310624_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Ki"sio' noi Water Resources
Facility Number I �-�� - G� Division of Soil and Water Conservation
_000Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
q=l 'O
Date of Visit: Arrival Time: Departure Time: /�?; p'� County: l Region:
Farm Name: r—arr,�,_ Owner Email:
Owner Name: (�� t��1 i Q w Phone:
Mailing Address:
Physical Address:
Facility Contact: / Dort- Title: 4 -
Onsite Representative:
Certified Operator: V.l / C�i✓ „ a2e3 L==
Back-up Operator: /`V'rz_ zf -Z) wt5 ff"`'
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C*apacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Fop.
Design
Cattle C►apacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,onl. ,
Layers
Design
-F aci
Current
Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
113eef 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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes allo
❑ Yes Jallo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

- [Facility Number: - Date of Inspection:
r.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[g No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
I7 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?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [Eg.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
dd Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Zt7 ` t/udam- / 9 u �-S I-2-
13. Soil Type(s): f1u-15
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [B�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3QNo ❑ 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?
Reauired Records & Documents
❑ Yes [2 . o ❑ NA ❑ NE
❑ Yes E3-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3.No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield" ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C?I*o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 71
J�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
D NA ❑ NE
❑ Yes [�q_No ❑ NA ❑ NE
❑ Yes 5,No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes �No
❑ Yes J&No
❑ Yes ®_No
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
V'�J7_5CL 7-W 0 01 C� ,
rJ so It
Phone:
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: x, Arrival Time: i i v Departure Time: County:
Farm Name: �, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
/'0 _ Title:
Phone:
Phone:
Integrator: /1-7 //Z
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region: 4 1 1&,,
Design Current
Swine Capacity Pop.
Wean to Finish I
Design
Wet Poultry Capacity
ILayer I
C*urrent
Pop. Cattie
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
iNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Ory P.©nitr Ca aci.
ILayers
Dairy Heifer
Dry Cow
'
jr,o Non-Dalry
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
jBeef Brood Cow
Other.
Other
Turke s
Turkey Poults
Other
DischarLyes and Stream Imnacts
1. Is any.discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
,2 F4o
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
L2-IQo
❑ 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-jaQo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JD-N/ ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

F�
Facility+ Number: �3 1 - h, C.j Date of Inspection:
Waste Collection & Treatment
4. Is sto age capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F TNo ❑ NA ❑ NE
` a. If yes, is waste level into the structural freeboard? ❑ Yes El"'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑'itio
❑ 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
'[TNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ 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
ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
12'RTo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C24o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.}
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[DNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑,No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E211�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
La<o
❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EE]"No
❑ NA
❑ NE
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Eplq'o23.
❑ NA
❑
Page 2 of 3
21412014 Co

Facili Number: - Date of Inspection:
.24
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;ZNo
❑ NA ❑ NE
2-5-As the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[2No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�(
E No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
F-3/No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
77
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�J'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ZNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E� No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[)No
❑ NA ❑ NE
omments: refer, to des 't�on Explain any YES answers and/or any additional recommendations or any other comments.
C ( 9 _
Use drawmgs'oi facility to better_explain "situatio 'ns(use additional pagesas necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
15-al(/1 r V,"'j9S I VV 500& a C&C-
Phone: 6
Date: fii LS 6
/4120I5

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: rrival Time: eparture Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6" P'— / r ` ) "-0—
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region: � /%
Phone:
Integrator: ` 1
Certification Number: L�
Certification Number:
Longitude:
acity Pop.
ge Ctar,
Wean to Finish
Wet Poultry
La er
[Non -Layer
Capacity
Pop.
Cattle Capacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
3o
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,ou1
Layers
Design
Ca aci
Current
P,o .
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes allo
❑ Yes PrNo
❑NA ❑NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes PfNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ETI ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes IlJ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm t?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
to
J�fNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
(ZfNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
PNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �No
❑ Yes 5"qo
❑ Yes No
[:]Yes No
0 Yes 6�0
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Q/ -3P.,�
W�
lLIo//V
Reviewer/Inspector Name- Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/20I1

r
Type of Visit: .g Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 3d County: L 11--m
Farm Name: R&Y4 zq Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: �� JY • YV
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
We
7inish
Design Current
Capacity Pvp.
Design Current
Wet Poultry Capacity Pop.
er
Design Current
Cattle Capacity Pvp.
Dai Cow
Wer
ELa
Nan -La er
Dai Calf
FeeDai
Heifer
Farrn
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oultr. C►_a aci. P,o
La ers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
I urke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�TNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

r
Facili NDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
4No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
7No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
ZNo
❑ 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
9TNo
❑ 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ';E] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KrNo ❑ 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
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Zj No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA ONE
Page 2 of 3
21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 7No ❑ 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 VfNo ❑ NA ❑ NE
❑ Yes Vf No ❑ NA ❑ NE
❑ Yes [?TNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VT 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 drawines of facilitv to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
pSignature:
Reviewer/Ins ector
Page 3 of 3
Phone: �J�"'b1We�a5fj
Dater
21412011

i 'A
Type of Visit: 010compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QTRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:l kl),- a) "Departure Time: County: � J�(& Region:
Farm Name: ir►Qr11w k� �y�.1 _ Owner Email: �`--�"
Owner Name: ti ml—P Tt, W Phone: .[phone]L%q
Mailing Address: a / s h! i 'j R ti Rtjl .15jT'"9L-t?2'
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &rce<
I w re,
Integrator:
Certified Operator:
�'1a
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
.,
Wean to Finish La er Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current D Cow
Farrow to Feeder
D�, P,ault , Ca aci P,a , Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
TurkeX Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes [2(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[;�<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[20�o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number_ _! � - j Date of Inspection: ') /! / g
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
jStructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): +
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [dNo ❑ 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 P!rNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 G�'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 dNo ❑ 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 E?rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crot) Tvve(s): &7elr 1 G� Isr.-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [El No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑' No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[if No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents 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
�3 No
❑ NA
❑ NE
the appropriate box.
❑W11P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Zf No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EyN
❑NA ❑NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ONE
Page 2 of 3 21412011 Condnued

r .. '16
FaciliNumber: - Date of Ins ection: 671J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2No ❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[;�_No
❑ NA
❑ NE
❑ Yes
[dNo
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
[:]Yes Z No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes VrNo
❑ Yes E No
❑ Yes ZrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): 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).
, P"p,w t a_
Reviewer/Inspector Name: S+US :��
l� . -,
Reviewer/Inspector Signature:
Page 3 of 3
Phone:ij�-�
Date:
21412011

• Divis'ion of Water Quality
JIlacility NumberE-:, - ® ®Division of Sail and Water Conservation V
Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �j ] Arrival Time: Departure Time: ® County: Region:
Farm Name: `�O(Y)6 j S jOA/ FlqZ(V\- Owner Email:
Owner Name: lJ,D1 iJLE T 1 Phone: oQ ✓Q - S `T
Mailing Address:
wu c� EDwaQoS Q.� &_c'LjQu7u.E Nc 985m -91-/��1
Physical Address:
Facility Contact:
Title: Phone:
t=
Onsite Representative: CLa(L I J� /� `� 1 oor-e
Certified Operator: (Y1 E[) ✓ y •
Integrator:
9:�), a
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
11
Design Current
Wet Paul[ry C►apacity
Layer
WC*-1ttlje7Z
Dairy Cow
Design Current
pacity Pop.
Wean to Feeder
L4 ip?
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
110.9P,oult , Ca aci I;o ,
I Layers
Dry Cow
Non-Dairx
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Puults
Other
Dischartres and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility dumber: - (o at-/ Date of Inspection: ) 114Q
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 M No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
(KOOA(
Spillway?:
Designed Freeboard (in):
%9.5
Observed Freeboard (in):
� R
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
EYes No
❑ Yes No
VW
❑ NA ❑ NE
❑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 A 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 [3Frozen 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
MY
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes INo
❑WUP ❑Checklists QDesign ❑ Maps ❑ Lease Agreements ❑Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Q Waste Analysis 0 Soil Analysis [3 te Trans ers Q Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections 0 Monthly and 1" Rainfall
Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Tacili Number: - Ig g L/ I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than nonnal?
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 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: ..«R,::. •. -
Use drawings of facility to better explain situations (use additional pages as necessary).
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
N NA ❑ NE
W.A.
V0119 c1 •i9
I014IA C).�I
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
^ac-tgGZAr! on1 �ck� 016 / 9
I L
CL o�C3 L l 5�--�� I IV 10
Nv rr DNA ��� G I�
SD
Reviewer/Inspector Name: MmA/Y0l4 Q:3141A
Reviewer/Inspector Signature: CIMOVWn
Page 3 of 3
Phone:
Date: O`� ��-
2/4/2011
11

Division of Water Quality f
Facility Number Division of Soil and Water Conservation /
Q Other Agency v .
Type of Visit Acompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: lL Departure Time: -County: L, -1Region:
Farm Name: owls �Owner Email: I I
Owner Name: WILL E ff• ES i�al Phone: �` Sa _S g—� yy
Mailing Address: of � >f LLA 1yc UR Sig
Physical Address:
Facility Contact: Title:
n
Onsite Representative: `46MECg)r �1LLGTTC V3F_S-104
Certified Operator: (Zorn rn EC) /V - w F 5 70.,!
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
Other
❑ Other
�o
Latitude:
Phone No:
Integrato
11
Oper or ertification Number: � � f
Back-up Certification Number:
=" Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Cow
❑
Non -Dairy
❑
Beef Stocker
l
❑
Beef Feeder
❑
Beef Brood Co
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: .
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
I No
Cl NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility*iumber:'� —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffff � No El 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: � N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ^6CJ No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) III���
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YNo El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 14
9. Does any part of the waste management system other than the waste structures require El Yes"IF No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? P
11. is there evidence of incorrect application? If yes, check the appropriate box below. El
Yes �kNo NA ❑ NE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �a__5&
13. Soil type(s) Ax ?�>
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ` No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes /// ��\ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendateons.orfany other comments
1. i.
Use drawini gs`of facility to better explain situitions. (use additional. pal;6'as necessary)
GALl�34z.ATIc�+/ bE oar g AL
Sc.uo6 E 14 4- eEEN eLF-IWED O" ►
cAqGc) w Vi6-LA- cnL4_� P �X& e'` R
Reviewerllnspector Name ��:;__1 Phone:
,
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

•r 4.
Facility Number: Date of Inspection
Required Records & Documents �(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ElNA ElNE
the appropriate box. 0 WUP ElChecklists El Design 0 Maps ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )kNo
❑ NA
❑ NE
0 Waste Application ❑ Weekly )~reboard 0 Waste Analysis G Soil Analysis ❑
/y�aste Transfers
❑Xinual Certification
ElRainfall ElStocking ElCrop Yield 0 120 Minute Inspections 0 onthly and 1
Rain Inspections
C7
Weather Code
v
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA-
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes RA ❑ NA
El 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?
❑ YesN No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
'
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes ❑ NA
LNo
❑ NE
Adil�ttonalComments andLor Drawings >- � ,,,re,�, ����:_
-- I F -yN1 S j4APPF_N5 J46,9//Y! SASE NAvE sam�,ve
ctaccac w etc D
5,,�, G �1N Go6PS S66N .
Page 3 of 3 12128104

Type of Visit 3&compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tp,�,,Q L�Arrival Time: '��- Departure Time: County: Region:
Farm Name: �]y EQ ��' � `�NLP- __ Owner Email: r�
Owner Name: L^ - i�7'1e Cz C.JESzL�/ Phone: SQ YY5�5698 - 31 yLI
Mailing Address: �� i L.LA2 t wAQD S }� Gu LAU I t_LC NG at�?518
Physical Address:
Facility Contact: f 1 \ Title: Phone No:
OnsiteRepresentative: WIZ--�E•i �OMEQ k�&-1T_CPV Integrator:
(�]�� 1 1
Certified Operator: �`E-unr w �S�/Y Operator Certification Number: sF
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� c [� t [� « Longitude: = ° ❑ 4 = 6f
Design Current Design Current
Swine C►►opacity Population Wet Poultry Capacity Population C►attle
Design Current
Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder
SACS
❑ Non -La er
El Dairy Calf
ElFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Dairy Heifer
Dty Poultry El Dry Cow
ElNon-Daily
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑El Beef Feeder
Pullets
❑ Beef Brood Co
❑ Turke s
❑ Turkey Poults
❑ Other Number of Structures:
❑ Boars
O#her
11FE-1-0ther
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at:' ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
12128104 Continued

Facility Slumber: 3J —(poi Date of Inspection QIN472571
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
El 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: LA boo^f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes JANo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ?(No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ( No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes "No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1 F_ � (6 ) 5 � i C� 1
13. Soil type(s) A uR
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 gNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ANo
❑ NA ❑ NE
��" :�i� `
Comments (refer to question #): Explain any answers and/or any recomisiendaf►ons or an�,other�comments � �
Use drawings of facility `to better explain situations. (use additional pages as necessaryj� U� "=
I
Reviewer/Inspector Name 6MAIqoA�' !Al S " ;4 Phone: qj6 -"+C7 C0 C
Reviewerllnspector Signature: Date: 3 mo Jb
12128104 Continued

Facilit *umber: —69U Date of Inspection !a U
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes'�ANo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
N,
❑ NA
ElNE
the appropriate box. 3 WUp El Checklists 0 Designs El ❑ maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes X No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑)kaste Transfers /nnual Certification
[] Rainfall ❑ Stocking ❑ ( op Yield 0 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes *0
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes )KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes/TjNo
❑ 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 )Z[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ANo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
12128104

Type of Visit Xcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 023Q51 ArrivalTime-® Departure Time: County: �-1�/ Region:
Farm Name: ffC� d _ (A G_'3TCA( T'- Deo i n Owner Email: /
OwnerName: L�-�ILLETTI< 1.- . � 1 Phone oLs-Spa-�)y"1
Mailing Address: ��� w l LC_;� W(�(2 �� p a�A�, �Le . NC
Physical Address:
Facility Contact: Title: Phone No.
Onsite Representative: izomEo U3ES t cw Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: a c = i Longitude: = o = , = «
Design Current
Design Cugrent Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
Wean to Finish
❑ La er
❑Dai CowWean
to Feeder
PE
❑ Non -La er
❑Dai Calf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
Gilts
ElNon-La ersEl Pullets
❑Beef Feeder
❑ Beef Brood Co
EBoars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
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?
h. 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 Ifi�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
El NA
[I NE
❑ Yes
&iNo
❑ NA
❑ NE
12128104 Continued

i
Facility Dumber: Date of inspection
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ElNA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L,AA&ooA 1
Spillway?: C
Designed Freeboard (in): . S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes yNo ❑ 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 ❑ E idence of Wind Drift ❑ Application Outside, of Area
M4i2- \ SEprl -Ocr F�r3_MAR
12. Crop type(s) � n C90's 56 CC J �
13. Soil type(s) ACC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
MNo
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
;Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA
❑ NE
Comments (refer to question;#) Explain any YES.answers andlor a.nyrecommendattons or anyothe omments -
,; - ... -.: .. - s ¢ _­4
, -
Use drawings of,factlity to better egplam s�tuattons: use additional pages as necessary).r
x
(4j
ra /,P l 1
/d2 Sc.EAjDG E Sui.ucy NoTI^I 8001C — e'4c-'- C A -PE& 4,a IF Gave- w 4 S T>01VC
i --wtt� r!�[,c ro t.�,wILL CrT �} 5L V_Ur � OoNE .d S�ntD n Cn17 n r
�g S41 L Q-E 1 rT � -y �� r s lI m pe 6 T
Ct&R-R-"—T CoG O=k�
Reviewer/Inspector Name jN S Phone:
Reviewer/Inspector Signature: Civlt� Date: a
Page 2 of 3 12128104 Continued

Facility Number. -3 I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists [3 Design
g 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ oil Analysis ❑ Vaste Transfers ❑ Aual Certification
❑ Rainfall 0 Stocking ❑ C/op Yield El120 Minute Inspections 0 Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and/maintain a rain gauge? ❑ Yes [�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
❑ No
10 NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
;q No
❑ NA
❑ NE
Additiobal'Comme.nts,.and/or Drawm
C�tLLETtr-- INESTOA/ ` $i-E__ tiKST fLEC(;1UEb tCA 61Cc4iLDS
fin[ M41 L — T'u6 C1cD 91 MS A,( -So Ar a1C_ aC; Ivy
Page 3 of 3 12128104

a
UX Division of Water Quality
Facility Number �{ 0 Division of Soil and Water Conservation
- 0 Other Agency
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 ❑ Denied Access
Date of Visit: 1 DES Arrival Time: Departure Time: L County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1fLr (L M opR.`
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
=�
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: 0 ° = A 0
14
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder 4(oS ;=1
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current; .;
Capacity Population
❑ Dairy Cow
❑ Dairy_Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
YI
❑ Yes b!LNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
1%No
❑ NA
❑ NE
12128104 Continued

Date of Inspection 19
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
%No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
/
Identifier: LA GW
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
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[N No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
bj No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
01 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I" No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[21No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
5c.uoGE_ 13VSWG9� Fo&'otl C`I' , ►4G1rP-r1,vCN �_AGoov
LO( ,ir 1)C2> A scxeucL� o4iF-T07- t HA-T
pal M 6 JL +
Reviewer/Inspector Name F S Phone: _q ! U
Reviewer/Inspector Signature: Date: p� 6�
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
N No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rOrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues '
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RfNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

IType of Visit Sjf Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other [I Denied Access I
r n
Date of Visit: Q Arrival Time: �� 0 Departure Time: ounty: PGZ� Region: 2!J
Farm Name: w r A ��)) 2M Owner Email:
Owner Name: _ ��f � (�y"5 >L-ya _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �) / Phone No:
Onsite Representative: W ��� l'f /`_0/�'��� Z%"A5�0 I tegrator: A��Pfi� �d ci
Certified Operator: _GSTo.J Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' = Longitude: = ° =
Design= Current Des , s ign Current Design Current
Swine '.,Cap city Ptopulahan �'?�'eo�ItryC pacety Population Cattle " Capacity Population
❑ Wean to Finish s ❑ Layer ❑ Dairy Cow
Wean to Feeder ` ❑Non -La et F ❑ Dairy Calf
❑ Feeder to Finish „:. ❑ Dairy Heifer
❑ Farrow to Wean i ": ❑ D Cow
DrY P� � � ; ��� I' A psi
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Beef Stocket
❑ Gilts ❑ Beef Feeder
❑ Boars ❑ Beef Brood Co
Other
❑ Other Number of Structures:
❑ Layers
❑ Non -Layers
❑ Pultets
❑ Turke s
❑ Turkey 1'oults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
,,,�___,,,{{{No
❑ Yes 1G1 No
❑ NA
❑ NE
other than from a discharge?
/
12128104
Continued

Facility Number: —(p Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S,ttrruc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !�
Spillway?: 4110
Designed Freeboard (in): 1 f�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes XNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �J No
El NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/
9. Does any part of the waste management system other than the waste 'structures require
❑ Yes XNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement? /,�(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JCJ No El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El 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
1%Drift ElApplication Outside of Area
12. Crop type(s) "61_Z(r&,U6} r �fz/i'�f�� - S.0 r�t�UrE25EfQ }
13.
Soil type(s) f �/
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
No
ElYe X_."
ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes II o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes / No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1 jp/yjFA-A-0 ON T6ZOL 4Y.-� L�.r}�L,.
�s 7'
4O�z2
I

Facility Number: — Date of Inspection « O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ),No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Y Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;_� NA
[3 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesxNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Xo
ElNA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
�.,('
❑ Yes ICJ No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes jNNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2 fvo� zds`
`
(qt�,35_0 -240V-r
0"
14
&^/,QDcr7- j .
12,128104

Facility Number / Z
JZ Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit to 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: Arrival Time: Departure Time: 7Z ounty:
Farm Name: P642W
Owner Email:
Owner Name: �ll ` LL 7T/?� li[/���DN Phone: _
Mailing Address:
Physical Address:
Facility Contact: dqTitle:
Onsite Representative: " lolneo 4K lg ar-7-6
y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Design Current
Capacity Population
Integrator:
PLZ/1J Region:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: °
tAJ,
Design Current Design Cui
Wet Poultry Capacity Population Cattle "Capacity Popu
❑ Wean to Finish ❑ La er
Wean to Feeder I ILI Non -La er
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder i
❑ Farrow to Finish
❑ Gilts
❑ Boars T __.�
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
M
❑ Yes P'No ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
Y10,
ElNA
ElNE
❑ Yes
No
❑ NA
❑ NE
I2/28/04
Continued

Facility Number: — Date of Inspection / O
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?
St cture I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
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 1 No
El Yes El No
Structure 5
❑NA ❑NE
El NA El NE
Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 9No ❑ 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? Vyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Y(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 Aoolication ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes JLJ No El NA El NE
maintenance/improvement? 01
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window EvidenceofWind Drift ❑ Application Outside of Area
12. Crop type(s) V'/� ZF V . Le,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X 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
'Pi,
� No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I d No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages; as necessary):
gi 4 Z,441_4 A �I)AW
414
IReviewer/Inspector Name I I Phone: '7f r 2 I
Reviewer/Inspector Signature: do Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes
<«0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ 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
0No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,�] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
/Additional Comments and/or Drawings:
74-1
110 - Cal q
Page 3 of 3 12/2&04

Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a Arrival Time: �� Departure Time: : County: `� �PGz10
Farm Name: ea �r ,2'-n Owner Email:
Owner Name: !22�u_e'T?�_ �G`590.J Phone: 0 248 ~30g3
25`zr5"68--3iv�
Mailing Address:
Physical Address:
Facility Contact: �J Title: Phone No:
/) G4 r �s In Al�/LDGL
Onsite Representative: ? � �V� 7 Integrator: S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =] o E:I ' = Longitude: = ° = I = 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy Cow
❑ Non -Layer j
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Calf
❑
Dai Heifer
❑
Dry Cow
U Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 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

� 1
Facility Number: — _
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: jibez
Spillway?:
Designed Freeboard (in): /q•!r --;g
Observed Freeboard (in): L�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application I
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 01'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/�/1Evidence of Wind Drift ❑ Application Outside
12. Crop type(s) ��M a (yR.4 ZA,/1'l
nPo"'es"E6 6j'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
wNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
�Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
L lilr2oL li9�c �,c��/605 ,�uc,4 AS
1v57A�✓L Z�//�i✓4 C_4f955 VIV 6142E
bid
Reviewer/InspectorName f, � d , j Phane: /O-7bT
Reviewer/Inspector Signature: Date: 512 q/47
12128104 Continued

1
Facility Number: —61 Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check to Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists A Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application '0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )A No ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes IV No ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
26, Did the facility fail to have an actively certified operator in charge? ❑ Yes JeNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No g/ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JZ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes )eNo ❑ NA ❑ NE
Adiiitiooal Comments4nd/0 Drawings..' ;
oz 6Ca205 L5' f ape z �/
2 1 J lvefo 7o- r c y ��.� -o �� o �F z.�c�s, Nf A
0 `Ax FRFA60.,.Wp )?�colLO
Ar
r4,,v e,4e5]n�� Ooz_6
4
�� 5���• � � �,�,ED �D
ZG lF�� 6l 21310
12128104

r46/14/2O05 17:
t It
FAX 125256$3144
i
i
t
I
I
WESTON SOW FARM
I,/
41110 zle
a 3,50 ;,OOX
9!o a9� 3a 40
Cm 01

Grower. Romeo Weston - 4763 Wean -Feeder oesil
o Address: 273 Willard Edwards Road cW
r� Beulaville, NC 28518 M
County; Duplin Sr
ZONE ELEVATIONS
TOP OF DIKE ELEV = 50.00
1 1
! 1 TOP OF STORM ELEV = 49.00
0 1 1
z
F ` I
STRT PMP EL.= 48.33 1 TOP OF TEMP STORAGE ELEV = 48.33
1 1
END PMP EL.. = 46.00 1 TOP OF TREAT ELEV = 46.00 SHW
1 !
1 i
1 1
a
1
FINISHED BOTTOM ELEV = 40.00
® n
w
0
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Afurphy-Brown, LLC Engineering P.O. Box 856, Warsaw, NC 28398 (9101;
v. }

FOwM ftsn-1
Farm Owner
operator
I Daily Precipitation Record
Facility Nurr"
use
���r■���r
�
wine
�a�����■�r��rMENNEN
IMEMMMIN
.... - Lagoon freebm;ra Is me
For lagoons will► spills
2. Freeboard plus availabli
3. Rainfall must bra , rdt
Mferen ` be n the lowest poirtit of a lagoon embankment ants the save! of liquid
the d between the level of §quid wW the bomom of the spMway *wuld be recorded.
* age ' i ity moat be Tecorded at least weeldx.
for rah event. 3MV2003
` . ,.,--,r

ti
1
.003
Fom FRw).-I
_
• • _ •
Waste
.�
[icture
eb•. • and Daily PrecipRationc• •
rl
.
_• 1 1 1
= 1 1 1 1 •1' -
-
- 11
-
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►' 1 :- IFA I I I lr1• • r1 I..
LLf
2

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: '7 ffO-Not
Time:
Operational O Below Threshold
�Permitte g1Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .............
Farm Name: ...... �OM E a ..... w E S roi. _.!..`. A. � - �..... - ... County: �......> Q 4r ........._..__.... ........._....
OwnerName: ........ . . . . . . . ................................ ................... . ........ . . . ................... . .... . ........... Phone No: ... ........... ......... ..............-•--
Mailing Address:
Facility Contact: ......................................... -...... - -- - Title: _._........... ----- .......W. Phone No:
Onsite Representative: irOIJ Integrator: ....L(-�-(�.�
CertifiedOperator: ....................... . ................. ........ .. ...... ................ .................................. Operator Certification Number: ....... -........ ._............ ..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 �1.6 Longitude 4 64
Design Current' ms i Design Current y_ Destga - Curr�eat a
- -,. `ems'. a :. .r'. "� .• -_ -.,- _ .." .. -.
Swine..,. act Po utahonr..- Poerltryg ; � -.Ca`skei 1.P0 'ulat,aki; Cattle M Ca'`acr -°]Po ntation
mCa`
ean to Feeder 7(p�
O U ' ❑ Layer ❑ Dairy I IX
Feeder to Finish
= [] Non -Layer '. ❑ Non -Dairy
❑ Farrow to Wean
Other
Farrow to Feeder
Farrow to Finish
a"= -
s� Total Design Capac><i ` }
€ _
Gilts
a.s
BOATS
a ' a
�Nnmber of Lagoons ;,
e
�
Dischacy-es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes W/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 L 1
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IIJ No
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: 31 — 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
❑ Yes
�<o
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
eN
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
NNo
11. Is there evidence of over application? If yes, check the appropriate box below.
ElYes
Z
I o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Frozen Ground ❑ Copper and/or Zinc
d+ �❑
12. Crop type (30t M U � W (,- o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
FNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes 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
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, []Yes or,
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 No
Air Quality representative immediately.
Comments {refer to question #) Explain any YFS answers and/oi-any recamme`ndahoas or any otl a comments." :.
t _ Field
Use drawings of facility o bi#f* explans stbuatmas. {use add tonal pages as necessary} Copy ❑ Notes
Final N x
SEW OUP G M14i w(AP 1v FECOC--PZ IIL 4?6v3 330 mow 7/3ofo7_
`
21) oj3tr:►W Cop q of u�G�rv►s� WO C RTrf CCATF of QIv69AGG AND K-K-F W-M4
Rc-corzDS. -
.) r. K F Ce i2E t.otLoS, oC' wEE k LY FR-EC- 6-aArZ_0.
o va o DT[cf W AE,tr hi afl►vC- Sorv,E 9-E SEE D.4G Dor-IE .
ReviewerAnspector Name71ZN
ReviewerAkspector Signature: Date: 514O LIT
12112103 1 Continued

Facility Number: — Z
Date of Inspection b
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 ' rovement? 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?
(iel 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?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
i'Yes ❑ No
❑ YY s UNo
('Yes ❑ No
❑ Yes
❑ Yes 9No
❑ Yes
❑ Yes FNo
❑ Yes❑ Yes
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit T' Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 / Time:
Not Operational 12 Below Threshold
0 Permitted © Certified [] Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: J / County: ;✓Iilol XA✓ �
Owner Name: .` Tr N Phone No:
Mailing Address:
Facility Contact: Q �� J Title:
W
Onsite Representative: �10�%1f� _ � GL6 T (4-
Certified Operator:
Location of Farm:
Phone No:
Integrator -
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 96 Longitude 0 ' DK
Discharpms & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 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 JgNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A No
Waste Collection & Irgatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

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
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require 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
ONo
H. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic CIverload
❑ Yes
IZNo
12. Crop type- / F�
13. Do the receiving crops differ with those designated in the Certi red Animal Waste Management Ian (CAWMP)?
❑ Yes
ONo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
PrNo
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
ONo
Required Records & Documents
ZNO
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
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
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
d4�zYes
JER40
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WrNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
V1 No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VINO
24. Does facility require a follow-up visit by same agency?
❑ Yes
ANo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Aj No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r ( q' # P- y nd/orany recommendations+or anv other c©mme©ts.'-
Comments refer to uestron Ez lain an YE$ answers a
:
Use drawings ocucilky to better:ezplain'situations. (use`additional pages�as necessary): ❑ Field Copy ❑ Final Notes
IIIFFfJ coP o� ��� 41114�1_ VsZ-5 r,4 �FC��05,
Co�I�L � cc T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: % 7i
05103101 v� f 1 Continued

Facility Number: IP2,41 Date of Iaspection a 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 at/or below ❑ Yes 0 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 leNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes /F///( INo
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 XNo
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
AdditionaMornments and/orDrawings;
69 AIV3 ;;C-7
OV AN/ L
y
w
5100

n"o
Routine SM om laint Q Follow-up ofDWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection -/q
Time of Inspection 24 hr. (hh:mm)
Q Permitted [,] Certified [3 Conditionally Certified [3 Registered 113 Not O erational Date Last Operated:
Farm Name:'M!`:n....... V".�........1..�A:V..!!V_.................. County: ................1�'� ........................ ...........
Owner Name :............ ?S!5- Phone No:............................................................
Facility Contact: .......................
-Title: ................................................................ Phone No:
MailingAddress: .................. v............................. ...................................................................._.._...
Onsite Representative.......!il!.....Integrator:...... N. fo.t`�5.. .............................�..............................r....................-...... .........
1............................
Certified Operator:
Location of Farm:
..... :.............................................................. Operator Certification Number:
r...................................................................................................................................................................................................................................................................
Latitude 0 6 46 Longitude 0 4 is
Dest :Current'. Desi -. - gn gn Current '' r ;'Des�gn:.,,.;Current
Swine .:. .
Ca"act ,Population Poultry Ca aci Po `iilatEon Cattle
rre
p ty-> p __. Capac�ty,'Po ulaon
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer L I ❑ Non -Dairy
Farrow to Wean '7� -
;' ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total. Design -,Cap q_y
❑ Gilts _
:. ❑ Boars ; OU-il'SSLW;
Number -of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Pondsl Solid Traps` ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field El 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'? J
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 WO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IX No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� it
Freeboard (inches):
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes JANo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 i — L Date of InspectionWWJLI� 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 j.No
."% seepage, etc.}
6:_Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANo
(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 CTNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes §KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes RNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
I I _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes (No
12. Crop type 614 ya
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b} Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: *.viQlatioris;oi deficiencies were noted during this:visit:. Y:oil will•feeeiye iio further
: rorres� ondeince: about: this visit. :::::::: :: .
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 gages as necessary):
❑ Yes Dj:�4o
Cl Yes \ NO
❑ Yes R:No
❑ Yes KNo
❑ Yes 'Ado
❑ Yes No
[:]Yes �&o
❑ Yes (LNo
❑ Yes -KNo
❑ Yes kNo
❑ Yes DA:No
❑ Yes [�114o
ElYes 40
❑ Yes ISINo
❑ Yes VNo
J uS'� Y.eC
�,,, �r C ►-- -� b ��.,.oC w r AL 9V5
C. f fl4 r d is p vim- �,4,
/ti-( LOr�s /Dd,L. 6490e � j��tu Cr.� b��L y �+��
ReviewerAnspector Name
Reviewer/Inspector Signature- rd
Date: �%

Facility Number: — Date of Inspection j
Odor Issues
?6r Does the discharge pipe from the, confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes *No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )?LNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3/23/99

I
/ ft
x [3 Division of Soil and`•WaterXofi4 atiou-- Operation Review -
Y .. '� Division of Soil and Water'Conseryatron sCompliance Lispechoii, , = ;
- r Division,of Water Quality Compliance Inspection
T
k
. x©Ot)her Agency.- Op+erahon Reviews �'- ` n
Routine 0 Complaint 0 Follow-up of DW inspection 0 Follow -tip of DSWC review 0 Other
Facility Number 3 2 Date of Inspection a z
Time of Inspection 24 hr. (hh:mm)
[3 Permitted P14(ertified ❑ Conditionally Certified 0 Registered JE3 Not O erational Date Last Operated:
Farm Name: ......... QM_ ........ .£ .'r . ......................... County- ......._.. .. ?�r+ ....................... ..
.....................
.........
Owner Name:. ..............................
Phone No:..---..--.-. ......
.._..................................................................
Facility Contact: '.................................................. .. Title:................... ....-..._... Phone No:
MailingAddress:.........................................................................................................
Onsite Representative: AV!.�s......W.0 ....7.£..................................................Integrator: C Q c'7
......4-� ._.............................1........
Certified Operator:................................................................................................................ Operator Certification Number :..........................................
Location of Farm:
t �rlc._S�,F?`� •i....Rs... _......s i'a.p...f+T.... �i��-}�.....4..=....C'.``-R-+� F 2� - 1 ...s7t�L....L :........................ J �fi_......�..._... d
r
7
5
Latitude ' 6 - Longitude �• �° 9.
Design Current---' Desi" Current Desi n Ciirreiut
9
Swine _ Capacity Po ulation Poultry_ -vCa acityTPo ulation_ , Cattle Capacity Population
❑ Wean to Feeder -. ❑ Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish Total Desi n Capacity
❑ Gilts.
Boars - Total'SSLW -
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes V1 No
Discharge originated at: ❑ 1-agoon ❑ 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 PNo
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Dries discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [/No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ''No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............�-�.................. ........................... ......... -......................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Gt• 0
seepage, etc.) - !�"
3123/99 Continued on back

Y
Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type C, 9tP- ' j_0A (P "' SA^,. 6" 1`^/
13. Do the receiving crops differ with those de!�ignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Renuired Records & Documents
z 99
❑ Yes ZNo
❑ Yes ONO
❑ Yes J6 No
❑ Yes VNo
❑ Yes 121No
❑ Yes VNO
❑ Yes XNo
❑ Yes JO No
❑ Yes 0_­'No
❑ Yes [(No
❑ Yes o
❑ Yes /;31NO
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
, KNO
18.
Does the facility fail to have at] components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;ErNo
19.
Does record keeping need improvement? (ie/ irrige ion, freebo// ard, waste analysis & soil same reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
j(No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
23.
(ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ Yes
ONo
�Ko
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O'No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
WTo
NO yiolaiic}ris:oi^ deficiencies -were n6ted during this 'visit- • Y;66 will •teeeiye 1i6 fui-thgr ;
COrreS ondence, abtriiti this Visit. . . . . . .
Comments (refei:to question ##) .Explain any YES answers and/or any`recoinmendations or auty other comments
Use
drawings of facility to -better ekpiain situations (use additional pages as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
3$75, 3-7Oc�
Date: a _Lf t
3/23/99

Facility Number: — bZ Date of Inspection�z.11 qC�
Odor Issues
\26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El 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 'O"No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2(No
\32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ;�rNo
[Additional -Comments ana _or; rawtngs..
�z} i�lzoDUc ��ID� ct�►E,v YeoB S „s'M Iir)cTcJS'arTS a-4 f--k.uS A ?AJKS
A,J-o Z,J RV-Nqw Ao- �-sc.-Tr wlUL-,,M Gzz.JC E _ E- QEQUi tZE.4.
Tb SAt.T eve Gv oil + k,-C-ALkgr t,C
cat ate► �-E� c Q-t� c_r�'�1 t" , T-4 Zx'rip-tJOV-0 fZ' e"
3/23199

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
of DSWC review
Facility Number
Date of Inspection I Io�3�gR
Time of Inspection q:16 � 24 hr. (hh:mm)
U Registered 10 Certified E3 Applied for Permit E3 Permitted JE3 Not Operational I Date Last Operated:
Farm Name: .............. .......1440 � ...... �... r YM............................................. County:...
......
....�t1 lyam...\.......................,
Owner Name:.....................Nlc.�U..........V1lfS.IIlt.............................................. PhoneVo:.....7—.I..SxL�.I.��'.3............
................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ..... 2-.-z3......n '.�frJ......
l6i.dwaiA......S-:.t........................ ........ 9.t:.V.toa.(.bz&. ./...t..N�f............................... ...I ......
Onsite Representative:.............&..V.mo........WASb................................................. Integrator:........t t� !?2.i� 5......................................................
Certified Operator:............................................................................................................... Operator Certification Number:
Location of Farm:
Latitude =* =, = ° Longitude =0 =, =-,
Design,. =Current v Design" Current Design Current _„
Somme v = Capacity Population- , Poultry . Capacity Population > Cattle Capacity Populahon,
'-' ❑ Wean to Feeder ❑Layer 'r ❑Dairy I'
❑ Feeder to Finish '": ❑ Non -Layer ❑ Non -Dairy
t Farrow to Wean 330
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity g
„ ❑ Gilts
Total SSLW
s" ❑ Boars <_ m
Number of,Lagooas / iIoldtng Po ds �: ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area s
j❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes *No
2. Is any discharge observed from any part of the operation? ❑ Yes [mpjNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes po
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Wo
c. if discharge is observed, what is the estimated Flow in pl/mm?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes PtNo
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes %No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes `f" No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1P No
7/25/97

Facih'4 Number: .31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes qNo
Structures (Lagoons.Holding PondsFlush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): .._.•......3......
10. Is seepage observed from any of the structures? ❑ Yes 2TNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 14 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 M No
Waste Application
14. Is there physical evidence of over application? ❑ Yes (, No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................. —6.1- ido........... S1C!:!fit..l..... fJ�YAi�\..... ........................ ...............................................................................................................
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?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0-No violations:or. deficieincies.were;noted,duting this:visit.- You'w-ill recei've:ilo:Furtlier ::
:. corresOOdeilce thouPhis:visit:: :
❑ Yes [&No
W4 ❑ No
❑ Yes No
Yes ❑ No
❑ Yes fj No
AYes ❑ No
❑ Yes MNo
Yes ❑ No
Yes ❑ No
t 2.. 6r'� t� v-,&,. or, l{�- OJ(jr a 14 04� 0 � 4'k GC^ � F +OLi�� f _We_ Qw. & r\'6c
b iskn f'T So -,\ 4- b3c'� r 0,6 u ` � vD 2r rtffi,ow t ok �'"o o m� i o an d � l(.
e,vot)e_� CkOG'.S aYavrn� +`r�V- iIPet l v\ °` OO J
K- McALLL i S 4
v. 5mc k %,bar_ c j3 r lI, doffs sinatl�� bo- e,)(Wd fp Sq '. — r;1-
A v..„eh, .0� C' u 5mt�l� o r«�v\ 4- 4L tbsJcc, �- g31las� .' G - 121 I
_ 1bs%�, - sOlbsf�c , 10 lb�JA' , Na Ib�ju1 .
<zt� � �', �5 rw� a�a.�cc� '� 1�a.� �►af 1ae.cs~ S A+�l t � a y. - 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: /��,� �/ , A .) Date:

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
19 Routine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other
Date of Inspection a l
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered ®Certified ©s.Applied for Permit © Permitted M Not O erational Date Last Operated:....
Farm Name: ....� �A�M {�......We. .a!J..-.1... -!r"'^ County:..D.L.T.-G. rt............ ........ .4.. �.
Owner Name:...1 �.�.1~ t...'x►►g4..... ✓'-....... .......... Phone No:.....°i 1 Q �.q. ................
Facility Contact: .............................................................................. Title Phone No
Mailing Address: ....... ...... ..in?.P 5.... 4 ...�nt..G N.t�..� 2.i C�
p...... .................i...............
Representative:...�J.)..1Ly.�-Q_.. ZL....f-Q..✓Y?Q......� 5..1�1..+ ...
Integrator: t..i.......................
Onsite Interator:.
Certified Operator, ...............................
Location of Farm.
Operator Certification Number,................
z85t�
........................
..... .... q. �.. r.... �. Ala.�,,......�.,.t.�....�,.�.}.�..4...Y...................................... 1 i
......... . .. .................. ............. ...................... .. .-...................---................. .............. .
Latitude 0 6 ref° Longitude • 4 64
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gitts
❑ Boars
❑ Dairy
❑ Non-Dairy
�x rQ...
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IRNo
2. Is any discharge observed from any part of the operation? ❑ Yes 91 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [UNo
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 jj� No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes IR No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes j$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 KI No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes KNo
7/25/97
Continued on back

Facility Number: - Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ;KNo
Structures (Lagooais,Holding_Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):.....................................................................................
10. Is seepage observed from any of the structures? ❑ Yes VNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes tK No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste duplication
14. Is there physical evidence of over application?
(If in excess o�f�WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type W-Kry •^ u..t�r4................................ ........................ ...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
IS. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
It -or. deficiencie's. were -noted during this;visit. You.wiH recei've-no•fti Cher
correspondence about this:visit.• "
X Yes ❑ No
le Yes ❑ No
❑ Yes J(No
❑ Yes JR No
❑ Yes J$No
WjYes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes CE�No
RYes ❑ No
❑ Yes 54 No
❑ Yes 5ff No
❑ Yes KNo
12• p-knm,,e tare b-a�-+�e a,ne. t e'.. )e3 "--L wa! I, �k try, Gc�• L�e1- �]i f i<+-� et a�fj
a b c .') + "-� -5 5 c vu.� d f t-� f r`L. a •� i`i�Q 0 v
l3 . (x'- t a- w-O_V D 0 „ti ..
is. W C r 1- G ', .+ _ Yo v i . , ,.�, d-� r ck-v��-+r• ; . e . w r r IL o n. j �-+� r , !>
ra C " T Lpo V-Q.+r \t i v� pn v'-ri� �, a h r +1 i�erto ,
S 0 w� c� r%� S u t�`� 0.
L C-V l 4. Tti 4- A-li ' �f
7125197
Reviewer/Inspector Name
Reviewer/Inspector Signature:Y C,\.n,�l p.v Q Date: 10 1 _I q-1

4
:a.
Site Requires Immediate Attention:
Facility No. 4—
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 10 ' G.M
Farm Name/Owner:
Mailing Address: Z �i �/_='r� �t-' !� ,P iP�% I U • Ire Zv_5dy
County: _ Ot , n 1 if\
Integrator:
rolls
Phone:
On Site Representative: Phone:Rf
Physical Address/Location: Frv,n r 1 .j l , Ic 11 _i v 50L: f-e't
r j'c}�on f SF. I of 1154 (a r, Gh r cn � 1547 fY-�
� - - - R _ i rn m PC. 12 rr
Type of Operation: Swine Poultry / J Cattle�v F2r�n
Design Capacity: U Number of Animals on Site: '-Z5
DEM Certification Number: ACE_ _ DEM Certification Number: ACNEW
Latitude: ° rr ' si•�� " Longitude: 2 r' ° 4S ' L1, L" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storan event
(approximately I Foot + 7 inches) Y s or No Actual Freeboard. Ft. 7 Inches
Was any seepage observed from the lagoon(s)? Yes or No. Was any erosion observed? Yes or No
Is adequate land available for spray? Yes ` r No Is the cover crop adequate Yes r No
Crop(s) being utilized: _c'rf`r1 ' 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o�o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -trade devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes
Additional Comments: _ c�+ on �� _ 1 --7-"d _ -e1/ = I 22T'J1Q h f �U�
�1 sLt Gt r . i . J ��1 G� l �t�� : (l S 0:25)
So'r�,.`,� 4 rr;� ��'a,� .� • I���-t � 1c:-� � -,5 !�v �'ecc�.-t-1 s . hE. h.=� �n. ,�1; • �� �r
'r1� yL n z l o J . ,.rf Irl VVI l r rr a _ r' kiq �u 7rzin . w j
Inspector Name
cc: Facility Assessment Unit
Signat
Use Attachments if Needed.

Site Requires Immediate Attention:
-Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 'E , 1995
Time: /O ' S
Farm Name/Owner: R6 m eo 'WQS forL
Mailing Address: d12r� 2iw ?t-d S ec-1 21, /.e Z'6 51Y
County: 01
Integrator: C2,- ro I Is Phone:
On Site Representative: 90mec, we5lcn --- Phone: Ql�f 5C�$`3144,`fG-G''�S-308
Physical Address/Location: _ Sc,,, Pink W11, FeQ-1,
r i' h+ on Sig ��S �54 Co . i ,' f can s1215¢7 for,- -ef irn d ]e r'
Type of Operation: Swine / Poultry Cattle F-?4-n1
Design Capacity: !�60 Number of Animals on Site: 250
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: --Of- ' si•z2 " Longitude: =° 4'� Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard. Ft. 7 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
'L Is adequate land available for spray? Yes r No Is the cover crop adequate Yes r No 402t�'e5
Crop(s) being utilized: r 2 0132c_ C��
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by than -made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes
Additional Comments:
2
►re.e,� ct.
ZtG�I'�GrS • Mr, riU¢--,k1h a t,24­ all Cf255 Grp
0 ___. L. Lew['5
Inspector Name
Signa
cc: Facility Assessment Unit Use Attachments if Needed.

U7•'19":15 is;_'�
a91ULJ611::-
USDA MRCS
Site Requires 7.r=adiace Attention
to a (.1:,
0
•
FaciUry Number_
SITE VISITATION RECORD
MATE: —TL'-'1 rl 1995
Owner. _ . _ - . Farm Name:. _ ML tj
County: X)U PL I P4
Agent Visiting Site: i3 'r „� -- Phone- Q f 1P
Operator. FLZaae: 3 9-
Ou Site I
Physical
MaIrma Address: car- 2. $tr,C 337—6--_,..___ �. ...,.,-- - •--•_-...
gEt1r_AtlltLE
Type of Operation: ' Swine K Poultry Cattle
Design Capacity: 'ZP0 Number of Aaimals on Site:
Latitude: ° " Lon-itLlde: ° "
Type of Inspection: Ground - -X - - Atrial
Circle Yes or No
Does the Animal Wash I ,ocn have sufficient freeboard of 1 Font + 25 year 24 hour storm event
(approximmcely I Foot T 7 inches) Yes or Na Ac=al Freebcnrd: J— Fee to Incises
For facs'ties with more than one lagoon, please address the other lagoons' freeboard under the
CAmrnexlts Send=
Was any seepage observed from the lagoon(s)? Yes a Was there erosion of the dam?.' Yes
Is adequate land available for Land application? Yes or No Is the cover crop adequate? Yes of No
Additional. Comments:
Fax to [phone]
Signature of Agent