310600_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

� Division of Water Resources
Facility Number J + � - (Q Q (� ©Division of Soil and Water Conservation
Q Other Agegcy
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: c,pf! Region:
Farm Name: U (fOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: !rid
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pap. Cattle
ILayer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
jNon-Layer I Dairy Calf
El
Feeder to Finish
Dairy Heifer
Design Current Dg Cow
D , P,oui Ca aci P.a . Non -Dairy
ILayers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Won -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes TrNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes VNo
N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [3Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: - Date of Inspection..
f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E <No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes _Io ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3(p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E N ❑ 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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes '210 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
13<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2<0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes g2r<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 1❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes No
0 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes E<o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Pq<o
n ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Eo-<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I3 i o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 02- o ❑ 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 To ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0 'Co ❑ 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. ❑ YesTo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes e'14o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes CQ-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments.
Use drawingsof facility to better explain situations (use additional pages as necessary).
/00 va ql �U✓//1 �/t.f L�� dam/
� a
Reviewer/Inspector Name: (J Phone: 1074
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412015

ivi"sion of Water Resources
Facility Number - GC/ 0 Division of Soil and WateFIG onservation 1
DQ Qther Agency
Type of Visit: ZTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access.
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: & '�: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
C►attle Capacity Pop.
Wairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Design Current
Dr P,oult , Ca aci Ro
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Da*
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J'No ❑ NA ❑ NE
❑ Yes L:q-No ❑ NA ❑ NE
❑ Yes J2 No ❑ NA ❑ NE
-d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes a No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ETNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ET -No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

E
Facie 'Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes_.ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes P3'No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [:a�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes L;J'Ro
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes .f5"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes .[f~No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J2'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes r— —'o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 4D No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;2ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;�3-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ErRo
❑ 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 .LNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" RainfalI Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes = TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _ED-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

y
Facili Number: - G Date of Inspection:
24- Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �,hfo ❑ 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 C'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:
❑ Yes Q-No ❑ NA ❑ NE
❑ Yes EfrNo ❑ NA ❑ NE
❑ Yes LD-No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [D-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �jNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑-No ❑ NA ❑ NE
Comments. (refer to -question #):;Explain -any YES answers and/or any additional recommendations or any other comments. `` r
Use drawings of facility to.better explain situations.(use additional pages as necessarv):
1
• c ra�S 1 cad O,rc
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
ldwfQ,- c,,,/r / ree a /
Phone: ! TZ& Rr?�?
Date: , -lAW
Page 3 of 3 21412015

Itype or visa: V t:ompnance inspection v vperanon xeview lJ ntrucrure Evaivanon v i ecnntcai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1, 14,f Arrival Time: d.,' 3<7AL Departure Time: County: �j ,�j�jh Region:
Farm Name: AS S �� r �� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine C*apacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
1) , P,oultr. Ca aci Pao
Layers
D Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Puults
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 E] No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes PNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes �No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adeq te? ❑ Yes ,0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 A
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes P 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 n 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes /ff] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No 0 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 n No ❑ NA ❑ NE
maintenance or improvement? T
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 ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Pa -No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
;E'No
❑ NA
❑ NE
1$. is there a lack of properly operating waste application equipment?
❑Yes
L,d o
T
❑ 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
No
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes,,OffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 21"No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

U
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t?
❑ Yes
Zj No
❑ NA ❑ NE
25 GIs the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
NA ❑ NE
the appropriate box(es) below.
T
❑ Failure to complete annual sludge survey [] FaiIure 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
PNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes j, No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
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 the 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 CAWW?
❑ Ycs,,PTNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes PNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes P No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages.as necessary).
Via,.,.,,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:&.J7 63
Date:
11412014

Type of Visit: �Eompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 9"R.outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: <j' Departure Time: County:
Farm Name: t/�PA��1� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �V` s d
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: /
Certification Number:
Certification Number:
Longitude:
Region6J -
Design _ML@urreut
Swine C►apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design e
Dr. P,ouIt . Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes en No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
P"No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
T;allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[; /ko
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214,12011 Continued

[Facility Number: YJ - Date of Inspection: ! Z 3
24.bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J�:fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ',O'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 fait to provide documentation of an actively certified operator in charge? ❑ Yes EJ"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ 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:
❑ Yes [:TNo ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes E! No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Wo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
se
rot,
0
d cat mod - Kaw < l�A- 4=�-- 2_
Reviewer/Inspector Name: I Phone: Z
ReviewerAnspector Signature: Date: ( L
Z":3
Page 3 of 3 /4/2011

:r_4
Division of Water Quality_
Nu[nber. =0 Division ofs,Sotl -an ""Water, Conservation
cy en '
_ ... QaOthe AA
firad-ij
type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical AssistanceR
teason for Visit
'P utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ElDenied Access
i rr_
Date of Visit: Zo Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o =' [_] Longitude: =o =, =
Design Current;
Swine Capacity °Population j'�'etPoul rt y *9(
Wean to Finish
ElLayer
1410 Non-L,
Wean to Feeder
Feeder to Finish
= 77.
Dryl'o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
` ❑ Layers
❑ Non-L,
Gilts
Boars
❑ Pullets
ElTurke
❑ Other El Other
tr Poptilafion' Ca"ttle°
[] Dairy+yCow
❑ Dairy Calf
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
< Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes
[:]No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued
ty;

Facility Number: - Date of Ins ection: 12,ZO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [-]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FicHity Number: - Date of inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
' 61VP- /%tg Ce CQI� wlkl Ya�a Je'�_ ';'- C�-ruCtCef
a(ll /Z LpA'I � Gl CGS /ie
la, 7Z lea
J5 20— 3510 Cet r
7/U 7K - 7 f1' 3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �— 7 K `7
Date: , — zo
4aolI

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Region: 0
Phone No:
Integrator:
� o�Of6
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = {l Longitude: 0 ° 0 $ = f{
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity. ..Population
Cattle
Capacity
Population
❑ Wean to Finish
iry Cow
❑ Wean to Feeder
on -Layer
iry Calf
❑ Feeder to Finish
❑Dairy Heifer
❑ Farrow to Wean
DrJ Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
on -Layers
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑Turke Poults
❑Other
Number of Structures:
a
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 J�_,Ko ❑ NA ❑ NE
❑ Yes 12No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes IdNo
[I Yes ZNNo
❑ NA ❑ NE
El Yes AE]No
❑NA ❑NE` '
Page I of 3 12128104 Continued

Facility Number: — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structpre 1 Structure 2 Structure 3 Structure 4
Identifier.
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 RfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,/'No ❑ NA ❑ NE
❑ Yes 2fNo ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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 ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes O^No
❑ NA
❑ NE
maintenance/improvement?
t l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes '2No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
J
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil -
El 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 2Mo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
,PNo
❑ ,Y� Yes No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 12�o
❑ NA
❑ NE
`Comments (refei-to question #): Explain any YES
Use drawings of facility to better explain situations.
answers and/or any �recommein dahons or, =any other comments
(use additional pages as.necessary) � `w
Reviewer/Inspector Name
. .._ :;_,
Phone:
: C -7
I
Reviewer/Inspector Signature:
Date: li
O
Page 2 of 3 12128104 Continued

Facility Number: 'Z Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
WNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0"No
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C:�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JZNo
❑ NA
❑ NE
23.
If selected, did -the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,-'&o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EJ/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�jNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
UNo
❑ 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
�TNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�j�--
Ltvo
❑ NA
❑ NE
x:
AdditionaLComments and/or Drawings:,
( J 4
/ 1,
7/,;X//0
l,7 r/0 9 - c79'
o Ce Jul-e -k C QM le Z
-r c2-d10 .
` F�rrn
0� Ae
-5-laY
Page 3 of 3
12128104

I`
Type of Visit ca pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitod Routine 0 Complaint 0 Follow up O Referral Q Emergency . 0 Other ❑ Denied Access
Date of Visit: /C
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: 11 Departure Time: County:
nt-S� ; 2 �; rZ'p - 7 Owner Email:
Facility Contact: Title:
Onsite Representative: S O�
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator• in
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 = 1 = is Longitude: = 0 0 . = «
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
iry Cow
❑ Wean to Feeder
IEJ Non -Layer
I
I
iry Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
El Farrow to Finish
❑ ers
El Beef Stocker
❑ Gilts
on-Layers
❑on -La ers
N
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Co
❑❑Beef
Turke s
Otl
❑ Other
urkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J;i1Qo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes E;No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes,.EMo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[]Yes L3 o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Npmber: 3 — Date of Inspection C( /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ZNoo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes',�INo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �o
❑ 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 EFNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
❑ NA ❑ NE
42Wo
(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-N b
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3-No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes Rio
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [!]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes � No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes .[amo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes -2 rvo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2-n—o
❑ NA
❑ NE
-Far,-10-t �4- l'ecd
!3 /vctx� cof r
Reviewer/Inspector Name PC Phone: Qr rJ�
Reviewer/Inspector Signature: L_ Date:
Page 2 of 3 12128104 Continued

Facility dumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesZ—No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �2NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sod Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes .ETNo
❑ 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 P.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes /
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Jallo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes):11q_o
[:1 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E]-tto
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes__12'1Qo
❑ 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 .3No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Rio
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ,Q" o
❑ NA
❑ NE
Additional Comments and/or Drawings::.
GL1�iP
r� Con
y/ ag I e��s 740 htl"s �
7 7119
Page 3 of 3 12178104

IType of Visit ,a -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !.,7- 0 Arrival Time: `G ii Departure Time. County:
Farm Name: r 1✓ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: _6-)//76
0004[= g, �o=I =11
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non_La et
Dry Poultry
[--]Layers_
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E]
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 UNo ❑ NA ❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
-�!No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -31 — i?U Date of Inspection 2 Z/
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9.Xb ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): /7. _
Observed Freeboard (in):
71-Q CCordi
' !
5. Are integrity the
t any of st ctures observed?
there i media threats to the
❑yes _[:�No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [,Ixo
❑ 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 �lo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes,2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C;�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes [-ilo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) 22,(rmx4a,
13. Soil type(s) 1Ci V �t Y-)
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 .❑ No
❑ NA ❑ NE
16. Did'the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes FfNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 23-No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O'No
❑ NA ❑ NE
Irawtngs of facility to bet/
Reviewer/Inspector Name �Kt� Phone:
Reviewer/inspector Signature: Date: l� a
1212814 Continued

Facility Number: '3 Date of Inspection (�
'Wcluired 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 ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _)2No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soit Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfali ❑ 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 ,ONo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
J2'1,4A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,❑'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
23"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA _2NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J:lNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,0'Ro
❑ 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
J:?No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�' o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[-]Yes
[,_]'No
❑ NA
❑ NE
e
Additional Comments and/or Drawings:
.� /3a
r�✓Iflprl 54 c7d, vrcrl Ya�� 1�
raC j�- GJ6i re° (�/�� Z2 S �� can
12128104

Type of Visit gCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit: I & 1716 0 Tune: I V-'JOc
Not rational O Below Threshold
13 Permitted 0 Ce ed © Con'dJittio Certified 0 Registered DateLast Opera or Abov Threshold: W.
Farm Name: •CA 2_ � _ County: _ . ��..... .. ___ ......_..
_.
Owner Name:
Mailing Address:
Facility Contact: I
Tiitle:Onsite Representative: ,� � .
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator.
Operator Certification Num r•
I&
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude ' ° "
Desiga Curti Desga Gurremt . :. IiestgaCmieat
„ i
Swine Po lionat' ci < Po Cattle L s `Po hon
Dairy y
Non-Dairy
:
.aty
oto SSLW
a _
Nmmber I:sgoD�S
m �r-ZI
Wean to Feeder
� La er
<: y
, ❑Non -Layer
Feeder to Finish
Farrow to Wean
�"-
�� Other
Farrow to Feeder
Farrow to Finish
Total Design
Boars
.Z'
Discharges & .Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes X'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes oNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �To
Waste Collection & Treatment t
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 00
Struct�e l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: / --- . ----. --
Freeboard (inches):
12112103 Contfnued

Facility Number: , — Date of Inspection
5. Are,there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes eErNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes tEf�To
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes -0'No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes i,eNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceru nprovement? ❑ Yes O'No
I L Is there evidence of over application? If yes, check the appropriate box below. ❑ yes _[ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
12. Crop type G /
13. Do the receiving crops differ with tho ignated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes e]No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes (;No
b) Does the facility need a wettable acre determination? ❑ Yes IJ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes )RrNo
I6. Is there a lack of adequate waste application equipment? ❑ Yes g No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes P�No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P�No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ yes XNo
Air Quality representative immediately.
a—2 °are :r. 4 outer,
r c—
;Camtatient, {re%tr,�bt� gtusteoa:#) F.�cPism:apy YES nswers aadtar aay� or swi ,aoipaudrtenls. a
Use drawutg of fly Lo`beaer pcplarn°�'tnati��ss. (arse��ditid�=ages as ac�ary� Field Copy ❑ Fiaal Notes
f 'JrYI iS i i�1 Za 1 y1 ) jq `
Pe car d s ne_ci+ o rcZQ_r 1
?� ,F•�,.-mom =.gyp .. -ra.,.s m�'�YT"- - ,.,SS, ;-�% °`��„"�--�3,....-...,.,.��„.�.�-�,�::�. ,x��
Reviewer/Inspector Name -
ReviewerAkspector Signature: Date: l 0
I2/I2M3 Continued

Facility Number: 3 Date of Inspection
Required Records & Documents
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?
N'PDES 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 1" Rain
❑ Yes ,0 No
❑ Yes .EMo
❑ Yes P�No
❑ Yes J�lNo
❑ Yes ONo
❑ Yes La'No
❑ Yes ONO
❑ Yes ONo
❑ Yes ;2 No
❑ Yes J2Wo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit I&Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 2 Time: as
Facility Number
Not O erational Betow Threshold
® Permitted O CCertified D Conditionally Certified 012egistered Date Last Operated Agh,�!
orAbove Threshold•
Farm Name: ./ L1It S �u & ►w County:
Owner Name:V Al, Ay 0 r' Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Vr 5 y Ito ✓
y�Phone /No:
Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine []Poultry ❑ Cattle ❑ Horse Latitude • 4 a Longitude 0 6 Du
` D seign' Current Design M T Current Design Current
$wine Ca aci P,o elation Ploultry Ca aeity § P,o elation Cattle Ca aciE P,o elation
rE
Wean to Feeder . ❑ La er ❑ Dairy Feeder to Finish ❑Non -La er ❑ Non -Dairy I Farrow to Wean Farrow to Feeder ❑Other
❑ Farrow to Finish
Total Design C►apacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 0MID Subsurface Drains Present ❑ Lagoon Area ❑ S ra Field Area
Holding Ponds 1 Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
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 4 No
3. Were there any adverse impacts or potential adverseimpacts 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 EtNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches):
05103101 Continued

t
Facility Number: 3l — 0 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?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
DSNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
h No
11. is there evidence of over application? ❑ Excessive Pending ❑ PAN Hydraulic Overload
❑eYes
15No
j❑
p �j
12. Crop type P/irt 4 -i 6�a ) * az- -/WA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[R 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
Rauiuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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
KLNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
fqNo
(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
KLNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
G$JJNO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commknts ref r to .uesiino-iii EX anyYES`answei s"andlar any reeoia�mendations-or any qt er.cauaments
( q, ) P r
F
d�rgawings ty to better (use as,
of§facrl ex}plain sltu_attons: raddEhonal:pages necessary) _ ❑Field Copv ❑Final Notes
Jv- -1v -/-4 4 w.-ste doP1,os W ys 47
re caoe&wi% s.��5 CUPrjr �•as — l�d�vf)
�P5'� O� ltr�in d` /'cPLDrG[S LGoI� CT�oGt',
D i i -h C e 4 Gt 40--n
- _- -
Reviewer/Inspector Name �^ -
Reviewer/Inspector Signature: Date:
05/03/0I Ql1 3��„ �l/�� ��� r-2� Continued

Facility Number: 31 Date of Inspection(}
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
05103101

0.Drvrsion of Water.zr
l2uality
w� Q Ihvision of Soil andWater Conservation
W
Q Oth-
eir Agency.
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Z Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Z /1 0 Time: � Printed on: 7/21/2000
Facility Number
Q Not O erational Q Below Threshold
Permitted []Certified E3 Conditionally Certified D Registered Date Last Operated or AboveThreshold: .... .......,.
Farm Name: % LI�GS...... 6"9 LtJ.....i�Rwv ........................................... County:..!iPLh'V._...............................................
AOwner Name: (vZ. .........! \.., .. Q Phone No: ..... .......................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:...0(ry lr1. ................................................................. Integrator: A-49 _.
Certified Operator:
Location of Farm:
Operator Certification Number:
J6 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude ' 6 69
_ Design Current
Design Current Design. Current
Swine ci Po eation
Poultry
nCa
'ti
-
Wean to Feeder
JE1 Layer I
❑ Dairy
=
Feeder to Finish
10 Non -Layer 1
10
Non -Dairy
'r
)Farrow to Wean
Farrow to Feeder
2
❑Other
rt'
Farrow to Finish
Total DesignCa ci
� ty
Gilts
Boars
Total SSLW `.
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation? ❑ Yes JW No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
/� No
❑ Yes Y(No
Structure 6
Identifier:
Freehoard (inches):
5100
.......... I ........ - _..._......
5p
Continued on back

i k-.
Facility Number: Date of Inspection
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 Overlo
12. Crop
13. Do the receiving crops differ with those desigitated 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?
(ieJ 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?
yioiaiiggs;et defe�enct�5 w'rb oo(ed dirrirs}ti Yoh w i rt iye o furt gr
ctir'respy deuce: abaut th's IIL • . .
CommenblItifer to question#): Ei_rpiain any_ YES; answers and/or any recommendations or any other comma
Use drags of facilityto=beeptaon(uaddxaasrabPe,necessary) — h_
_
❑ Yes FfNo
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes ONO
❑ Yes 0 No
❑ Yes P No
❑ Yes JVNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PfNo
❑ Yes XNo
❑ Yes �dNo
❑ Yes P(No
XYes ❑ No
❑ Yes P�No
❑ Yes [INo
❑ Yes io No
❑ Yes A No
❑ Yes toNo
❑ Yes gNO
�9 j , /1/�,E'� ��� � �/i�S�� GAiI/ a �� �C•�I lh�i� z�/lii�'S
Y5 7
47 ell, LllpUkre A
Al
Reviewer/Inspector Name 1512
5/pp Reviewer/inspector Signature: Date: f

4
1'0
Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes O/No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yeso
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 J No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Ld W
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
'Additional -Comments an or Drawings:- ;
112- A,, 4A)
�y 5 0
SGr/%14C-
� T
if -
(,k;-, 025:51%ZOe7- S
51�'7147_'C-
S/00

l]rVEston of Water Quahty r
' Q tvision of Sat1 and W vnservstton
Ater C
Type of Visit XCompliance Inspection O Operation Review C Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �i"6 V Time: © Printed (in: 7/21/2000
6d
Q 'Not Operational Q Below Threshold
0 Permitted © Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... . !- -...J u.t.!..................................................... County°:....- - -- ................ .......................
........ s ... ......
Owner Name: Phone No: Iy s�� � �S ()9gsll
FacilityContact:.............................................................................. Title: ................................................................ Phone No: 1
MailingAddress:......................................................................•---..__....._......_...........................__....._._...__.... ..........................
l ID
Onsite Representative: __.. L. !r..`........ �S ....... ✓ Integrator:......... �\_...... i...............................................
Certified Operator:,,,,,,,,, Operator Certification Number: ..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° =z Longitude a i is
Design Current
Swine Capacity PODuIatiOR
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag000n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid "'ante Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes b(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyancc plan -nude" ❑ Yes ❑ No
h_ If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. if dischar�ze is observed. what is the estimated flow in galhin"?
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 bi'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes t?slo
lVaste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Structure I Structure 2 S€ructlirc ; Structure 4 Structure 5 Structure 6
Identifier: ........................................................................... ..
Freeboard (inches)_ ys
5100 Continued on back

Facility Number: 3 — 6� Date of inspection Printed on. 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes D<No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes f.'9(No
Waste Application
10- Are there any buffers that need maintenance/improvement? ❑ Yes kNo
IL Is there evidenteof over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes XNo
12. Crop type �p -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes %fVdaLNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio violafiflns:or. if hcie.ncies were noted-diWitig this:visit:-;Y:ou will receive tiq fui-ther
- corresnonde' about: this visit::::: ... .
0'Yes (:]No
❑ Yes I,'-xrNo
❑ Yes JR(No
❑ Yes b`No
❑ Yes ❑ No
Wes ❑ No
❑ Yes '4No
❑ Yes R No
❑ Yes 9No
❑ Yes VNo
❑ Yes 'VNo
❑ Yes VNo
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):
��� Gl� �'-i+ 1...� ��� �-.Q_ ate t^►--�-��-'t.+--t-� �-1[��, `�t,,t?,�
c_� s� 1Q t�l' Z- Y e ire eA
� ��� ►-�..� w � �� j
"_�'+ Ll�� 1yyk5 -- COItti ::-IVAly �%I �• 4 d'r'-us Li
Reviewer/Inspector Name y\ (A 6�Q, 10-3T5—_M 6 Jl : o�
Reviewer/Inspector Signature: Date: 4 - 91 `-`o D 5/00

Facility Number: 3 — (J Date of Inspection Printed on.. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor below kes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
itiona -ornments an orDrawings:
rl cy , tee. w�l-e �c c� `—� s C� ►�4 e,�, (�a
5 `t-
r7) G4�1 4-'t 4� 19� -QX d E-,A- d
G GCL._v3�
eve -'A t V-"� <P'Vc'k�' L, " -'�- Z' Q'- g'
5100

i Division of Soil and WatermConservahon'-Operation Review
i _
Division of Soil and Water'Coitservation' Cori [iance Ins ection - '
p- - 1?
Y t ,�Divisiion of Water Quality _Compliance Iiss ection _
�:Othei. Agency = Operahon Review e -
ti br
Routine Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 3Q 24 hr. (hh:mm)
© Permitted © Certified 0 Conditionally Certified 13 Registered 113 Not O erational Date Last Operated:
............. ....
Farm Name:—A.lyi .......... Q. .......L.-.`� 11�L....................................... County:..... ....0 �!.jh.:......-�.../.......
�...... ....................
Owner Name:.....,���1 y,,tr �k . f'i��. Phone No f '�1-��...a.`?r`..:!. (........................
S A• (, Phone No: !/U a�S
Facility Contact: .. .�r..................... )-.-.... Ttt1e:..........%Z��.......-...........................-. ...........
Mailing Address: .........................`"1 ......�ilPrsSS. ......(,2' :............! ........ ................ �L :..)...,/ .. ............
Onsite Representative: . rt „ „, ..ram...., Integrator: ...... ..........................................................
Certified Operator: . Operator Certification Number:
........................................................................................................................................................
Location of Farm:
r......................................................................................................------- ....... ........... .................................... ...................... ..... ........................... --.........................................
�
Latitude 0 & Longitude ' 6 j '64
Design Current:
Swine.. Capacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
2 v
❑ Farrow to Finish
❑ Gilts,
❑ Boars
_ Number of Lagoons 0 ❑ Subsurface Drains Present ❑Lagoon Area LP Spray Field Area
Holding;Ponds /Solid Traps ❑ No Liquid Waste Management System
_Discharges & Stream Impacts
1. Is any discharge observed from. any part of the operation? ❑ Yes 1No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes 0 No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ YesT/Af-
d.No
c. If discharge is observed, what is the estimated flow in gal/min?
Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes PNo
2. Is there evidence of past discharge from any part of the operation? [:]Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes V No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Plo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):...........................................................................................................................................
5. Are there any immedia threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes To
seepage, etc.)
3/23/99 Continued on back

Facility Number: I — Date of Inspection
6! Xre 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 r
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 4N0
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 *o
11.
Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN
❑ Yes
91No
12.
Crop type M56
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
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Cl Yes
ONO
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
PNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M!No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
19No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
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 1f No
24. Does facility require a follow-up visit by same agency? ❑ Yes JX No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �kNo
10 yiblatioris.
o� deflciencies •*ere hbfed diWing fbis:visit; • Y:oir will-tebthri6 06 rui th r ; ;
comes oridenee: abcru this visit:: • .. • • . • • .. • .... ..... • . ' • • •
Coinments:.(refergto:question #): Explain any, YES answers and/or any recommendations or;any.;other comments:"
Use drawings of facile to better,ez laiii:situations use additional: a es as necessa
. - -
t3' -- - - �_. E_ � P . g _ I S')
r V, _ �`
,o-� well.
k
r /s Ge� Cr�p �tan a+'�dt -�'es A�'�{ i'zvYO 9,%
t 7 7eG e E'S5C// i h/ ni w C/ A
Reviewer/Inspector Name
Reviewer/Inspector Signatur r Date:
AZ
j
11 M) l_lz)� C 3/23/99

Facility Number: —
Datc of inspection J1-.7Z-
Odor Is aces
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
[ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
( No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
ElYes
No
g
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
&0
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�(No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
o
JAdditional omments-an or: , rawgs: e
3/23/99

Name of Farm/Facility
Location of Farm/Facility
Lagoon Dike Inspection Report
31 r &60 • -
5►� Ie3a
Owner's Name, Address t i 5 l -LAC 6.0- _
and Telephone Number
Date of Inspection Qt 5 Names of Inspectors A -
.C?�`b 1 u
r .
r[
Structural Height, Feet afd Freeboard, Feet a�
Lagoon Surface Area, Acres 3 �1 �- Top Width, Feet
Upstream S1ope,xH:IV Downstream Slope, xH:IV
Embankment Sliding? Yes _ No
(Check One, Describe if Yes)
Seepage? Yes . _�Z No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up: Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments
,ter.

Name of Farm/Facility
Location of Farm/Facility
Lagoon Dike Inspection Report
31 rCoe),c -
S1�,;- 1ja3a
Owner's Name, Address �_ Lyi 5 �_ A(on-
and Telephone Number
Date of Inspection
C?�v1 V Z 5O
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
9-5 Names of Inspectors
r
�d Freeboard, Feet
3 A e- _ Top Width, Feet
Downstream Slope, xH:1 V _ -314 - /y
Yes No
Yes - y- No
Yes No
Yes No If Yes, Depth of Overtopping, Feet
Follow-Up,Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

i
Facility [Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted M Certified p Conditionally Certified p Registered In of per ahona Date Last Operated:
Farm Name: AL.Y.LS.S.Q.W..E MM.................................................................................. County: Duplin WIRO
Owner Name: ALYIS.R T.QN............... RAYMOR ................................................. Phone No: 910-285.-5751 ..........................................................
FacilityContact: ...............................................................................Title:.........._............................_.._...................._ Phone No:....................................................
Mailing Address: 114.CYPRESS.CREEK.ROAD.................................................... Wallaer—MC ........................................................... 2846fa..............
Onsite Representative: .......................................................................................................... lntegrator.Murphy..Eamily.Earru.......... :..........................
Certified Operator:AlYis.R_................................. Raynor Operator Certification Number:2I1120.............................
Location of Farm:
Latitude' ®0®4 ® Longitude ©• ®C ®'°
g esr n;:"CurrenU,.,
Swine- -` -Capacity.Population
❑ Wean to Feeder
p Feeder to FEET—
❑ Farrow to Wean
® Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Boars
Number of=Lagoons - ❑ u sur ace rams resent ❑ agoon rea ❑ pray �e rea
Holding Pondv1'-"961id1Tr�SL o Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [3 Yes p 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)
2. Is there evidence of past discharge from any part of the operation?
[]Yes []No
[]Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
..........................................
Freeboard (inches):...............24............... ....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
p Yes []No
Continued on back

Facility Number: 31-600 Date of Inspection
16. 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 maintenance/improvement?
❑ Yes
[]No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[]No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[]No
11. Is there evidence of over application? p Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
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
p No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
p 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
p No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did ReviewerAnspector fail to discuss reviewfinspection 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
CY ; N.o.�viotations:or.-de:fii`ncres•were_moted:durilig:this visit.' - oa;viil:rereiv, a no further-:.
..... .. ... .. .. .. ........... .
:: i•or�es�vndeince. a oitf this:visit::::::::::::.. :::::::::...:..:.: :
freeboard available. No problems observed.
Reviewer/Ins ector Name F
p Alan -Johnson � C aKooirtz (DI�;Q)
Reviewer/Inspector Signature. Date:

Division of Soil and Water Conservation [3Other Agency
®Division of Water Quality i
�'
Routine O Complaint O Follow-n ' cif DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number �,
Time of Inspection L L 24 hr. (hh:mm)
©Registered 0 Certified © Applied for Permit' 0 Permitted 113 Not O erational Date Last Operated:.••,,,,,,,,,,,,,,,,
Farm Name:...........M.VJS.......$G47......1 r►, County: ...... D.0 p.hl...................................... .......................
OwnerName:........L X�111 ....... !.F Qt ........... ✓lQ........................................... Phone No: ... (9.19MX..115.1...........................................
Facility Contact: „•••.•„• . Title: . Phone No:
Mailing Address:.......�.L.` .... .7��?? SS....... Sr � �,.....:..� d................................. ....Lt lA .t.rns..t.... N.................................. n? L(.........
Onsite Representative:....... !.1l� 5...........K1_ y-N .......... .. Integrator:......6A C�................................ I................
in
Certified Operator-, .....ce.`..... }!1.Y.............:................................. Operator Certification Number ..........................................
Location of Farm:
0&.....�.Csz1�
.... aa..e :.....1P.f.....nK... 1�0. a 5..�:�s...:wr�.z i ...a.� ....�4!4. ��},............................. ............................................................................
.............. ..... .......... ............
Latitude Longitude
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IN No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? i
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [N No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
V] No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[ No
7/25/97
Continued on back

Facility Number: ' C}
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes fij No
Structures (Lagooiis.Iioldtng Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... :.................................................................................
Freeboard(ft): ......... Z.,.!!... ........ ......... ................................... ........ ............................ .............. .............. ...........................................
10. Is seepage observed from any of the structures? ❑ Yes M N o
11. Is erosion, or any ether threats to the integrity° of any of the structures observed?
❑ Yes
�9 No
12, , Do any of the structures need maintenance/improvement?
V 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
O No
Waste Application "
14. Is there physical evidence of over application'? T
❑ Yes
No r
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..........�(Y.V-e..................... (?h. ........... .St1:1Eal...... Viar....... ........................ .............. ..................... ..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18. Does the receiving crop need improvement?
-Yes
❑ No
19, Is there a lack of available waste application equipment?
❑ Yes'
O No
20. Does facility require a follow-up visit by same agency?
(Yes
❑ No
21. Did ReviewerAnspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
MNo
22. Does record keeping need improvement? `
Yes
❑ No
For Certified or Permitted Facilities Only
,
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
E.No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0 No.violations or deficiencies. were noted during this visit.- .You.vvill receive no further
coerespondence about this'.visit:-: •' .:. .
Comments`:{refer'to question #): Explain any YES answers and/or any recoinEnendatioiRs;vr any other ciminents y
Usedra1 g ws of facilitv'to better explain situations. (use additional pages as necessan) ; K y .
kh�ihbO
ve_ t,,sorl4i,,� br )eta &,ea i rt el (- L Kl,� �%xv'r kod
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1"lZ-LIAA, 151. 11 10 141b cc e su-- tr 7/25/97
owl
Reviewer/Inspector Name I
�tn .lam `!.f-W
Reviewer/Inspector Signature:, rl_��% - __- Date: la

❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
e.,
110 Routine O Complaint O_Follow-up of DWQ inspection O Follow-up of DS�_v O Other _
w� Date oi'Inspection $ Zb
Facility Number D
Time oi'luspection :3O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm :Status: ❑ Registered ❑ Applied for Permit (ex;t.25 for I hr IS min)) Spent on Review
J. Certified ❑ Permitted or Inspection tincludes travel and processing)
113 Not Operational—Operational-1 Date Last Operated . .................... .... ... ....................... ...... .......................... I ........... .
bLFarm Name: `r Coturty:....:?�+"�.............................................
.......� ..... Y� 5......A/r?.....F.G YrYI.......................................................................
Owner Name:...... i �A1!t`5..... ..... hAT..................................................... .............. Phone No:...L 1C1 Z$5 —?5�................,.....
,..................
Facility Contact: ... jv1 :1.........�!ltc1Q�........................ritle:......... ca.b.?AUr.................................... Phone No: 01!1��..
.�. .-...T���....
i1lailing :Iddress:...3.1 ..... !�.1 5+. ........C.Jlxe. ........ 4ll.............................. ....... ..........lel��I st.C........1J.C.................................... .4?.j.4.iv.G...........
Onsite Representative: ........ .t.`hLv-.->.......... 4.44,..................................................... Integrator:....MuX..............................................................
Certified Operator: ............................................... .......... .... Operator Certification Number: 7'.U.lA
Location of farm:
�............ 1 .....St? We-g .....�,.r an... K !ixf..... (.' : Qn...........SK...{.. .....�xM is Q�� .rr'�...5....en..............:El t ....�`��......�f�... �..:........ ......................... ....................I.... ...... ........ ...........
Latitude 0 �« Longitude ' 1 :4
Type of Operation Design . Current Design Current Design -' Current
Swine Capacity Population Poultry Capacity; Population Cattle . Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
El
Farrow to Feeder
J D
❑ Farrow to Finish
❑ Other r
ee of Lagoons [Molding Ponds ( ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area •,•
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
ER No
2.
Is any discharge observed from any part of the operation?
❑ Yes
j1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
V] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQI
❑ 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)
El Yes
No
1
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
S.
Does any part of the waste management system (other than lagoons/holding ponds) require
ERYes
❑ No
maintenance/improvement?
4/30/97
Continued
on back

Facility Number: ...1....... �...�.,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
(RNo
Structures Lagoons and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (@): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
..........I:....... _ .......... _... .........................». ....................... .... .....
_.... ...,
..._�
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
EZNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
MNo
(If in excess of WMP, or runoff entering waters of the State, notif�y� D`t WQ)
15. Crop type ......... SnS
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[25 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18.
Does the receiving crop need improvement?
❑ Yes
U No
19.
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Ja No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EZNo
For —Certified
Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily'avaitable?
❑ Yes
RI No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IM No
24.
Does record keeping need improvement?
❑ Yes
ONo
Comments (refer to questron #} lrxplatn any YES answersµandlor any recommendations or any, other comments
Use drawmgs;of facility to better explain situations (use additional pages:as necessary} �,
Z „•,
S. L.owwv-<- at,) cats wad ie��J ��. �►elds � i � � z s6vO toe. {NW a,. rr..se.cQ •o �rCv 4
P`l� i ^�/z r+�pr� S�in1�tR 1r tvlu l� e -+ 1 `ec� e [7 n h r5 52�5 �ar r� ►v� W c�e� w� . has -
tZ. EVOSkov, area-5 OK OVW ViM o� fAs� Slnot�� �1? �'��ec� wi� day rar•� nSeedec�. �re.
real s k,J J L e_ mse,� e3 ,
LQ_ t-asao►. t]CSigh Sskoc/Q
cc: utvlston of water VuaUty, water duality . ection, Pacility Assessment Unit 4/3U/97

Site Requires immediate Attention: N�
' Facility No. _ j I --& D p
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: <F A .1995
Time: l -
Farm Name/Owner: 4nc 'i�
Mailing Address: 27` a ,3 a,( c-?-ff3- N_ �� oAFr
County: _Dt4P! i A - -
Integrator. _M j rP j - - -- Phone:
a�SH �F�n�tvJas� `1nd'
On Site Representative: Sr6 vC- G'�PECA Phone:
rOCO^ wa %a eA -+- 1 c t 1 .e Ll- I c;- -1-ry. 4- � 4,7'A4-�
Physical Address/Location:
Type of Operation: wine ✓ v Poultry Cattle
Design Capacity: (�b0 Sows -_ Number of Animals on Site: 306a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �{' �J ' 194t_A' Longitude: +1 ! �5 ,7 Elevation: -22
Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
• (approximately 1 Foot + 7 inches) (Yes r No Actual Freeboard: Ft. Inches -
Was any seepage observed from the lagoon(s)? Yes r'No Was any erosion observed? Yes oi(i o/
Is adequate land available for spray? rYe- r No Is the cover crop adequate - Ye or No
Crop(s) being utilized:- clel�
Does the facility meet SCS minimum setback criteria? 200 eet•from Dwellings? Yens r No
100 Feet from Wells? e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orN
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or o'
Is animal waste discharged into waters state y -made ditch, flushing system, or other
similar man-made devices? Yes No I� Yes, Please Explain.
Does the facility maintain adequate w to management records (volumes of manure, land applied,
sDrav irritated on sDecific acreaee with cover croD)? Nor No
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.