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 review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
21,4o
❑ NA
❑ NE
❑Yes
ZNo
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
;5'No
❑ NA
Of
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
[,-j No
❑ NA
❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
2jNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�I//o( lr d eh G.5
u
3fa
S'Ioa e
311106 'H611-
a�6 . �P�e
lee/ S
z , ee 3-cr re
Page 3 of 3 12128104

Type of Visit 2f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: o� % Arrival Time: Q�� (J Departure Time: L� County: 11A Region: 1(44
Farm Name: �✓ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 16s zaje
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:!!"'" 1�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I ❑di Longitude: 0 0 = 4 =
Design Current Design Current
Capacity Population Wet Poultry . Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
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 J2'No ❑ NA ❑ NE
❑ Yes
J2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
EfNo
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
12128104 Continued

`z Number:73 —V7 Date or Inspection
ollection & 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 ,Q No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ILL -
Observed Freeboard (in):y 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Jallo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Z 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 _2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J' No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes ,ONo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes P`No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? '
❑ Yes .0"1Vo
❑ NA
[:1 NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes E]'No
❑ NA
❑ NE
. r:�':,.,.:_M ... .: i:• .. $:'s.�� .�; ',�� e, . � :��M, ��. i ��or „�,f ':'ivw.,x:� "s„"v31� �€ :r�R.II',:n�rra9k' Snls=;�^�Ffi
.u%�ti�i�3��.i:C:��191��i�Y�t"
P/use lo,6,IV G A,11 /Peel's GS GcIOO
�vc�! hd�G On!� o� l�ovrs i "All
lP�ri/Ir
%,c Idf hQo,-G .r,„ eG /G3 7 r Pce
Reviewer?lnspector Name Phone:
�s r.
Reviewer/Inspector Signature: Date:
1212814 Continued

iicility.Number: 3/ —V% Date of Inspection E7tt_
RemMed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /In No ❑ NA [:IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .AENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑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?
❑ Yes
P 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
F-1 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZI 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 ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Z 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 J2 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 RNo
❑ 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 ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 'zNo
❑ NA
❑ NE
4.+Add�t�onul Comments;and/or=Drawi g!
.d k1 .
'�t3) ?Ump
nk-e-ds r-clIA1P(ec'
12128104

Type of Visit VICompliance Inspection O Operation Review Q lagoon Evaluation
Reason for Visit .l Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberJDate of visit: % O Tune: / : D o
Q Not Operational 0 Below Threshold
13 Permitted Q Certified 0 Con76.2k,&,tis
'onlly Certified [3 Registered Date -Last Opera or Above Threshold,
Farm Name: ... C[(rS�.l..'�4aC ....»l. �. _'_....... County:.... �� ».»..........»..»......» ..»............. _ .
do
Owner Name: __ _ _.__ .........._._._ . .».
Mailing Address:
Phone No:
Facility Contact: » ... _._._.___. ....... Title:Phone No: _ _....... .. _ .... _ ._ .
..�..__._._Onsite Representative Integrator: .............»..... _..._._..
»
Certified O erator: _._ _»...__. Operator Certification Number:_.__.----___
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • ' «
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any'adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes I;PNo
Structure 1 Stru 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ......_.._�... ....._.. _.. .__ ... _ ... »» . _ .__.._. »...»» .»» .....»» . ». ..»»...»» »................._..._.._...........
Freeboard (inches): Off«
12112103 Continued

Faculty Number: — Date of Inspection V jy
5.Axe there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ElYes ,0'OFNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �j 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 allo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QNo
9. Do any stuctures lack adequate, gauged markers with re4uired maximum and minimum liquid level ❑ Yes ;2-Ko
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes "Oto
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �filo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type i/y!/ii2L'aA, / ' J
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Lssues
17, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
/S-) 5"rm' ui
cel,
ReviewerAnspector Name ''
ReviewerAnspector Signature:
Field
❑ Yes ,_No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes 7 o
;ayes AINo
❑ Yes ;:Wo
❑ Yes ,ETNo
❑ Yes _,ETNo
❑ Yes EfNo
❑ Yes P'No
)py ❑ Final Notes
Date: l;
1 arurur �.urusacuxrs

Facility Number: Date of Inspection .x d
y7 _
iGguired Records &_Doc_u_ments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPI)ES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ZNo
❑ Yes "RNO
❑ Yes Jallo
❑ Yes ONo
❑ Yes 20140
❑ Yes ,ZrNo
❑ Yes fNo
❑ Yes B'N' o
❑ Yes ;INo
Y
Ofes ❑ No
❑ Yes ❑ No
❑ Yes EFNo
❑ Yes VNo
❑ Yes -AMo
❑ Yes PXo
12112103

f ( Y
M
Type of Visit /— Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Emergency I
Facility Number Date of Visit:
[] Permitted 0 C rtitied 0 Conditionally Certified [3Registered
Farm Name:
Owner Name: u5�
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
0 Other ❑ Denied Access
Time:
Not O erational 013elowThreshold
Date Last Operate r Above Threshold:
County: GZN —
Phone No:
Phone No:
Integrator:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 64 Longitude 0 6 Du
Design Current Design Current Design Current.;,..
Swine Capacity Population Poultry Capacity Pooulation Cattle Cavacitv Po tilation
❑ Wean to Feeder I I I JEJ Layer I I JEI Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Discharges & Stream fmoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes Z�lNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
JNo
❑ Yes
PrNo
❑ Yes
7No
Structure 6
Continued

Facility Number: — Date of Inspection D?�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
`II
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
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
PfYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Xyes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
A No
Waste Application
10. Are there any buffers that need maintenance/improvcment?
❑ Yes
;KfNo
11. Is there evidence of over applicatio ? Excessive Ponding ❑ PAN ❑ H raulic Overload
ElYes
�(No
12. Crop type ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
/E�No
Required Records & D2cpments
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?
(ie/ WLJP, checklists, design, maps, etc.)
El Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
'No
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?
�idCr
❑ Yes
(ie/ discharge, freeboard problems, over application)
�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
24. Does facility require a follow-up visit by same agency?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments r :� o
( efer,to questidn #) Explain any YES.answers and/or`any recommendations oFtny pth.er comments
y.pages arY) �'a
Usetdrawia 's of facilit to better ea lain situations use additional sr.• ❑ Final
.field COPY Notes
.�
Mew C /E/�,1'� % �9t3 moo.✓ '�Z , �0�4 Lo�� SF t .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: D
05103101 Continued

Facility Number: 31 — L Date of Inspection
Odor law
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes XNO
❑ Yes V No
❑ Yes ANo
❑ Yes
ElYes ;dNO
❑ No
Additional Comments and/or'pcawings ; .�� , ; :;
I,� 14 �/
�
4e'Florz-y
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y
05103101
tc
7.

Type of Visit Q'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Cr6ther ❑ Denied Aocess
Facility Number ! $
Date of Visit: 1 ! 1 0 Time:
Not Operational Q Below Threshold
Permitted © Certified © Conditionally Certified E3 Re)gistered Date Last Operated or Above Threshold :.........................
Farm Name:...........���....eQ'GJOI"�....°!✓!^^� 1.....�........ County: ..sir,,,,,�i�........................................................
OwnerName:............. v:� V.s...... a`..:. ,t:'.��........................................................... Phone No:.............................................................................. ..
FacilityContact:.............................................................................. Title:.....................................................,.......... Phone No:...................................................
MailingAddress:......................................................,.................................................................................................................................................... ......................
Onsite Representative:. J� vS..g d. �e................................ ................ Integrator:... 1 r y .....................................................
Certified Operator• ,,,,.. Operator Certification Number
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude + 4 64 Longitude 0 d «
Design
'` Current Design Current' Desiga Great
Swine Poul
Ca aci Po ulafion ` .. _.___hT '_:.:,Ca aci . Pa `ulatioil ,,
❑Wean to Feeder
Cattie ':Ca'� aci .E1'o'"uiation..,..
❑
Non -Dairy
Discharnes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [3 Yes [3 No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes El 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? Q Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [],No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................................................................................
................... ....... ............................. ....................................
Freeboard (inches):
5/00 Continued on back

1recilily` Number: — rj' Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 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 maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application_
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
�'�1Q yiQl iiQgs'or dgf c�encie v re e4� d4rnog tji js'vjsjjt; • ;Y;oo wiij •teeoiye 00 fli;t6gr
ctirres osidence: about: this :visit:
;Comments (refer;to question #):, Explain,any YES answer`s€and/or anyfeecommentlations;or aay other comments."
;,�; i� r= i'
, , , i k €..: : �1 ar i 1I fr s €� 3, fd I ga
Use drawings of facility to better explain srtuatfons. (use additional pages as necessary): ; " iz 1
a
t'
7�liS ��SpeG-rt`oz-.,. LJ IS dOOC qS 11 TD�WIItO, �Oj„y.,,�� ZctY1�6✓ �j A.
�' i l ] n c.S- a r. -F,r a► ,7� i Ja r i G- O -F� i (. C ra r+, e o W a pv d perAa r^-�c ®4
,�o,�-�e wtilea�6Ur2v�e S, JY� �at�Se 1'?eed�3 o Ch-T oose ke rat4e he
T0 0, 4e, r k1 S V y e 41, A- het s e vl o u,y Ll jA'z�(q jOnt; cpt-� i o1
AN Jaind ,shaulof be CleG.d A►Ld re4A AD
s- fl wfr►^Avdel -b 6e s ri ed &.1 6e -rwdek ; ZOL.
L
Reviewer/Inspector Name Slia J-IetAjn [ ;i, LCl,*, '. E " ¢ ' J'f ji �il,.:,,., i +3;1; , ��' •r�� �` E' '�.�
Reviewer/Inspector Signature: Date: f / f.5A j 5/00

Type of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 'Routine 0 Complaint, 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified 13 Conditionally Certified © Registered
Farm Name: ................. Pc1... 14•............
OwnerName:.. ................ O f....................................................•....
I 0 Time:
0 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County- .:lf .U.................................................`.......................
PhoneNo:....................................................................................:.
FacilityContact:.....................:..........................•........•........•........... Title:................................................................ Phone No: .................. .................................
Mailing Address:
Onsite Representative:.... s. V. f.Ur Cky ..............................................." Integrator:.....M.. .rf.. ,
Certified Operator: .. Operator Certification Number:
Location of Farm:
w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude • d 64
Design ' C.urreat
C2DnCif0 Pobulatilon
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number,otU
'Holdhik Ponds /.S
TpsK'
Des ign°Current ! ;Desigio
Poultry. Ca" acity: .Po •elation Cattle Ca' acil
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
TotailDe"sign Capacity , C
Total'§kw'-' C
Subsu
rface Drains Present J10 Lagoon Area L Spray Field Area
No Liouid Waste
Discharges & Stream! Impacks
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. 1s storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............. ..''.-pp................. ............�................ ............... .--................... ...... .............................. ......... I......................
Freeboard (inches): 24 30
5/00
❑ Yes [�rNo
❑ Yes'Lallo
❑ Yes 2 Na
hI�
❑ Yes ONO
❑ Yes 0No
❑ Yes'�INo
❑ YesXNo
Structure 6
Continued on hack

Facility Number: 71 —14% Date of inspection 1 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other,than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 3e ►-mot vdn Ga ✓► I r©l graze ,y-rt4 1) Gra,'^
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: 1 fj ;atics:or- 00014 o0im *ero ii e a En {�+is v�s�t! You wii� >�ec► iye ti u r.:
coraresnoridence: albotik this visit: .................................. .
aimentk(refer to -question #) ; JExplain`a- y M
F-�=r- t,. ..- 'I-�._V '.I r-'.'E< J G'_.:
❑ Yes XNo
❑ Yes A No
❑ Yes Z1 No
❑ Yes ;jrNo
❑ Yes jpfNo
❑ Yes 2fNo
❑ Yes ONO
❑ Yes ,KNo .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,"No
❑ Yes j2rf4o
❑ Yes A10
❑ Yes ONo
❑ Yes PNO
❑ Yes ONO
❑ Yes XNo
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
40 wcoe
qna� s s 44ed W� '-1% Ld dotY4 o;
eek-
eve yrf s o n 4L,e J 2, q .
Is,
5e0-%e Cote-CA-f eat' ? eemi uda%
Jel d s wi^ vieeA
j,1 prpVcd .
"r.
c�c,, i�ear, a,. 4v 64o K
af 4,0 ;r1reG-1I
14,
k7eed -'D
4a �e i •-, w►orep s -^4 y ;eI A
Ae v-
Pv 11 /j afj0e,0✓'3 ao go zwef
A wq4cf',D 61e -
Reviewer/Inspector Name
p
Reviewer/Inspector Signature: -t�_ Date: 1 �1 Sm0

Facilit Number: — Date of Inspection I j�011
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes _Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 10140
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 IT&O
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 J''No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Olo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments andfor' ra ngs:
i
5/00

i Division of Water Quality
Division of Soil and Water Conservation
l
IO,O,. the_ CA..CiCy �
3 }€�
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Foilow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 'Time: Up Printed on: 10/26/2000
Q Not Operational Q Below ' Threshold
Permitted [3 Certified [3 Conditionally Certified [3 Registered Date bast Operated or Above Threshold
FarmName: ........ :•?..:." ..5:....................................................................... County:.....1 � - .1�-, ............................... I--,-..,,..............
OwnerName:........................................................................................................................... Phone No:
FacilityContact: .............................................................................. Title:....................
MailingAddress:................................e...........Q.................................................................
Onsite Representative: \ \Q •, 'lYG..�
p..................................................................
CertifiedOperator: ......................................................... ..................................................
Location of Farm:
Phone No:.. ...................................
....................................................................................... ..........................
Integrator: .....!.,",`~i'��.— ........................
..... Operator Certification Number: .........................................I
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 & �i Longitude 0 =` 11
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JEI Layer ❑ Dairy
14 Feeder to Finish ❑Non -Layer ❑Non Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
DischaEgLe & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. II'di charge is observed, was the conveyance ntan-madc`?
El Yes
❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, niftily DWQ)
❑ Yes
❑ No
c. IE'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
a No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
'tNo
SIruCLure I Structurc 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:.............................................................................................................................................................................................................
Freeboard (inches):
5100
Continued on back

acility Number: — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
bNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
XNo
closure plan?
❑ Yes
(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?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
*0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
_Waste Appliottion
10. Are there any buffers that need maintenance/improvement?
❑ Yes
IZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
&N0
12. Crop type �0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
tR�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
J ;No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is Vended for a wettable acre determination?
,Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16, Is there a lack of adequate waste application equipment'?
❑ Yes
UrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�rNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes XTo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�<No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JSfNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
'C�(No
No
�'cio yiola�ignjsor . rjcie;r�cies wire �Qted dt itig his;visit: Yop wi�i >!•ee iye trio furtitt~ ;
corres• oridence'. about: this visit.:
ominents (refer to question #): Explain any YES answers and/or any recommendations.'or any otherm coments.'
KU
se drawings of facility to better explain situations. (use additional pages as necessary):
rI =11 S iv2- = q 8-/1AM
, �1G�-,
oL, A-t .0,-Ii CL,� Lc'L L'11A Ame 414
576-,Q_ z r . _r��
•ems e,�, l 4�, L.L_(1es — AK,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
'10-3�S 3 � 00 X: .)L�
Date:
5/00

•:% Facility Number: '2 — r] Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MNo
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 �rNo
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 .ENo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes NNo
s
Addifional Comment&and/or Drawinsg•,. i �.'' i
Se��� �.-��� �l-"ems. �►�c�►-�e-� i�,==� �-��� ��-
5
1�) �C+z._�`� �-e�.�. "1G � Gi.i'S�S.S�� �►� 5T41 ��'c .� �� .r4Z-- C-( + CfCIJL\'�
J
5/00

Lagoon Dike Inspection Report O� p
Name of Farm/FaciIity QuU e Ei 3
Location of Farm/Facility
urn L e P 16 Q c7
c ��n-- i� S .-t r o -- r-I 5
Owner's Name, Address U f ,"S 1; - _ (a " -e _ 1
6�e PAS 4­ e_ lI 7,,,n c L
and Telephone Number
6e1,1<U.,Ile, ,0C 2r5/j�- C9/Z)� �F)-.�<y3
Date of Inspection
))
Names of Inspectors r /r�G n 4 G
Structural Height, Feet �,�'"
�� S / �S�CFreeboard,
Feet
Lagoon Surface Area, Acres see c�rG�; �.-. �Fe�Top Width, Feet
Upstream Slope,xH:IV
!
3 f
Downstream Slope, xH:IV
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
�0,0 d _5_ C_Pe
ifs�l
rr
Seepage? ,Yes No. I-C C OU
(Che One, Describes if Yes) , p
kc wcl� v�c5 t etvt
Erosion? Yes No �C�T r> S ✓� O �C�
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
r �*% 41"-^^ _�'
v
Yes No If Yes, Depth of Overtopping, Feet
1_1f EJ ou
Yes No
Yes - N, No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Oth r omments
o p-
'rS
ntec'
Le ,' t%qN S
Yes No
hkY< o-Qp� J ,k
.`
n-1 t_ e-A e It �6. P
C r `(y r•. o 4 4 e C eK
l !
r , o �• � f ►�v v. I1 , -- c r, L C b cry �c, r•.� t t� c�
't/LLre c Se . ,,,, �,, , d ,

i
r
r
�� � s �� � �� ��

.'.:LaS�.r'�?.�..`i.ie+�"�•i'�'. �'d�--^�.-w .f. �.:V .,ti... ....... ......z\ a..Jt r..t ... ...-, .,�x� �n._...w J-...i.. ...r...... ..—.rt .n-�L..•....n i�aa. n.-:Y�`." .... Y......, ..i.��. ...+. .:�.L:F.-i�1. ���1�4.'--..,E.,. ...x... e..
l y �
G�Oart� 2 Lagoon Dike Inspection Report
Name ofFarm/Facility 2 sr C(7 I �•
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection ANames of Inspectors -C)
AZ LA-
cyll'< kell-
0" ) �f
Structural Height, Feet Freeboard, Feet _
Lagoon Surface Area, Acres J Top Width, Feet
Upstream S Iope,xH:1 V[ Downstream Slope, xH: I V 6
Embankment Sliding? Yes No 1/1 m
(Check One, Describe if Yes) �1
j f
Seepage? Yes No. - D61 _ _ e n n �'er7 7 v � � ' ^ � C
(Check One, Describe if Yes)
�T T'
Erosion? Yes No ! Q -� c a, �r �/ 42 r
(Check One, Describe if Yes)
1 ( i
o v..
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? _)LYes No If Yes, Depth of Overtopping, Feet ^'
j ti 1° IL
Follow -Up Inspection Needed? Yes �No
. C S�
Engineering Study Needed? Yes No _
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
r } 11
Other Continents 4� C_G a ►-� r � < �t P t f �L_ o -, d I'et(c a t 1,
t
r

1�b
hqr
----------

N
LAC 001J �gLagoon Dike Inspection Report-
n
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Vrl� L E N r,,. k, ro d�� r�'<�L�o. S� S-,3
Names of Inspectors
Structural Height, Feet e),r'� �f 5� 1 �"SrJe reeboard, Feet
Lagoon Surface Area, Acres ce- ���„ �.. �,. h AG�, Top Width, Feet
I(Upstream Slope,xH:IV 3 - r-
Embankment Sliding? Yes
(Check One, Describe if Yes) J
Seepage? _:_ Yes
(Che One, Describ ifyes)
iCe wcl �,.c5 t
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
V, e f-
�'
Downstream Slope, xH: IV . 7
No _ of J' L4 �&
< ff
No- �J--lJOS��� IQC oo�
,rT
,Yes No _ dl ACV S
r )
( I" 4 C C ! 41lrr V PtI r]d i/-1 rn
v es
XYes No If Yes, Depth of Overtopping, Feet K
Follow -UP Inspection ection Needed? Yes No
Engineering Study Needed? Yes N, No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Othir ommentsCt r JC C'0V O^r
o 1( 1
� �iKCr scc
4q,
t ,C 52�ci �C•
r\CeCff TJ
el
Yes w
No r J
J-12
r, / C i!> u. u 0J,
f T C
't1C.reL se . ,{, h,,, d ,

wo5-07
s '
vy7JVy'
_/',6�
Ape

'�i.%-^`tfr','=�rsr�;r...t�.F�•;r��=.J:3='.�:•..:.........-....::4k5.:'..::T.........>�._,...`=,c._...:r'..-...�c»��...�..1._�_,+::A%r'-�.:1:ir:.....:fi........,..�-r'c:.,..:..G.r::at•:�.�.__._:.,�.�..+.._,1-=,..._
l 1% �n nn
ADa�J Lagoon Dike Inspection Report -- 6.. -._d`
Name ofFarm/Facility CCUi.-�
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection /07 Names of Inspectors C(} AJ
-_1 C /< c r—
Structural Height, Feet Gr `� Freeboard, Feet
Lagoon Surface Area, Acres SPG A C Top Width, Feet
Upstream S1ope,xH:IV Downstream Slope, xH:IV
Embankment Sliding? Yes -,k No j r e
Check One, Describe if Yes [1
Ir ✓ F ,r rj
Seepage? Yes v L ! ^ r
(Check One, Describe if Yes)
Erosion? Yes No JZA ,� c r a.,, �,!�f C2.r �l
(Check One, Describe if Yes)
r}
ODD� G1 1 l Glroy�.� M o .f- dSrC­ rna f
Condition of i T Y S t1 C r y
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? _Yes No If Yes, Depth of Overtopping, Feet
iA- �OC_
Follow -Up Inspection Needed? Yes '�__No
Engineering Study Needed? Yes r No r
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments t � ,� o� � , � c +.✓ 4
c
CCo ve --�

p 2dj -.'? /L?
J�
z b S
—.7
h9l
-' a .:3 �y's,r"'}vsrr ti x;vr:K;"•? -r2"{ �^k'- �Y."t'K 2"7.^- : r_:;:'; : •i�ry=' ; `•: , : ••r, - r n.. z _ _+', r�'t' : 7-r. •^"Y{ny, ;Y --

Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
Permitted ■ Certified p Conditionally Certified p Registered 10 Not Operationa Date Last Operated:
Fm-in Name"-. RUEUS.I3.GUSE..h+ARM............................................................................ County: Duplin WIRO
OwnerName: Rufius.E................................. FLU= .......................................................... Phone No: 9.1fk-:289:-3543 ..........................................................
Facility Contact: ................................................... ...................Title: ...... Phone No:
Mailing Address:. l.65&YAS1URE.BRA.NCH..R0AD............................................ RE1.1LA.V1LLE,...NQRT.H.CARDLINA... Z8518 ..............
Onsite Rclo-eselitative:.................................................................. Integrator:Murlft...F.amUy..F',glans......................................
Certified Operator:Rufus,.E................................. Rome ................................................ Operator Certification Number:2II2S0.............................
Location of Farm:
e�aansYl e.suu .Au. Yvy... ar.a ou ...rnt.. a.t e.>n ers,cc o�t.0 . may... an ..astntre.. r raat .ga. a .ort..as uxe...........
Latitude Longitude ©• ©° ©��
3 es>gn°Design f E4E, urrent, es�gnEE urrent �E,_s
13. Poultry' Capacity Population Cattle ` Capacity Population
Swine Capacity .Po elation
❑ can to Feeder
® Feeder to Finish
❑ arrow to can
Farrow to Feeder
❑ Farrow to Finis
❑ Gilts
p Boars
pLayer
', ❑ Non -Layer
p ter
TR al'Design Capacity
ToUI SSL:W
3,698
499,230
. ... � I ; .11! , NueroL' n®u Sur ace rains Presentrea ® prayagoos re rea
Haldmg Ponds I Solyd Traps Ova E 3 E ❑ o rgUr aste anagement System
.p`j.
1. Is any discharge observed from any part of the operation? p Yes []No
Discharge originatecl at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? []Yes ❑ No
b, If discharge is observed, did it reach Water ofthe State? (If yes, notify DWQ) [3 Yes ❑ No
c, If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? If yes, notify DWQ) p Yes p No
2. is there evidence of past discharge from any part of the operation? []Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway p Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....#1.................... ..#.2.................
Freeboard(inches): ...............1................ ........ Ctlw igdl...................................................... ...............................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

IF
Facijity Number: 3t-475 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
p 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 A l )lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[]No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
[]Yes
p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records &_ Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24, Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
©No
U - N: 'viah'tions:or.defii~ien'cies.were.n-oted .during: this .visit.: Ydir w' i11' ieCeive' no. further.:. :
:. ,.comes 66deki . abbir( this:visit:
cane Floyd Assessment w
ent
arm was flooded. Dike was kept intact due to flooding and overtopping on back side of lagoon #1. Vegitative cover on backside
f lagoon 01 dike wall will need to be re -seeded. (Water on dike wall)
.)on #2 (back farm) dike wall had good vegitative cover and no erosion was observed. Cows were roaming freely on dike wall
grower was advised to remove them ASAP.
inued on page 3
Reviewer/Ins ector Name s tr�:zefmsai °� "�nfuiE@aI�"s"isI�Faf�CrC�auifiddj619_ , a i rgG'�i 5 r4lEEsa9�l6a„ ei'} l;� : Ra "`.;E�f ;EE kl�;�kae %
...
€
Reviewer/Inspector Signature: Date:

;.
13 Division of Soil and -Water Conservation ,Operation Review,
.Division of:Soil and Water Conservation €inspection
t € 3 �i ,
-,
d t.l,.;i
i I
„Compliance
1 si i. €. € Y I , 9 i E �: I
Division of Water uali,,;s,,;,€
Q ty , Coii�►pliaiitce Inspection i €
•i,
jE. E, g
4 �' €
t
�,�i
— — • ioni
Other Agency
.�=[Operati-Review I
Le Routine Q Complaint Q Follow-up of DWQ inspection . 0 Follow-ug of DSWC review O Other
Facility Number t/ Date of Inspection /17j
Time of Inspection 24 hr. (hh:mm)
P.......ermitted CerCertified3 Conditionally Certified (3 Registered Not O erational Date Last Operated:
ce
Farm Name: ........... ... I�.P..!�! 5 A v x�. County: k.1. I 1 �...............................................
Owner Name;
.0.......... Q. Vt St ............. Phone iVo:....,..'�f .�(�� Z�...`.3.
........................
Facility Contact: .... ..1n. S .............. Title; ........ &!wyAl. lf...... ` Phone No: ........................................
Mailing Address: ! iG�.-� ,gis,L.... Xex&yal.e,....`i/............. ate........
................................................ ........ .. A..................... ....
Onsite Repsentative:......... 1 .......... L� Ir4 .'........................................... Integrator: .Ff'.............................................................
re
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A.
..................................................................................................................................... ..... ......... .................................. I.... ..
Latitude • 4 •` Longitude ' ' °
Design
Current Design
Current Design Current
Capacity
Population y CaacitPo`
e
elation Capacity PopulationSwine
Wean to Feeder
❑Layer
❑Dairy
Feeder to Finish
❑Non -Layer
❑Non -Dairy
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
r
❑Farrow to Finish
Total Design Capacity
ElGiltsr
❑ Boars
Total.SSLW �
�
� Number ofLagoons
; Subsurface Drains PresLagoon Area
; ❑ent❑
Spray Field
❑Area
HoldingiPonds 'Solid Traps
E
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated aL ❑ 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 gal/min'?
d. Dees 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: (T'bIA4-) RSAtt�
Freeboard(inches):'"z�....................2.7.............................................................................................,.....,....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ONO
❑ Yes
[—N."No
❑ Yes
0 No
N
❑ Yes
[(No
❑ Yes
[Ifo,
❑ Yes
[No
❑ Yes [YNo
Structure 6
❑ Yes Aio
Continued on back
3/23/99

Facility Number- 3 --�/ I)atE' o}'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?
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 Apalication
10. Are there any buffers that need maintenance/improvement? .
11. Is there evidence of over application? _ ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ 4th 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?
RequiredRecords &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24• Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
10 yioiaEigns:or d fciencies wire p�teO• d rrigg t. s.visit: • ;Y;Otr Wii1 ree iyte tid futftr, ;
...... ... .....
roeres�6nd6'e.A' ' f"this vesit. ..... . . . . .
❑ Yes 4 No
❑ Yes t,No
ElYes ll(NO
❑ Yes 01No
❑ Yes XNo
❑ Yes kNo
❑ Yes R�4o
❑ Yes Xo
❑ Yes ❑ No
Yes ❑ No
❑ Yes ANo
❑ Yes &,No
❑ Yes XNo
❑ Yes *o
❑ Yes WO
El Yes PNo
❑ Yes RN
❑ Yes kN0
❑ Yes VNo
❑ Yes [N(No
❑ Yes J4 No
Comntetits (refer to';question #): Explain any YES,answers and/or any recomritendations tir any�other comments'
UseAtawings of facility to better explain situations We additional pages as necessary) ; E „ � h , ; , •' 1
jAiQS jai& i? wilt be re-hl r&i d Ky det "P�- 5v hAtt aK� �,,& IQ- r2
f8r+ev v it 6e Cort-I-xt V .vs 4ec (n. Sete kI;S+ 4v& '"k—gctl av d— sj5A;,i •p .
GK 1dwntt /f J �j 1
Cy" 1A'. I/Y,�/!� /rvl lar/lr�n �/ N/.c♦ lLf�/�S �. /J/ii✓f� �h 6_1- kllyCP_/ril
Reviewer/Inspector Name 71`l t;&' aMe
Reviewer/InspectorSignatuyae_ _ !�•/'�Lr. Date: �4
3/23199
��o) J*6--34iav oaG-t 2� S

Facility Number: — Date of inspection -bl
d
Odo Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below '�'�Yes�'l�o'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence df wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �NO
❑ Yes x"No.
❑ Yes XNo
❑ Yes �No
❑ Yes VNo
Additional ommen and/or. Drawings: 3
� v�wN �'�C in (JCS W) V .�/ 7 T 1 [.. f Z 7 y
Gl% l r7rt,�r Cri>d 3✓IC�✓t / IIVV" �"' ,S [ r � � -�y /?G!
rl o yGl , fir r m r,Vtr fs `Aopl w Q nw xij Gbn �1k z vas -pl6xleoC
547lrrh wst c rS . �rD►nVGY 1S Ck"vr�"L� fy bact i r� 41,4I1 OP raw. ctVA. 5Pr 1
}-ie Ids ar{ ��erd✓�-.� Ola; y , Over-sr�v�•'� y5 C�r�Gvti 6�, do►�c .
�
r. liv-e%C� die}
J
3/23/99

E 3€ a -€ _. 7 b [ -n k :. S E €: 1 'Z € l L k IF 83 9 g
i Q' Division of SoAI a,"" eki 6nservgti4n o eratipikX t+lew
3 > E,,4 1 a �i� ;';�' E .�-„€-.F ` Ew�';,r._ i.; ,. :€ E 3.1i ��,,g >.r?�,, 5 a . E ,4 � ,"ip£ sE �', °4 �r Elb k 3.iY. -s € tk;€ o { a€ •€i�"ii i
�.Dtvtsion of SOB a00*,ater CO�tserVStIa71 Compliance spectator 4�3€ 14 q
4ip3 €eL€( ,.-,., .i;,.€ 5.c''�=�tr .3 .iiE y9
iV�siiin of Water Qt,alttyE -o� pitance6lnspeCt}on t` ' �3 € ? r
• p q
.." F
er Agency :' d eration KeVievv
-
Q Routine Q Com laint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Other
Facility Number is Date of .Inspection
Time of Inspection FF9 24 hr. (hh:mm)
© Permitted [] Certified Q Conditionally Certified 13 Registered 0 Not O erational Date Last Operated:
_ .........................
Farm Name: .. # ,U ...... 1f1r1, . county: ..... I........ ................... .... I..................
Owner Name:. ��..'.... LEI.s......................................... Phone No:
FacilityContact: .... Title: ....................................................... Phone No:...................................................
Mailing Address:
Onsite Representative: ........................................................................................................... Integrator:....... ..... Ef....LL�
......................... ...........
Certified Operator: ................................................... ............................................................. Operator Certification Number: ............................ 0.............
Location of Farm:
i
....................................... ................. I........
Latitude 0 ��° Longitude �• �Ors
Design Current E° ': 3 Design Current Design Current
Swine
Capacity Population ,,,,.Poultry:..E....< !: Capacity' ,Populatton:� Cattle Capacity Population ,
❑ Wean to Feeder
i
❑ Layer
❑ Feeder to Finish
❑Non -Layer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
° € ,' TafaLD6
X4,pKi
:7
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated tit: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �5» jv
Freeboard(inches):..............................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, j Yes ElNo
seepage, etc.) 7k
3/23/99 Continued on back

FacilitiNumber.3+ — r%] Date of inspection
6t'Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? [-]Yes [:]No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Ru uirecl Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0; o yioiatignjs:or ilOfciencles rvgre jnpteOd ttrfng this:vEsit: Yoh ;will ree�iye iiti l utt1h
'Co......rrespon de' ' e: about. this visit.
Comments referuestioit€#): Explatn�ar y YES answers°and/or any recommendations `o r any otl `er comments.!` Fy 1
( 9
Use drawings of facility to better explain situations. (use add�honal pages as„necessary): ra tt -E•
��. 1�(llkli �w� � S�-�-��� im�LC/.�ilt,,�� 6vl ��I'Yll;�--.�'i���5�D ���J� •
Ar4�' remmye, &,?Ywe Am /-Azw/l atke VW/_
•(�� ��• C%C�/i�4 GY1 I�?�S�" �/ai ��� ��� ��rSf ..Scr�vrrR1.
J
" r
4f� .�'
Reviewer/Inspector Name /i` a, (7 t R F� g
Reviewer/Inspector Signature ' Date: a
/] 3 Slob -et 1 Zt9 .DWQ — Cr'7� w ""7i''t�/ �Jl' 3/23/99
rq

❑ DSWC Animal Feedlot Operation Review
D V Q Animal Feedlot Operation Site Inspection
Itautine O Com laint O F(llow-up of l)A ins ertion O Fal 0w_u of I)swc review O Other
Date of Inspection 2 ��
Facility \umber
Time of Inspection L I.S = 24hr. (hh-.mm)
E3 Registered ZI CertifiedtJ E3 Applied for Permit © Permitted Not Operati7nal Date Last Operated:
Farrar Name: .................. . .... .ri�T41S.......k?we......... ��... ................ County:.--..�u�i�....... ..... _.....�.....
Phone \o ....
Owner Name: .... _...i�1t ...... ,......................._......�.... f�L..�.1�.. �....._.....�.......... �...�.
Facility Contact: :.................. ..................................... ..... ............... Title: ............ _................
f Phone No
Mailing Address:
Oft%ste Representative: .............KAS............�sl�i�.............................. .._........ Integrator:......Mut................ -...................................... ...
Certified Operator Operator Certification Number;.
Location of Farm:
Latitude Lonritttde
::.. . -Design :: -..:.Current :: :, :°:Design :.Current . ,Des r Ce�rreat
Poult Ca aci Population Cattle Ca' cr Po ula#roa . Capacity' -Population ' r}' :. P h _ — = -pa . ' . ld
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
iimber.ot Lagoons:/ Holding`Pooris ? Z ' ID Subsurface Drains Present ❑ Lagoon Area Ppray Field Area
❑ Na Liquid Waste Management System 4
General
1. Are there any buffers that need maintenanceiitnprovement? ❑ Yes N.No
2. Is any discharge observed from any part of the operation? ❑ Yes Rj No
Discharge ori;inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, way the conveyance man-made? ❑ Yes tM No
b. if disch m-,z, is observed. did it reach Surface Water" (If yes. notify DWQ) ❑Yes bg No
c. 1f discharge is observed, what is the estimated flow in ;al/min?
d. Dries discharge bypass a lagoon system? (If yes, notify DWQ) ❑yes 10 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 1Z No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ICJ No
S. Does any pan of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenanceiimprovement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes f No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facilit�•�;umbcr: 3
8. Are there lagoons or storage ponds on site Which need to be properly closed?
❑ Yes
No
Structures [Lag_ortns, oldi ^ Ponds. Flush fits, etc.►
9. Is storage capacity (freeboard plus storm storage) less than adequate?
'19 Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: z .... _.... __...... _...............
_........
Freeboard(ft): ._- _ �.: ...._....... ... __ . Z.... _......... _....._._..... ....... ._..................... ......... ..... _ ......
_....... ...... ...... .......... .._...._...... .........
_.......
10. Is seepage observed from any of the structures?
❑ Yes
(� No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.'*Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
R No
W wrde Application
14. Is there physical evidence of over application?
❑ Yes
FX) No
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type :....... . ............ _.. .. - • _._.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑Yes
MNo
17. Does the facility have a lack of adequate acreage for land application?
j] Yes
[%No
18. Does the receiving crop need improvement?
5d Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
P9 No
20. Does facility require a follow-up visit by same agency?
0 Yes
11 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
22. Does record keeping need improvement?
® Yes
❑ No
For Certified or Permitted Facilities Qnik
23. Does the facility fail 'to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
R No
[] • No.violations or deficiencies. were• noted d&ring this:visiL .You' 441l receive- no further
correspondence. about �this:vis , ; ; ...
:
9.1Y, 5VW clew xweclnow4 in lc,�oo,. 1, t_a5oo:, Duel !&6c0d bU kwb-td ,r a MQOnsilaL V
�-i fly r+�.vttu.v:
IL. �ros;ort �wcas o�. otI`Fur ►1C-0 WQ-ll [t co;ll * i s�LlJ be.. PL3 Y- reSee&d. C.a�finu
nn� �i �l0 rt 1. � p�r•�t a,,S , ©t (rT'-- wo'h s 04l b(e� 161ons skoui cL be, Mow-ej.
im.pro C�r-
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b V� f is oaerk 'v-- 6'x4t�,4'1 at. a50- v r OZ4tr1`4
l�. 3er ,_�q �►�((''a..l� �t-e��s rn,�s�` e
�p:i �vV� �O� RSS1'��GGr �s sS �1Y1W
Canes L� �%�1 ,koj O be �� fae f ed or~ Sa aL ct1 So, kd - W6Sf c ciyw es S�oJit
Wi�r- s-�cYth !`PCOr C. `�CS�� "�,�eJrhCCt/�1�l`G 0►� SkOUId 6e" ' GYtr\ 1 ccA7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
0 Routine 0 Coni faint R Follow-up of DW2 ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection 3
Facility Number `�5 Time of Inspection mi= 24 hr. (hh:mm)
© Registered 09 Certified [3 Applied for Permit 13 Permitted 113 Not Operational Date Last Operated:
FarrarName: ................. kf.a.ND.... .at ...... tr+.................................... I .......... I County:.......................,..................................................
OwnerName: ............................K+�5..F,.:.....&ve`................................... Phone No: ...............
Facility Contact: .................................................... :......................... Title:
MailingAddress: .......................................,..................................................................
Onsite Representative: ............t<1.t.��vs..... r......... ROL"L. ...................................
CertifiedOperator.....................................................................................................
Location of Farm:
.................... Phone No:...............
........... Integrator:,.,
Operator Certification Number..... .....................................
.........?►...... e it.........510.e.......�?.£'....SR,...I���..p....0..15........ ......l-l�?.�j...��A.. .....................................................................
......................................................................................................................................................................................................................................................
Latitude =11 Longitude =- =, =11
]]esign Current ' Design Current Design Cu
Swine ,,, Capacity Population = Poultry Capacity Population Cattle Capacity Popu
❑ Wean to Feeder ❑ Layer Dairy
Feeder to Finish ❑ Non -Layer JE1 Non -Dairy
❑ Farrow to Wean A
El Farrow to Feeder Q ❑Other¢
❑ gip. �E, Farrow to Finish Totat D
esign Capacitys x
❑ Gilts
❑ Boars
Total SS LW
❑
'��
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Elolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
........................................................................
Freeboard(ft):...........................................................................................................................
14. Is seepage observed from any of the structures?
I I. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ Yes
❑ No
Structure 5 Structure 6
......................................................................
❑ Yes
❑ No
❑ Yes
❑ No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..... ........... yf .......................Sbr i.�..... .. ........
i..................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted_ Facilities_ Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No violations�o' d'iciencies:werenoteddaring this, visit.-.You,wiH ie'ceiven&ft rthter` :
corrOP66dence dbouf
El Yes - ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
i�. &xmoaQ s�riggi Sl,�,,,t�j b2 �01,t�OKJ �r��� Sl tin of �1Qg. 1 �� g �r� Sk.ld 6,--
�Iru+tk by 5ee�, lo, M1, Q.`m` clss{��sls la� '}�v— �errhvpo� icx�p� �,� S�YYry ��� 5rta�0
loe maul -�v �����ssr��m�w�vu� 11� l�ltl�a Sru�1� ioe. t�S�1r►�ar P or rlo'�. �u+1�L1" JM ur4
�m;l r�Vri•s or"�tl d i�o �� asS;'Sk.,1ce , 1
7125I97

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection - 1 G-
Time of Inspection Z5 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
®.Certified ❑ Permitted or Inspection (includes travel and nrocessinLY)
❑Q Not Operatti�onal Date Last Operated: .................................
Farm Name: .._1.1.f..2c�"tl�x...1.(t+..ttadeln.l....... &pr.W...................__.... _..................
Land Owner Name:....X1.uaa ..._ :...........\�r,�1,A..St..........._................_.......
.
Phone No:..._q..j.t7....- aZ$g.r..3.5�i.._....._........_...........
FacilityConctact:............................................................p......._........... Title: ._..........................
^_Q............_.. Phone No: .... _......... _.........................................
_.
Mailing Address:..�.�4.5.2L. 1pm&W.&.......L7�4a 4. ...... LtiRt—A............ ...................................... rg.S..l_8...
Onsite Representative:.... ..................lU{••1i�Y••............................. Integrator:.....Mxcp.h ..................................................
Certified Operator: .................................................. ...................................... . ..................... , Operator Certification Number:..........................................
Location of Farm:
Latitude =' F5W. =" Longitude 0• ©. ET!31.
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes RNo
❑ Yes ® No
❑ Yes ® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®.No
Continued on back

Facility Number:.. �..1L,..,. �..?.�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes RNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 91 No
Structuccs (Lagoons and/or Iiolding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
..... 1.R.4......... .,. .....I.I.-I............. ............................ ............................ ............................ ............................
10. Is seepage'observed from any of the structures? ❑ Yes a No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 09 No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-I2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Wa t .Appliption
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...................................................................................................................................................
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
K Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
®,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,
For
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
Certified Facilities Only
❑ Yes
No
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
®Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J,No
24.
Does record keeping need improvement?
KYes
❑ No
Comments (refer toAgtiestion,#) Explain any YES;answers''and/or.any recommeindations or any other comments
Use drawings of fk' ility,to better explain situations:; (use additional pages as necessary}
r �3
12 • V—e v e t nje_ % a -y. e. �-E✓e-d o n. (¢ A o a -11 i v p_ i t� . I ,., V_" � tr o '�, � S a ,.�.-C
►� � o b e o-v--�,I_ � w. V w 0, L 1 c l u-y o o I. P l ero.�s a C a ••�. r_�
'D I, w; t-tti
� � . S � .n.�-Lo w-tw +.s la e� { Ya-.� � 0�-t� S f � 0 �t �,.., (�st�rw.�v r1Lc1 T► ��
►^- war t- o o 2 . � o..�.�- e -r i s ► " t a - C_L_e_ t-, LA_-_ <-a-V--e r
l V Lk ►^-oo-
q. w.L b �v,.,,,, S
�e ds [Z
2Z . A w a Q�L w••.. w a--S .�. cw L a ti r Q- ` -- 6--�3 i
cam, ,r t-tr,k
Reviewcr/InspectarName ° MEN ok
Reviewer/Inspector Signature: rA��Date: 7a
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number:11 ......... Date of Inspection: 1 -7 1&
Additio'nal Comments and/or"Drawings:!'
C4 cz— E-1 -1-1
2A - KA
0 V- e�,f LJ-VL-4
c� 4. 17-ol.C-0,
4/30/97

Site Requires Immediate Attention:
Facility No.-?/ - y 75
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 , 1995
Time: ,0- 3 .4:�) pm
Farm Name/Owner: �U N C�US�. ' ecw2 2 � MailingAddress: _ 1IRO Pg5fu C f. 6ruc i1Jeu ern �� 2 $ S�
County: L
Integrator: It Phone:
On Site Representative: q Phone: Z V 3 S4 3
Physical Address/Location: lr i Ie S TYC Ken -Z47 5 V+'[ 4e.
on sr- lq 53 , 114-- m) on ri'!aht
Type of Operation: Swine Poultry Cattle ,. r-7)-n r 5h
Design Capacity: 2�C�o Number of Animals on Site: 2Co CaD
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' �7l Longitude: �� Sl ' 3 11 " Elevation: Feet
1i�1 11
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: _Ft. 0 Inches
Was any seepage observed from the agoon(s)? Yes o(S) Was any erosion observed? Yes o No
Is adequate land available for spray?Pa
or No Is the cover crop adequate? es r No
. Crop(s) being utilized: Ir Yrl
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
A;
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments:
Ljt)dz L.
• Inspector Name
AL
Signature
cc: Facility Assessment Unit Use Attachments if Needed.