310678_INSPECTIONS_20171231

NORTH CARQLINA
Department of Environmental Qual

31 10147
Type of Visit: 0 Co=outine
e Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r�.w�� � r ■ r� ��u
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ! C. 41 rr: s
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: 1 43 Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Design Current Design Current
Wet Pouttry Capacity Pop. C•arile C►apacity Pop.
I Layer I Dairy Cow
Wean to Feeder
I
jNon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design C■urrent Dry Cow
1) . P,ault Ca aci P,o , Non -Dairy
Lavers Beef Stocker
Farrow to Finish
Gilts
Boars
Qther
r—TO—ther
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E24o ❑ NA ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection:
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 l 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
ff NNoo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑"1Vo
❑ 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
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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 LA
N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ U Yes 1V ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑ Yes VNo
N
[3 Yes
❑ Yes 1�T
❑ Yes [10
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [a NE
❑ NA ❑ NE
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �NoCj
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ Na NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ETNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes YrNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes �No❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes <No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes C2rNo [] NA ❑ NE
Comments,(refer to.question; #):'Explain anypYES answers and/or any, additional recommendations: orany other comments:.
Use drawings of facility, to better explain situations:(use'additional pages as necessary)P` -
T' • -v r�GO S LQ r t --fit , t e
Reviewer/Inspector Name: 0r a Phone:
Reviewer/inspector Signature: /"i DaterAyLl
Paige 3 of 3 21412015

Type of Visit: i0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Others 0 Denied Access
Date of Visit: Arrival Time: [,�` Departure Time: ounty: [� . Region'
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &Aa0z LCM
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentgllllllllllllllllllllIfLesign
Swine Capacity Pop.
Wean to Finish
Wet Poultry Capacity
Layer
C>urrent Design C►urrent
Pop. Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Da!a Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . I TURF Ca aci
Layers
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Jallo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes J�J_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 O'No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ENo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes El -No ❑ NA ❑ NE
of the State other than from a discharge?
LPage"'�>
l of 3 21412011 Continued

Facility Number: - Date —of Inspection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes ONo
❑ 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 fj'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yeso
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Fr -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes f�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,0-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes LEr&o
❑ 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 .E�[`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P�Ilo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes _❑'No ❑ NA ❑ NE
❑ Yes E�]-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 ,EI-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 En"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes E4-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 7, jDate of Inspection:2L2_jt--11
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes An No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,O'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes )allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes O'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes r�'flo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
J"
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes )0"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes p gb
❑ 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
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
'FeyNo
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
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
10No
❑ Yes J2�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facilitvto better explain situations (use additional Dazes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q
Date:
214 011

r
peof Visit: Q Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
ason for Visit: Q Routine Q Complaint Q Follow-up ' Q Referral Q Emergency Q Other Q Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: hX A J74V�
Certified Operator:
Title:
Phone:
Integrator: rmflda
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to FeederF
LNon-Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
1] . Pj©ulte.
Design
Ca aei
Current
P,o
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I 113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
urkeys
T U
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?
❑ Yes �o ❑ 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 E f No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes /No
❑ NA
❑ NE
of the State other than from a discharge?
�"—'
Page 1 of 3 21412011 Continued

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

Facility Number: - Date of Inspection: Z(
24. Dio the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes A
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
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
VrNo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
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
A No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V] No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Reviewer/Inspector Signature: LZ Date: F3 dal It
Page 3 of 3 4120 1

Facility Numbet r
Division of>Water`Quality%- -
h
O, Division. of Soil and Water _Conservation ',
O.Other Agency
Type of Visit P-co—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Accesss�/
Date of Visit: Arrival Time: Departure Time: County: Region: [/"/�
Farm Name:_Ll� 9A Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
On site Representative: Ct�!
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator-
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ` =" Longitude: = ° =, 0 ,,
Design - Current: es Currents
Swine Capacity„Population Wet:Foultry CapacityaPopulatioii
E1 ~Wean to Finish ❑ La er
.. ❑ Wean to Feeder 10 Non -Layer
w ❑ Feeder to Finish _
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder'
ElFarrow to Finish
❑ Gilts
< ❑ Boars
Other77
m, =
❑.Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
I :J
Discharizes & 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
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 P'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes J!(No ❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes .CJ No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection E�*/
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?
Struct e 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/ improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ 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-andior any recommendatiogs or any other comments
Use drawings of facility to better explain situations. {use addrteonal pages as: necessary):
Reviewer/Inspector Name
ZA.t' .f, Phone: -�
Reviewer/inspector Signature:
Date: 3 c3D
Page 2 of 3 1218104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L2No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 2rNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes _Q NO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Jallo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes _P-bio
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes _Q-No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Iallo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes F,,Ko
❑ 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 E pdb
El NA
[I 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 LINo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ;1,1?6— ❑ NA
❑ NE
I fj L a Sl
14
o s�
Page 3 of 3 12128104

ADIivision of Water Quality
Facility Number 3 J Q Division of.Soil and Water Conservation � _ r
O
Other Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Arrival Time:
. Q Departure Time: County:
Region:
/r��
Farm Name: � �
3
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [= n = . ❑ Longitude: = ° [� ; = «
,..� ..x
p
- Design Current Design Current _ ,� "Des gn Current
Swine "" `Capacity Population Wet PoultryCapacity Population Ga#tleCapacttyPop4ulation
Wean to Finish I 1171E] Layer ❑ Dairy Cow
❑ Non -La er f ❑ Dairy Calf
Wean to Feeder
Feeder to Finish
Dry Poultry
Farrow to Wean
Farrow to Feeder
A❑ Layers
Farrow to Finish
_ ❑ Non -Layers
Gilts
❑Boars ❑ Pullets ;r�
El Turkeys
'L
-Other El Turkey Pouhs
W ❑ Other; ❑ Other
"c¢K+rt. --Y" ,i�x.�� .. �.. ._.»i.�.wxw.s:v-'.bw�,++ ..-_ -'. �a �;5.w&•-., w.Y;.,v?/Y+.�r.'ve
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
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 P410
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
;To
❑ NA
❑ NE
❑ Yes
9-
❑ NA
[INE
❑ Yes
ieNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes grNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes f3 No ❑ NA ❑ NE
❑ Yes YfNo ❑ 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA [-INE
(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 El NE
maintenance/improvement? J
1 t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�dNo
❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;rNo
❑ NA
❑ NE
Comments (refer to. question.#}:, Explain any YES. answers,and/or any recommendations or:°any other comments"
Use drawings 4.kcility to better; explain situations. (use additional pages as necessary): T ry 4;a
AL
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1248/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R(No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J2�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
j�?No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Xo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;rNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
G?%4o
❑ 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
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ 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
ZN
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:�p
Jan:
Page 3 of 3 12128104

Facility Number ,3
jo�'lSivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit itP tompliance Inspection 0 Operation Review 0 Structure Evafuation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a� Arrival Time: _ _0eparture Time: County: Region: � �
Farm Name: r
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gifts
Boars
Other
❑ Other
Title:
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator: Integrator: Z4
a
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = ° 0 , = it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I I ❑ Non -Layer
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?
Design'' Currents
Cattle Capacity Population..
❑ Dairy Cow
❑ Dair Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: e
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
ElNE
ElYes
No
I
❑ NA
❑ NE
12128104
Continued

Facility Number: ?1-45;7W Date of Inspection
Was& Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA El 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �rKo ❑ NA ❑ NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA El NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ FAN > 10% or i0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
qN' o
❑ 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
6</
❑ NA
❑ NE
rGomin 'nts (ref [ queshowTT xP n, any;YE5 answer an or all -recom end ons or any other comments.
Use;drawings of facility to better explain srtuatrbns:�(useradditionallpages;acessary,}.
Reviewerlinspector Name Phone: �% r
Reviewer/Inspector Signature: Date: < G
1-age L of 3 114izoiu4 L,urscl""ru

Facility Number. f Date of Inspection /91
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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?
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?
°�grrn p� j�� cars
4e/f 6""qo a-C;y',
❑ Yes JZNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
[;No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes Mo ❑ NA ❑ NE
❑ Yes R(No ❑ NA ❑ NE
❑ Yes No [INA ElNE
❑ Yes Ld No ❑ NA ❑ NE
Page 3 of 3 12128104

A•:
Facility Number 3 6
.Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit P<Ompliance 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: Arrival Time: / Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Gee r ��
— 0—
Certified Operator:
Back-up Operator:
Location of Farm:
,..._Design
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .
❑ Other
Ph Re No:
Integrator
Operator Certi rcation Number:
Back-up Certification Number:
Latitude: [= o = ❑ « Longitude: = ° ❑ ❑ u
rent ` Design " ;Current Design Current:
ation WefPoultry `Capacity Population Cattle Capacity Population
❑ 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 Cowi
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes J2•flo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes - Ll No [I NA [I NE
❑ Yes TNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes ZNo
❑ Yes ,0 No
❑NA El NE
El NA El NE
Structure 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
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
_L2Ko
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �Ko
❑ 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 [[.ATo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑yeso
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 [T No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2fio ❑ NA ❑ NE
maintenancelimprovement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P<O
❑ 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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes j2l�o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[2-No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5plo'
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
G -
Reviewer/Inspector Name Phone: l 7-8 S y
Reviewer/Inspector Signature: �� Date: d
I6/L0/V'! LV"fars" R

-'acifi Number: V
ty -� % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;3-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QWo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [I Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q-Ko ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JD -No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j2wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑-i�o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_[2,NO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DNo
❑ 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
D-Ko
❑ 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
0-mo
❑ 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
D-NO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L -Ko'
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Zkll5ivision of Water Quality
Facility Number 6 Division of Soil and Water Conservation
0 Other Agency
g
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
_]
Reason for Visit 'Routine O Complaint O Follow up O Referral O Emergency Q Other ElDenied Access
Date of Visit: ! / Arrival Time: Departure Time: County:
Farm Name: irG�� _Ot q/lJ � Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t��Gi' C ,Ct r� _ Integrator:
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
ElWean to Feeder
ElFeeder to Finish
ElFarrow to Wean
ElFarrow to Feeder
c ❑ Farrow to Finish
L I Gilts
❑ Boars
Other
❑ Other
Title:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region: _(QLAt
Latitude: = c = ' = « Longitude: = ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle
ElLa er I
. ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Capacity Population
El Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Cowl
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 l of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: -rp'j Date of Inspection
MLas�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: r
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.10. 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)
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?
jo Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any:other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
/gas e h16
Reviewer/Inspector Name P, Ko,.j tk der I Phone:
Reviewer/Inspector Signature: A'_" Date: ( 4 G
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
leowired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (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:
' 7�Cards
Page 3 of 3 12128104

Type of Visit _)2Mismpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ;116utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: vZ Arrival Time: ; Departure Time: County:'— Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ` Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 ° Longitude: °
Design Current.
Design Current
^ Design ' Current
Swine
Capacity Population
Wet Poultry_CapactyPop�ula orr`
CaEtie ; Capacity Population
❑ La er
❑Non -La er
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Pull
❑Turke s
El Beef Feeder
ElBeef Brood Cowl
El Boars
Uther
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ 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
P'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
❑ Yes
19No
V No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 12'No ❑ NA ❑ NE
Structure l 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 j2i o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P"'o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes 'Ll-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J21Z ❑ 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 Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ-95 ❑ NA ❑ NE
maintenance/improvement?
l 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<o ❑ 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 Drib ❑ 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 _[J-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination-❑ Yes eNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,,,ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EJ-55—
❑ NA
❑ NE
Reviewer/inspector Name ! .� / _ t° Phone: OF
Reviewer/Inspector Signature: Date: Z
12/28/0 Continued

Facility Number: 3 7 Date of Inspection 2
Regeir_ed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check. ❑ Yes ZNo ❑ NA ❑ NE
the approprrate box. ❑ W UP
❑ Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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 ,dNo
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[ !`fir
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YNo
❑ NA
❑NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
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
?!fNo
❑ 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
PNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
❑ Yes
Prillo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
AdditionalComme�ntss and/or Drawings:
c7 7
12128104

1ihvIsron of Water Qna ky
` Q IDiVisioquf Sor7 a_ nd Water Conseryation gam ` ry
F O Other AgencyM.
-.
s _
Type of Visi��Sit:;Zoutine
Cpliance Inspection O Operation Review O Lagoon Evaluation
Reason for O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
1 Facility Number mate of Visit: 1 V Tune:
1 O Not Operational O Below Threshold
ermitte ] Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ....._ ._ ....... _ .................. __. County:......... D u. F _ ..... .
OwnerName:..._ ...................._.... ................ .......................... .............................. ...... .......... Phone No:.......................................................................................
Mauling Address:
FacilityContact: ...... .............. ........................... ........ ...... ....... .W_ Title:.-- .---------------- .............. .... Phone No: _
Onsite Representative:.._... R,a_.....,�� _-- - - - ....�._........,..... Integrator: .. _............ __. ..._.... ..._...
Certified Operator: . . ............. . ................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 �1.4 Longitude • 4 «
Disch_Mes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L �0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes a
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: __.... / ---..-... --.......__..__,.............._.............
Freeboard (inches): 3 D
12112103 Continued

Facility Number: 3 1 — Date of Inspection y 5
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? ryes
No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehimprovement? ❑ Yes L�No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes L
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [IFrozen Ground [:ICopper and/or Zinc
12. Crop type BEQMt)0P (ft \_L_ "�5* "ATin
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?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
Yes
NoN
❑ Yes
�❑
l�'No
❑ Yes
❑ Yes No
❑ Yes 0
❑ Yes No
Commentser to q on #} platin any YFS_answers and/or ay rerommems sons oranyiommcommen w
;Use draw, of faem to better rxplatn sitwstaons.k use additeonal pages as necessary) $ ❑Field COPY [l Final Notes
s
g,) Uow slam AT RyOrZAO' 4-7 1)&_Ds rb Re Aooekssc-b.
I ; o�ER-'ZEJ Cy,aQ W is PcOP , L-P+2C� AREAS IMSsagA . 691DPD(�ST
SAS T�EEC�'���-
ReviewerAnspector Name , x
Reviewer/Inspector Signature: Date: Q
12112103 1 r Continued

Facility Number: 3
Date of Inspection j
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?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25_ Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2fNo
❑ Yes �No
NYes
❑ Yes o
❑ Yes o
❑ Yes
❑ Yes
❑ Yes N
❑ Yes No
es ❑ N
❑ Yes PN'o
ElYes❑ Yes /No
❑ Yes
❑ Yes ❑ No
12112103

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _.d Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �{ Ij? C L Time: 1 10
,3
Q Not Operational Q Below Threshold
[] Permitted [3 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
- v'io I ; �....................... ....
FarmName: ......t :�.'..' '.......................................................... .... .... County. ------ ..__.................
Owner Name: .----�3fOWPJ -S_O _ C� �o��'�� ---- ------------ -- Phone No: ---------------------------------- - ----_--
MailingAddress; ..................................... . ....... . ...................................................................... ..............................
Facility Contact: ........................................................... Title: -• ...................................... .... Phone No.
w Ca o%f Onsite Representative: -�� ���5����!� .[Uo � r�i _?^._. Integrator: - /©
----___--- ns D�-
Certified Operator: ................................ . . : ............. .......................................... . .... ........... Operator Certification Number:
Location of Farm:
,,d5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �4 Longitude • 6
D'es�gn Current
-
Design Current = - :
Design Current
Swine r
Ca act 'Po alatIon
"`�ou1f ry
---
Ca -act Po-ulation' Cattle Ca aci Po ulation
❑ Wean to Feeder
❑Layer
-
❑ Dairy
eeder to Finish
rf 2 eO
_
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
=
_
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
=
tow Desi n Ca PaCt �3'
❑ Gilts
=
❑ Boars
- Total SSW-_
Number of Lego ns z
y [ Subsurface Drains Present ❑ Lagoon Area
❑Spray Field Area
i
Holdmg-Ponds hSolid Traps ❑ No Liquid Waste Management System
r fi
rt �r
-
r'
= -
Discharses & Stream Impacts ,
1. Is any discharge observed from any part of the operation?
_ ❑Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes -dNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ETNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:.........4-----------.._.------ _---------- -------- ---------------------------•----------------------------------------- ------- ............................
Freeboard (inches): 3 :q
Al Hi9/A7 - -• A .
:r=-�'<...?s��'K��.. _:_t=Y2',ti'i?{��%..�'-'.:^3-a'l:�//_d�ci'l.:{1_1}GY:�S��-.ti sue...TM�77::Mt+r..',+ti�'�-1«-:.�':.rr...:"r..^t'4�2rl-�c+�.s:-�x•+f.sr.,�•r_r ._c-�.�._-.. a.- --.-�._-r.,...__. ...,..--.

UNUXUl
Facility Number: _3—6'7
Date of inspection tf Z3 D -
5. Are there any immediate threats to the integrity of any of the structures observed? (iet trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
Uontinueu
❑ Yes �No
❑ Yes ,)�No
❑ Yes 13'�o
❑ Yes Mo
❑ Yes ErNo
❑ Yes O No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes O No
12. Crop type 13e —.,of o, 14c`'` M -i +vc, -- --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ono
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Syyi 'Yes ,WNo
16. Is there a lack of adequate waste application equipment? yI23/dL
❑ Yes /El"No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soiI sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? Cl Yes Ej"No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _,ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application) ❑ Yes E?Ko
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes j2rNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ETNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes_2rNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� Njn=an YES -answers and! an recommendations onan ofhencommen s 'ST'-r-T. fi r
Come►tents (refer two question-p y y
�y �-
;Use diawm s'of fac>Zit Ito better ex lam situat�oins [use;additionai pages as necessary)
y P -Field Copy ❑ F s
final Note
�.
o, fe ytp
�'reebo�rd recprc{s S1,ow 9 l-i�­'j levcl drop -Fife— 3S 4,, 39' rnc1,<s
off' -r-- C 6 air 14 ��,- {r c+r"l 3�7d %OZ �G' 7/ In /D Z A'� Dl A/sGs q Gado 1o,--�
3q 4,9 3q ;nclie 1 '4rc"_-6oGr'4 f:-ar.. �1J6�6Z �a z�z3�nZ;-��erB q�e
YeG D.-dS �VQ i �c� 6/e +.✓G� i G�, Q C. C o14 ti ''a r `AC1C
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2� OZ
r>..:.;:. V t w, x �.:.... .:f-- - «•-1 :��._._.�r.<n r ._.:-. r-_. r:.. s ...,.__ �- _---.-.. ..........

i
Facility Number: 3 j - Date of Iuspection t! 23 O 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 ❑ 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 ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ja'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 ;3'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 Xi No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes L2'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Uornments an orDrawings: 7.
O>7-� �PPl;CA4' ► /tcordS jlave �'�f"e-re � low ,�'c��e�
oh ke Sgw,e Ike saw F;e,Id; Acje ,^�c��rds (e4el�
�%Zd2-Z� is �e►'-� �er� �a✓ 4l,e eh4;,-e 6601"?c3e"�l4 I",'e,ld
otS oy�ase/C J.0 Feld bre/c4o zones. Need a
enSuee 4k.4 4e- e-vl4l -e 7,�i°Iq ,,5 te;kj vT;I) zed evey7ly ziS
o 1pr ored Jo -� e o� e �^t�d s� rq Y �� d v� U h e q ✓'eq r►2� e -� �a h
GYt/ p-}L,e ;y, �% ! ✓ei'1 r�z°ld eS�eG rll4 I'�t�i41, 4�e leGa�a(
SyS�er►'� qS
15. Dver�tll } �� a��cl'S fZ`�r� Ae �jerwtvdq q�d -�vr� GrO'R
r�-1 well., � a wed c ✓ � -�L�e/ c &-e srow�ie, 1
1 ✓ e Qlec, IYl so„-(e o`T
-t 4e T Gio1� -��� 1Gck f�"te" ne4
9
de�;5,00cq c ye. lVec4 4e beget Ae de-&,5vtmJcd
Gros ih -4liese AregS.
I o �� r✓! - . Sv ? s ,� ►'t^ r . /U a d i Ord , G ^�� d �.r LOL 41.-f r
�ree b le, ve i /'coal ► „A5 I -,a fie G9%1-1
be so 1hCran.S sa-ek,c eS Jh -PC�'sonY?e i ,-Cr- d;r� Lie
/eve,Is a✓ Joel'h yx 41,c bv,'1.�;� J p +s GdLtlor 1-izve beet
or'41 aJ
L✓o�-Job i�_'/eT-}�L.G2ve ]
71 v aei..,eGi 1 e ZOQj nPf111C'-17'rObi 1'e-cord-f Ly' 41C
J
5100

Type of Visit 'S Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 S Date or Visit: ! [ O Time: I A-01
I�erational Q Below Threshold
Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ..............
q 0 Du 1;
Farm Name: ......... ACounty: ...... `............................................................
Owner Name:........... rc �„i ,� �. 5.....01..... CAY o �.'e-^................................... Phone No:.......................................................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:...................................................
MailingAddress: ..................................................................................................... .................................................................................................................................
Onsite Representative . ....wes4 oL.Integrator: ...g
rarn.'s.°....�...��......................................................................................
Certified Operator:... , Operator Certification Number:
Location of Farm:
'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� �« Longitude
Design Curirent
Design Current Design Current
Swine Capacity.
Pott
Cattle
ay Population Capacity Population
❑ Wean to Feeder
Layer
❑ Dairy
Feeder to Finish rj Z o O
PE] Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
. ❑ Farrow to Finish
.
'Total Design Capacity
❑i G - lts
❑Boars
-
Total SSLW
Number of LagooAs ❑ Subsurface Drains Present ❑ 1 agoon Area 10 Spray Field Area
Haldr PondsJ'Sohd TraE s No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes A No
c. If discharge is observed, what is the estimated flow in gal/min? H to,
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) El Yes ,9 No
2. is there evidence of past discharge from any part of the operation? ❑ Yes X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
01/01/01 Continued

Facility Number: 3 j
Waste Collection & Treatment
Date of Inspection
4. Is storage capacity (freeboard plus storm storage) less than adequate?
structure I Structure 2 Structure 3
Identifier : ............... `.................. .
Freeboard (inches): ........... 27.__�J,,,..............
❑ Spillway ❑ Yes J4 No
Structure 4 Structure 5 Structure 6
..........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JZ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? a❑Yes �zj No
(if any of questions 4-6 was answered yes, and the situation posesan
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes J9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 19 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
j$.No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
19 Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
A No
12.
Crop type -3 e r'r"ti V Cc., CE m ckT VOk
13.
Do the receiving crops differ with those designa ed in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
X[No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
$ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
EINo
17.
Are rock outcrops present?
❑ Yes
FfNo
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
JZNo
❑ On -site ❑ Off -site
Required
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;R No
20.
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
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
X Yes
❑ No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JZ No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
X No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
A No
(iet discharge, freeboard problems, over application)
❑
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
5a No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
:gNo
Odor Issues
28.
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?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
jKNo
01/01/01
Continued

Facility Number: t — Date of Inspection Q Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9 No
32. 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
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
2.1. VSe o� wo s4e anell s ; s p(aJed t,,�;� �,:.-► �00 da ys o Apt f�c��,on
Cuen4s �p.• Ca11Lvi s oln 41,e T�Z1'Z-7's•
M. E'nso re 41,g4 sir ! i klers ,,-,14 L s4ors eAee ;•-� pwa�Per p la ces neap
W 00e(5 ; So +^-.e -FV l! c, i✓ 6 (e S r!¢o od 4 n be rCP M" A w 41.., 9Lar r OL4- Otte
le-fl C..+4,,P)-er ote �':c �� Z, AdjJS4 s4ois G1 id ensure p,,aPQ,r
t iJ )'1 G T 1 v yt , "\i� •"f l l(l er i ✓� k� a r`s / t ! 'r'-e J 4. 6 . -r--' 4H e & JMO k C 1'1
;n lelit 5 0k4 4i e "rne nea,,-r e1el. 61 instJr� -fat
,SP�';���c✓� c�rlB i+'t c��leO� in till r rSa'' 10c'.4iopts as Yle GeSsa., y P"cow^
�o a ape r'al-�-i r�i � s¢e f"'► - I
Reviewer/Inspector Name rt
Reviewer/Inspector Signature:
Date: t / 1610
T
01/01/01

J81 Division of Water Quality -`
0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit IS Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up 0 Emergency notification O Other ❑ Denied Access
Facility Number
Date of Visit:
� � 7
13 Permitted © Certified ©3Conditionally Certified © Registered
}
Farm Name: c4 rh T' q
A- I e F �
��Time: :I Printed on: 7/21/2000
Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: ........
County:.. ...� .I.I.P..'..........
Owner Name: ..................... �11j..'.'.........a......(W:e 1 4 �G Phone No:
................................
Facility Contact:
......ride :..............
MailingAddress:...................................................................................
Onsite Representative: .....
.., C� f ..Y' ....."" al.0�................... ........................
CertifiedOperator: ................................... ...............................
Location of Farm:
................................................................
Phone No:
.......................................................................................... ..........................
�Q f CR J/
Integrator:., v,rQu!'f.s. ................... �...Lr...yL,.
.. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' C�' �-� Longitude
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I 1 10 Subsurface Drains Present ❑ Lagoon Area ❑.Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. 1f discharge is observed. did it reach Water of the State`? (If yes, notify DWQ)
c. 1f discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I SIMCWre 2 Structure ; Structure 4
Identifier: ....................................................................
... ................................... .............................
Freeboard (inches): 9
5100
Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued on back

Facility Number:,3] — b,7B llatc of ij�spcction 7 B 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 ❑ 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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �Vo.*Whtid is:or de#ide,ncies -were n6fed• diming #his'visit'. • Y;ou will•receive fid f'ukth&.
:: ctirr , ' 6fi ie' ' e: ahatat: this visit. :::::::::::::::::::::::::::::::::: :
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JgNo
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
G1D11d L,646d #P9 reYonse -d a re�o �.-ear, Srcc.+n's of G�r�l;rq
4)"J -rr ee beard wM s 1S !1
It. r"--Qe6meel is oJ 11" La.000" level s�okrd � l pweled ;Yt 4
r,,?srort.5; 61e�-lute+! '"'tiarlr�er.
I 1 �l
Reviewer/Inspector Name y)ew R m44 S
Reviewer/Inspector Signature: Date: r% 00 5100

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit © Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
31 678
Date of Visit 5-10-z000 Printed on: 5/1612000
Facility Number
O Not Operational O Below Threshold
Permitted 0 Certified E3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .............
Farm Name: FarjmA............................. .. County: D.Uphim ............................................... W..1.Q.........
OwnerName: ................................................... ................... Phone No: 9.10zZMA8.00 ..........................................................
Facility Contact:.............................................................................. Title: ... Phone No:
................................................................................................................
MailingAddress: P. .Box.48.7............................................................................................. W..MsAW...NC.......................................................... 28398 .............
Onsite Representative: ............................................................................. ....... . .................... Integrator: Bjr.owa7A.af.Caro"ajjx .................................
Certified Operator: Rxvid...................................... Ieh:.................................................... Operator Certification Number: .18795.............................
Location of Farm:
................................................................................................................................................................................................... .......................................................................
r
® Swine 0 Poultry ❑ Cattle ❑ Horse Latitude ' �� �u Longitude
❑ Wean to Feeder
® Feeder to Finish
7200
7150
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M 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 D WQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(inches): ............... 2-5 ............... ...................................................................................................................................................................................

Facility Number: 31— 778 Date of Inspection Printed ..• 5/16/2000
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N 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 N 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 N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N 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 maintenanedimprovement? ❑ Yes No
11. Is tbere evidence of over application? ❑ Excessive Ponding ❑ PAN N Yes ❑ No
l2. Crop type Coastal Bermuda (Hay) Rye
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
P'No'violaiiootis'tar:d;eCrcieiicies-iveie:rioieii.during#tiffs visit:. �ou�v�CreceivE nofiiritie'r.
'.'.rnrrpeririuNivirP aluiiit'tBi�•varil:' '.'.'.
❑ Yes N No
❑ Yes N No
[-]Yes N No
❑ Yes N No
N Yes []No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
I I & 19 - Field # 1 -Hydrants # 02 & 04 have hydrolic overloading on 08-25-99 and 08-26-99. It appears the # of sprinklers used was
correct. Hydrant 02 had used 50 sprinklers at one time. Hydrant 04 had used 49 sprinklers at one time. Todd Rowe will recheck the lrr.1
rms to justify and correct this problem.
Nr
Reviewer/Inspector Name

Facility Number: 31-678 pate of Inspection 5-50— 000 Printed on: 5/16/2-000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M 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 0 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 0 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 0 No

' ,& Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 3WCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit )9[Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit -
Al Permitted [3 Certified © Conditionally Certified © Registered
Farm Name: �°t �'�`
Owner Name: .O t-�' n's O' q r d �� .�a �y��
8 2? 440Time: ) ZO Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County:. ....r ...........................................
Phone No :....................
Facility Contact:.............................................................................. `Title:............. ... Phone No:
MailingAddress: ......................................................... ..............-..................................................................
Onsite Representative:.�err2�oVt �ogGr(Q Integrator: ...s.� 1 t.J......i.I...C'W? .. . ..................z.......
Certified Operator: .............. ...................................................., Operator Certification Number:..............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
05 Feeder to Finish 7200 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 ❑ Subsurface Drains Present 110 Lag,K?n Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes '�kNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ) El Yes 0 No
c. ll-discharge is observed. what is the estimated flow in gat/ruin? tit /q
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes VfNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JEL No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 5No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ............--.................. ..-......................... ........ ................................... .................................... ....... .-............................ ....................................
Freeboard (inches): 23
5100 Continued on back

Facility, Number: 3 / — Date of Inspection 8 D Printed on: 7/21 /2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El 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
0 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 '
S. 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?
Oyes
❑ No
IL Is there evidence of over application? Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
O No
)❑
12. Crop type her ^11)d e,- �'7�t�i,i S'"1 R G ✓a r✓1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
fiffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
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
;D No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
�RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
kNo
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'?
❑ Yes
�j No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
)•No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
zo No
o yi. . tigris:or• deHeiencii=s •were noted diWihu! this:visit' • :Y:oir wiil•reeeiye iio ffi then
corre�oridei c' e: a�aut: 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 pages as necessary):
dLf 44e Sol, ai re41s�or;-ikl/eff +1'J2arr �t, taolod s QVe no stofs
'And Cct, sfe.&� i^10 WoOdxs Af@e, �v
gel ;it r eede4 �aG�f��Uhs Ta ✓►'lctr'>7 i� 6veers.
IS. 40 t'14)n 6eWk1-t11do �rci sses a*nd rQ�o]ace w)'4, beK�l uda i' \
�l��m�da-(;ej�S, �A]P r3l,v-� v"ti�'errAl 4S4i�--n)7d{ be9,n rCSfo•is;b/(e ls�r4rIf
t1 TO lOt✓e'r IR�oon leVe!- ' -P{�2eG�Abi;S+t Geve-O'M tvr, �h e` k( , Lb4ck e(P;dd T•
44 kPj C1- JA49j19a'7 4e 5-4af PVIY ievef i,j q I-ejoay7tr;b L I.
Reviewer/Inspector Name st/O tT e wq ►' !Q� lj S Reviewer/Inspector Signature: Date: [� Q

Facility Number: 7 J — ?Q
Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
N 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
A No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
PNo
roads, building structure, and/or public property)
29,
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
j No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
3/23199

_z^ Division of Soil _and Water Consei vationi . Op"eration Review, r "
Division of Soil and V[Watei ConservaElon -Compliance Inspection
4 Division of Water: Quality -;Compliance )€nspectaon
� Other Agency O ation F.Mew' -
g yer
. p.. _ r
12 Routine Q Complaint Q Follow -tip of DW2 inspection Q Follow-up of DSWC review Q Other
Facility Number 3 6? Date of Inspection
Time of Inspection ! 24 hr. (hh:mm)
to Permitted © Certified © Conditionally Certified © Registered [3 Not Operational 11 Date Last Operated: ..........................
Farm Name: ............... tip . ---. County:...... ................
Owner Name: ......... I l...-....6 ..-..-c—aymi !a- ......................... .............:... Phone No:.. �. ��.. ...-....� ...... ............................
Facility Contact: ...... ......--...SIV I,WACY.1. .......................Title:................................................................ Phone No:....---..--........................................
P. Mailing Address: Q �.. 4.y7 .......... "! if.S('A4...NI.................................... ............ l?......
Onsite Representative:
6L1S................................... Integrator: �nS.
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
V.xN ......Li nt....Si[.Ifs.....!?. ...... J1S.... I.Z.S ....a..D :.5.....11n 1.t5... . J t- ...�.1 .... W.t................
r.............. ....................................................................................... ............. ............... ............... ............................. .............................................................................................
� r
Latitude • �� Longitude • ��°'
Design Current.. Design Current Design Current LL
Swine
• Ca acity Population ._Poultry, —Capacity Population _ Cattle Capacity ..Po ulaEron
❑ Wean to Feeder ❑ layer ❑ Dairy
Feeder to Finish Zp(rj El Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
[] Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity- 7Z
❑ Gilts
Boars jotal':SSLW
Number of Lagoons, ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System _
- -
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ElYes No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potdntial adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): .........7-�.................. ............ ....................................................................................................................................................................
.. .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [UNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date o1' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
1'Vaste. Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio yiolatioris:or deficiencies -were notes during phis:v7sit; You wiil receive dourtptr
coeres�6fidettce. abouf this visit.
❑ Yes [�RNo
7lp
41 Yes ❑ No
❑ Yes tA No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes RONo
❑ Yes W No
❑ Yes ® No
❑ Yes ER No
❑ Yes ER No
Yes $y No
❑ Yes PqNo
❑ Yes ( No
❑ Yes M No
Yes ❑ No
❑ Yes �No
❑ Yes N No
❑ Yes V No
❑ Yes 110 7� No
❑ Yes _ No
❑ Yes 0No
refer to9
Comments ( P, question # : Explain any. YES answers a©d/oi any -recommendations or4h -other continents.-`
Use drawings of facility to_better explain situations (use additional pages as nece§sary);'.•
8n o d; ic.e wolf aF (Ar, s 6ULe- mere - (V'm t _ [ 1
slAz ] (aR- t&,.bo4- 1
E�l►1U�� S���r� � ihti+�/�Ne (1 i v� k`� �� SL1Y�,� pwC.r" '
. ZJ1 a T-14 ap(,1� c��l`a�• e �y� #�- ` `` Oru— sW�+' J Lb �-
+V-ca's `iD S►N gt 1 � �1l1a � h � �. � 2 • S lrti (i �VA iN � `Z- 5 v�� -l'iR CT
a� (bs /PLC,K P
Reviewer/Inspector Name r. w y;r
Reviewer/Inspector Signature: ,.` _ f / L• Date:
3/23/99

• FaeRity Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [; +No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes [� No
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONO
3/23/99

[3 Division of Soil and Water Conservation 0 Other Agency
ivision of Water Quality
Routine 0 Cam laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection �
Facility Number 3
Time of Inspection S"' 24 hr. (hh:mm)
Registered 10 Certified [3 Applied for Permit 10 Permitted JE3 Not Operational Date Last Operated:
Farm Name:
................... ---&ram....... .Q..........................................................---................. County:......... s. i^.................-----......................................
Owner Name: , .Q4Phone No:
Facility Contact:................�4.;� x!�.. .. Vt�R.!-............... Title:................ .... Phone No
..................................::.......:........................................................
MailingAddress: ... �t4A......_.......................................................... .........11!�hrS DI.......­;�n ..................................... �� .........
.....................
Onsite Representative:............ g
l- ........... a�uti................................................... Integrator .!'.fl aYi&........................................................
Certified Operator:............................................................................................................... Operator Certification Number:.......................
Location of Farm:
....... ........In145.. —. .�...Ja ........... e6i:L7/n.. a........Mz..a[4...........................................................................................................rV
............ ....................... .............. ............ ......... ......._......................................................
Latitude a 9 46 Longitude a 04 0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes allo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DIA Q) ❑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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Q No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes q No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 91 No
7125/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Laeoons.Holdini! Ponds Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 55 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ............ L .................. .
10. Is seepage observed from any of the structures? ❑ Yes V No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes (XI 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
(] No
NVaste 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 ........ ............................ SP,i�. gf,A.6.......................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
( ; No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[N No
18.
Does the receiving crop need improvement?
0 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[R No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[N No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[M No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[,9 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(Z No
�] No.vialations-oi defidencies.were nt'ted-during' this'. visit'. You.'vM1 recei'Ve-'no' Airiker'
correspondenctti ab"yot this: visit:: ; :
12, Lac�oe,.. �;U.c �a11 sho,llry be r�.c�Wcd.
ZZ. 1,f•yAwr, 1, 4o�'6, -k�u ld 6 W1 u �ti. 4 c GAY�j
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:, �, l Date:

F� ❑ Division of Soil and Water Conservation ❑ Other Agency _ �X
Division of Water Quality
' M
altoutine 0 Cam faint 0 Follo.v-u of DAV2 inspection O Follow-up of DSWC review 0 Other
Date of Inspection Ip t
Facility Number
Time of Inspection 24 hr. (hh:mm)
[] Registered 0 Certified 0 Applied for Permit © Permitted 10 Not O erational Date Last Operated:
Farm Name: J.;&.K'- * .... i .................. County-V..XAT.i%....... I .......................
.
Owner Name:.. .. .X....+C .....-GnCt7..lr[` !`-_................................... I.... Phone No:L..1..1-0.).... ....................
Facility Contact „ Title: ........ Phone No:
J u
iMailing Address: .... Fn.... ,tk}K. -1.� �...... ..................
Onsite Representative:....5�._,_....
11„li.
Certified Operator:.....................................................
Location of Farm:
............... , p �.,.....t,�..c ..,..........................
r
.............. Integrator:......................................................
.............. Operator Certification Number:.........................---.............
�11(ti.... S. ......... ...4 .......�. �. �`�i.�1.x'�Z�L.1C10.... ..,...5!..=.L......1t�'1.1.......�.F.V..................:� ............. L.
1
....D....... t.Y.x' ,CJ1!, ..C. ,j`..1.�i.'.'L.......s1�1..1 .... .. i. ........... .............................................................................. I ..........................................
1
Latitude • ` 96 Longitude ' C "
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface. Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galtmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than ]agoons/holding ponds) require
maintenance/improvement?
b_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes 1ja No
❑ Yes RNo
❑ Yes &No
❑ Yes El No
❑ Yes CR-No
❑ Yes iKLNo
❑ Yes F-No
Continued on back
0

Facility Number:3
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
E.No
Structures (l.agoons.Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
allo
Structure 1 Structure 2 Structure 3 Structure 4 Structure. 5
Structure
G
Identifier: .......................................................................................................................................................
...................................
Freeboard (ft): ............
10. Is seepage observed from any of the structures?
❑ Yes
allo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E3 No
12. Do any of the structures need maintenance/improvement?
❑ Yes
15 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
1.No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
1,No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type -- .... >-�u.............................................................................................................................................
.. .....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
91 No
18. Does the receiving crop need improvement?
{&Yes
[I No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
❑ Yes
nNo
21., Did Reviewer/]nspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
P&No
22. Does record keeping need improvement?
Yes
[I No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
H No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JEq No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
tlNo
E' No.violkions-or deftcieiteies. w'ere-i o'ted-during this:visit.- You:will receive no' ,further- :
correspondence aboitt this:visit:: ;
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7/25197
Reviewer/]nspector Name
Reviewer/inspector Signature: eL ,,—L . , , - _J'1 - M, �,, Date:

L�
is
Site Requires Immediate Attention• N0
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. d �� , 1995
Time: 01®
Farm Name/Owner: &OW019 rh4lr
Mailing Addres
County:
Integrator.
'C.
Phone: 471
On Site Representative: / Phone:
Physical Address/Locadon:
Type of Operation. Swine j Poultry Cattle
Design Capacity: Y0.0 %Op- Number of Animals on Site:
DEM Certification Number: ACE - DEM Certification Number: ACNEW
Latitude:Longitude:-7A0 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 ear 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Actual Freeboard:., Ft. Inc s
Was any seepage observed from e agoon(s)? Yes 90Was any erosion observed Ye No
Is adequate land available for spray? Yes r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:40_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelliaes
es No
100 Feet from Wells?s r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific a eage with cover crop)? Yes or No
Additional Comments: ��,4W-! /71 JAB /OQ
S)ow dvc- r
Inspector Name jligntature
cc: Facility Assessment Unit Use Attachments if Needed_