310713_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

0
(Type of Visit: 0 Co ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A,, F� c—�i -)
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: !� /
Certification Number:f
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design C►urrent
Wet Poultry C«apacity Pop.
La er
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
feeder to Finish
O
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P,4ult , Ca aci P.o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Imuacts
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 D'No U NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes = ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: e'� I - Date of Ins ection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
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 No ❑ NA
❑ NE
waste management or closure plan?
I.f any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA
rNo
❑ 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 Ej No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 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
Q 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
❑ Yes
rNo❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[3 NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
TNo' ❑ NA
❑ NE
Reituired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes l No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Dumber: IDate of Inspection: Zf ll-7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NANE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes ❑ No ❑ U NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes ffN0 ❑ NA ❑ NE
❑ Yes P'*No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[, N
❑ 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
]�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
1'� L_ 1
No
❑ NA
❑ NA
❑ NE
❑ NE
Reviewer/Inspector Signature: Date: 2 l
Page 3 of 3 21412015

• Division of Water Resources
s
Facility Number - %/, 0 Division of Soil and Water @onservation
© Other Ageenncy
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: '� �/ jj/ �6 Arrival Time: 3 Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
)L-1 /-ho l u S k�_J ­­-- -S
Latitude:
Phone:
Phone:
Region:
Integrator: c�
Certification Number: t 6s
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
ILayer
Non -La er
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
We -Feeder
eeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult ,
Ca aci_
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
keys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Other
OtherI
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
F5No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: / b
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 ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
;�Ko ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I.CJ go ❑ NA
ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q-<o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3N ❑ 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 0 No ❑ NA D 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 ]Nc Q 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

Facili *Number: - / Date of inspection: Ir
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
ffNA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [3'_
❑ Yes E3No ❑ NA ❑ NE
❑ Yes nN NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments:(refer,to,question:#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawmgs of;facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name: a—e- v , I e�� '_� Y
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q t O ,-7f 73�
Date: L l�
21412015

Reason for Visit: C� Routine Q Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: / S Arrival Time: Departure Time: r% County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: II I Title:
Onsite Representative: k/+L h0 r 4 S e
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: [__I G S /s 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent Design Current
Capacity Pop. Wet Poultry Gapacity Pop.
ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
2 v
I jNon-Layer I
3000
Design Current
D , P,oW Ca ari. Pao ,
Layers
Feeder to Finish
Dairy Heifer
'Farrow
Farrow to Wean
Farrow to Feeder
to Finish
Dry Cow
Non -Dairy —
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Other
Other
Turke s
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CfNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
['Flo
❑ 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 I of 3 21412011 Continued

Facility umber: - Date of Ins ection:
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I" J i'lo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ 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 []'90 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes E�rNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [!fNo
❑ 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 ! r �vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ef No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfNo ❑ NA ONE
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 ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
VT�No_
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesFj"'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CT�'o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F:�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 G3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No' ❑ 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

Facili Number; - ? Date of Inspection: $- _r r
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I__I 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1'J<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L"J 1"o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [J'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
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [fNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
ZjN ❑ NA ❑ NE
LJ 1" NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to questio"n #) : Ezplain any BYES: answers and/or any additianal recommendations or"any other co ifti s"
,..x
Use drawrnffacilr y to betterexPlarn�srtuatrons" (use addl�onal:P es are:
ssary) �'" ,."
WN
Reviewer/impector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 Er 73 9
Date: A ( J
2/4/2014

Type of Visit: WFompliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: )Moutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1,0&
Farm Name: &A 0� Owner Email: �T
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative: Integrator:
Certified Operator: s Y tLitb�� �� �'�/�(( Certification Number: 99 1�50
-- r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Da'x Cow
Current
Pop.
Wean to Feeder
Feeder to Finish
on -Layer
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dr, P�oulh.
C•_a aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Wither
NJ Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [3 NE
[] Yes [] No ❑ NA ❑ NE
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 ;n 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 I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes XNo [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L�_ I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VrNo ❑ 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 5�fNo ❑ 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 P�'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 VrNo ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VT
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes YJ No [DNA ❑ NE
❑ Excessive Ponding 0 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
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes
ZjNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VfNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7 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 VjNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VrNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: III - rl jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XfIqo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ' PIONo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes <o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 7^No ❑ NA ❑ NE
[]Yes P-No ❑ NA ❑ NE
❑ Yes rNo
❑ Yes qfNo
❑ NA ❑ NE
❑NA []NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes O"No ❑ NA ❑ NE
Reviewer/Inspector Name: h.`�_ Phone:
Reviewer/Inspector Signature: 4 aDate:
Page 3 of 3 21412011

Cype of Visit: j0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance '
teason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access t.
Date of Visit: Arrival Time: ; Departure Time: � County: fifbn
Region: �U. Owner Email:
Farm Name: �t
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: •
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: Q
Certification Number: —1 d &3
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
C■attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design Current
D F P■ouitaci_ P■o
Layers
Dai Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
KLJOther
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�n No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IVo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

t
FaciliNumber: j - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes J�IrNo
❑ 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 Y No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes L? No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PE�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
_110
❑ NA
❑ NE
acres determination?
[r
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�' o
TT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
ETNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J!�TIo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

� h
[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes Zj No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes k!I'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes )2�No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes in No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
g] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
&9'� """v' cvrI6�' o f -�w -
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: J0 ��•�}�
Date:
21412011

—'�—' Divvisioa of Water Quality
Facility Number - j 3 0 Division of soil and Water Conservation I
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: �3 County: CJAJ Region:
Farm Name: C-- Owner Email:
Owner Name: �x 1� �pwAGZ�S Cll(S �� —30►> Phone:
Mailing Address: 30�� l (—C- MLI � p W R(L�S 1 �LCAC JQ U l LLE c $S
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: G nL.-'A-R.pS Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
We to Feeder
Non -La er
DairyCalf
Feeder to Finish
Q
Dr PP,oult�.
Layers
Design
Ca aci.
Current
P,a
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ONE
[:]Yes [] No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fieili tuber: - j Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UdJ1�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "o No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on which are not properly addressed and/or managed through a ❑ Yes PkNo ❑ NA ❑ NE
waste management or closure plan? Vv777
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ��No ❑ NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��Lt-� L�, 5
13. Soil Type(s): —d N6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
X
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application Q Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ I/aste Trans ers
Q Rainfall ❑ Stocking ❑ Ilop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
0 Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Amber: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I N No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes %1No
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 XNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �Q No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
Yes No
❑ Yes No
❑ Yes PN 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question fl: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):- ".
�AjA.
NGSP/ 1. v
(�])g It) ao
511 V/) �• 1
Dj`,5111 i • �a - w �E����� C'c.,�c-� cap`
V cb G �
�lA� cotes _ c� �i s
N �
Reviewer/Inspector Name:
(Reviewer/Inspector Signature:
Page 3 of 3
`Ttka.Nev'� (3 k"�CQ y a M VC-1) W Pa-0s
Phone:1%3rd
Date:
21412011

Division of Water Qaahty
Fac>ltty. Number �� 0 Division of Soil and Water Conservation
, Nw,
OtherAgency
aW
Type of Visit Compliance Inspection 0 Operation Review O.Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County: u Region:
Farm Name: _ � 1 _N,c1c Aing Owner Email:
Owner Name:'-� r2`_`� 1 K 1��WAQ �g Phone: q��,a}
_
Mailing Address: ��`'� �'L AQ 1 ` it` d g ELCLA U K r AQfSh?
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ��h-- ��W Inte ator:
Ltification
Certified Operator: ! ��" l��1�1�_ Operator Number:.1
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = ' 0 « Longitude: ❑ ° = i
Design Current DesignCurrent 4
Swine Capactry 'ity." Population 'Wet Poul'Capacity Popal Aon "I
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
35 d
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
°Dry Poultry
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number,
—
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑Yes
❑No
[3 NA
[I NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

aciliiy Number: — 1 Date of Inspection 1/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? - ❑ Yes L751 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T❑l No ❑ NA ❑ 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
'N 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 LX! No ❑ NA ❑ NE
maintenance/improvement? J
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.) ✓✓✓✓✓✓ X
❑ 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) RjG, 5C-,)
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
r9
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
VI -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answer's andlor,any.recomtnendatigns or any other comments.
`Use drawings of facility to better.ex lain situations. use additional g ty p ( pages as,necessary)
Reviewer/Inspector Name
�. //V S Phone: 6 +30':4
Reviewerllnspector Signature:
Date:
Page 2 of 3 1212RI04 Continued

Facility Number: Date of Inspection ! //
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )� No
❑ NA
❑ NE
0 Waste Application [3 Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑ V/aste Transfers
❑ Pinual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1 °
Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
ElNE
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
1
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
ElNA
❑ 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
6 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
WINo
❑ 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
XNo
❑ 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
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
7771
II�I�f10 /.5
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: County: CIAI Region:
FarmName: `/ Yif C 1� F—.Qvm Owner Email:
Owner Name: �c-xTc� �bWA�zi�S Phone:
Mailing Address: l�l�t_A2� �D��Atz� P-c�t�r A u lt�r . %� o��S51 g
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 1 e!�_ ���1�144�S
Certified Operator: '�bExTe f�_ C�wRI�QS
Back-up Operator:
Location of Farm:
Phone No:
integrator:
10 Co
Opera or Certification Number: &� T
Back-up Certification Number:
Latitude: = o = & Longitude: 0 ° 0 i
Design Current
Design Current
C*Desi!N-urren#
Swine apacity opul
We# Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer I I
❑ Dairy Calf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
El Yes �`-�'" [INA ❑ NE
12128104 Continued

Facility Number: �)—� J`3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No
❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L-ICiOCVV
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? I `
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 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 t No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �No
9. Does any part of the waste management system other than the waste structures require ElYes ElNA ElNE
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 Po ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � - CC� '3r,
13. Soil type(s) eCf _
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 JANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0- No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes `qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )6 No
❑ NA
❑ NE
Comments (refer to.question #) -Explain any -YES answers and/or any m recomendations or anv"7other cUlm ments,
Use drawings of facility to better explain situations: (use additional a es as necessa �': f
lJ . Tv t
j `Slog b 5
ReviewerlInspector Name ANON )N 5 : Phone: 1 d "i7 i9 �� 3o94
Reviewer/Inspector Signature: Date: %Jol/d
12128104 Continued

Facility Number: = Date of Inspection Q /�
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropriate box. E] WUP [I Checklists 0 Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers lj�inual Certification
/E]
O Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes V(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes *�iNo
❑ 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 ANO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes XN.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �I.
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P No
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes qNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0 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 lb 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 -�Z`No
❑ NA
❑ NE
CVaU9M710/V5' F-1yKE ao)ca
IZ2&04

Type of Visit 131compiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: u Region:
Farm Name: Q�Zj Owner Email:
Owner Name: �! �Q— t�W�-�S Phone: 91C2��� Ohl
Mailing Address:Qnr
Physical Address:
Facility Contact: A Title:
Onsite Representative: Gt,-�. ,-,, DS
Certified Operator: �ellt �-_ GbL­'.--Ra_DS
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: ) to 3(oy _
Back-up Certification Number:
Location of Farm: Latitude: =o = 6 =is Longitude: = o =' =
i
Design Current Design Current Design Current
Swine Capacity Population Wet.Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
n-La er
❑Dairy Calf
Feeder to Finish
S
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑ No ets ers
❑ Pullets
❑ Turkeys
❑ TurkeyAoults
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Beef Feeder
10 Beef Brood Co
Number of Structures:
❑ Other
❑ Other
Discharges &Stream impacts
1. is any discharge observed from any part of the operation?
El Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;6No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

r
Facility Number: — f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �(No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: "6C*A/
Spillway?:
p G
Designed Freeboard (in): 1. J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
[I 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 0 No ❑ NA [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;Q 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 NA NE
maintenance or improvement? ❑ Yes ) No El NA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
rQ1 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 El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) �Q
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
O No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
-NNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
ONo
❑ NA ❑ NE
Reviewer/Inspector Name Phone: 01/6
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

1 � F
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ yes i No ❑ NA ❑ NE
the appropirate box. 0 WUP EJ Checklists
0 Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Xaste Transfers ❑ Xnual Certification
❑ Rainfall ❑ Stocking ❑ �rop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�iNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�4NA
❑ 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
J4 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 reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
't�No
❑ NA
❑ NE
AdditionalComments.andlorDrawin �s::... _. E__. �_ � :tea :•x� _.� _. '
Page 3 of 3 12128104

f Division of Water Quality
Facility. Number # i 3 O Division of Soil and Water Conservation
-� •-• O Other Agency
Type of Visit 19Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 ToT I Arrival Time: ad Departure Time: County: IK Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: � f Title:
('l
Onsite Representative: 1U- nCLk 7CW
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
0
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
5c9C)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non-L
Pullets
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =O=t
Cattle
Design, Current,
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
LRNO
❑ NA
❑ NE
12128104 Continued

Facility Number: — i3 Date of Inspection t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
-RNo
❑ 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: ACt�ol�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R[ 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
4 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [PNo ❑ 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 FK1 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
mainten ancelimprovement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or l0 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
A3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
J2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4�1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ 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):
19 • 7Z to t�->,- +RZC- ctrf:.c-K
pI�%+KL-C�
S(CS A/ W(,tl�
Reviewer/Inspector Name GMANOA G E S 4 A/ ME L L Phone:
Reviewer/Inspector Signature: durrib Date: ari �0 g
12/2R/OQ I-antinnod

lFaflity l<7umber: 3 1Date of Inspection 8 i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t@ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropirate box. ❑ W-Up ❑ Checklists ❑ Design ❑Maps El Other ,�,r
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes L�l 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? ❑ Yes eNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f�fNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Me
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
10 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
EU'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EVNo
❑ 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 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
ETNo
❑ 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
E�}No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
fNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

i
X Division of Water Quality
Facility Number J�/ !L,� Q Division of Soil and Water Conservation
i
-- - Q Other Agency
Type of Visit 0Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit f� Routine 0 Complaint Follow up Referral Q Emergency Other ❑Denied Acces/s' /
Date of Visit: 3 O Arrival Time: ' j Departure Time: County: �y�� �� Region: 6e 'eV
Farm Name: _ K/ �� ` �t�'�- Owner Email:
Owner Name: _ f t'i fOtr/F}2I�5 Phone:
Mailing Address:
Physical Address:
Facility Contact: n Title:
Onsite Representative: �Fi]Lc1g D5
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Boars
Phone No:, /j
Integrator: yiQ'z' "— Y Rdc:Ji�l
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = S 0 Longitude: = ° = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
II❑ Non -La er
Other
❑ Other
Dry Poultry
Non-L
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Co
Number,of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

1
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: o
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes XNo
❑ 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 L?rNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�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/improvement?
It. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WinnjdDrift ❑ Application
%Outside
`o/f/Area
12. Crop type(s) �Fi2frlyd D�} �����. -� 11y'/� CJ . fC�drea/, l�•stf�T, <11y. 66fnJS
13. Soil type(s) /i/h %¢
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes 04o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination , ❑ Yes ONo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
I;r_ vv %7 lrElaoe>
W�5 �f_ %�yYhr-41h7�
Z9/
�N3.9 � / o,✓ cz,.-�E ��
❑ Yes ❑ No ❑ NA ❑ NE
ReviewerlInspector Name
'. Phone: O 32
Reviewer/Inspector Signature: - Date: p�
12128104 Continued

{
Facility Number: 3, — f > Date of Inspection O'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JVNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA El NE
El Waste Application El Weekly Freeboard [I Waste Analysis El Soil Analysis El 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 PNo
❑ 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
X 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
gfNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
7(1
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4No
❑ 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?
ElYes
,
XNo
❑ 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
El NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
12128104

Type of Visit gCompliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: /9 /p Arrival Time: �; j Departure Time: County:
Farm Name: A7E-421-5—CR Owner Email:
Owner Name: T=QI�009zw5 Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
0 Technical Assistance
0 Other ❑ Denied Access
Region:
PhoneNo:
o:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ' = Longitude: = o =' =
Designw1urrent
Design Current
D11 esign Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish ID Layer
❑ Wean to Feeder 110 Non -Layer
Feeder to Finish t3
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Gilts ❑ Non -Layers
❑ Boars ❑ Pullets
❑ Turke s
Qther
❑ Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
////
El NA
[I NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
19 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

i . N.
Facility Number: , —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes
�No
El Yes' ❑ No
El NA [I NE
❑ NA ❑ NE
Stru " e� I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � /V
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): !i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 0No ❑ 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? 116
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JKNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 El Evidence
' oofElWind Drift Application Outside of Area
12. Crop type(s) l��A?//l�t� �.
.. /
13.
Soil type(s) �
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[XNo
❑ 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
/VNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
/o 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):
2�� nlf�o Srnekz�c Lf ���,� �Ty �ccl,
Ry
Reviewer/Inspector Name �y �� Q Phone: O 6—
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design [3 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes)zNo ❑ 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? ❑ Yes 04 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes FrNo
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;;rNo
❑ 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
I No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
/
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
FqAkD AdA
i"G 4e .0!-: 6
.,f
%Hf ECOiFZOS,
Page 3 of 3 12129104

IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 16 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ld O - Arrival Time: MA0_ Departure Time: County:
Farm Name: r Owner Email:
Owner Name: _ ���,Ei�-� EazlQfUs Phone:
Mailing Address:
Physical Address:
Facility Contact: , • lTitlle::1�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
- -f
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:�� �tl/
Latitude: = o = g = Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
a ❑ Non -La et - -
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes -0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
, ❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WrNo
❑ NA
❑ NE
❑ Yes
;21No
❑ NA
❑ NE
12128104 Continued

I
Facility Number:; Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ 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 VrNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )ZNo ❑ 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 �KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windpw ❑ 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
;ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
91 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
Cl NE
DvAJ1912e t �&40 l�L� SS /'� �� � ff�F— SS vcs/✓O
lam` �Gvo,J.
A9
r, _ Ar2w_z.'-
-D
Reviewer/Inspector Name ' Phone:
Reviewer/Inspector Signature: Date: $ p�
12128104 Continued

Facility Number: — Date of Inspection f r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _VNo ❑ 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 VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes X No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ZNo
❑ 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�dNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ZNo
❑ NA ❑ NE
Othher Issues _
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PfNo
❑ 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?
10
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
❑ NA El NE
If yes, contact a regional Air Quality representative immediately
//
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes VNo
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes /0 No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes )dNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
s`
41)
r�s� �r f�/is ���P c: 5VaL •�
`,P
Z'q J j M05 r
I2,1VO4

Type of Visit A Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
O Not O erational O Below Threshold
);Z'Permitted� Certified © Conditionally Certified 13 Registered Date Last Operatedor Above Threshold: .........................
Farm Name: ......_. �_... --- LY.r�� ....... County:
Owner Name: - ............._.._._......__....... _.. �. ..... _.. W ........ Phone No: _.......... ._.
1VLwhng Address: ............
_.......................... _ ....- _....__� . __, . - - - __�.. -. .. .. _ _�.. - _.W ._.�W - __ ...
Facility Contact: - -...-- — ................. Title:.._ ................... ........ .... Phone No: ... _ ... ... ... - - —
Onsite Representative:.._.. _U_...1.�1�,...................... .... Integrator........�_..........._..._... ».� ..
Certified Operator :... .................... _........ .................. ... ... ............................................ ... Operator Certification Number:....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude " f " Longitude • 4 «
.: Design ` Curreat� ,. �DeSlgn Current Current
�`_-
Swine
ciPo'ulation ttie
Ca Po nlahon
,--k,. °Ca'act ,PQ
illation glPoul#ry=,___.'`:Ca
Wean to Feeder
=_
Feeder to Finish Zb
$' -
Farrow to Wean
-
Other '
Farrow to Feeder
_
Farrow to Finish
{ Total Design Capac><ty
.. Gilts
Boars
-
> -
Tatai SSLW
.
f.'
vim.>ry'g
M Num_ ber of LagoonsSolid
Traps
❑ Layer
�
Dairy
❑ Non -Layer
��
❑Non -Dairy
Discharges 8- Stream Impacts /
1. Is any discharge observed from any part of the operation? ❑ Yes o
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 EO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Sim,I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................re
...-•....._................-----............ ..................... ..........
Freeboard (inches):
12112103 Continued

Facility Number: :3 f Date of Inspection I� aK
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ /Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type #3 6-" C lit 1 560
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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.
❑ Yesj3No
❑ Yes 040
❑ Yes[kN/o
ElYes 7No
'
El Yes
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes
No
❑ Yes
❑ Yes
No
L 0
❑ Yes
To
❑ Yes
To
❑ Yes 3<0
❑ Yes l�9O
❑ Yes �10
❑ Yes Flo
:Comments (refer to_quest<ob l#)-011irn any YES�a»swe Fs and/oi any recommenda`t oias or airy other comma ts.
_ _
Use dr`awmgS of facility to better explain sztiia�ans {use addetiop_ pages as necessary): , .; ❑Field COPY ❑Final Notes
�,
RFr�E�N w Da�JE . � COAITIMO j 0� Sty beQVEtZ6
nl�cv tAW
5_6)M-f SWGe WD CflLUKAT ►� �DoN�, OBTfild �r0 I P�.Au K�� fM
��GorZ dS .-" C ORbI �Dc.
R[.[.L°aA ® ,
ReviewerAnspector Name
Reviewer/Inspector Signature: Date: O
12112103 G Continued

Fdcility Number: —
Date of Inspection t d
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWIvIP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes El/No
❑ Yes V
❑ Yes
❑ Yes 7No
El Yes
❑ Yes 3<0
❑ Yes io
❑ YesIN
❑ Yes ��No
B<es ❑ No
❑ Yes 1314
❑ Yes Xo
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes �' o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
12112103

9 f
Type of Visit (Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification eOther ❑ Denied Access
Facility Number Date of Visit: / Time: �
Not O erational 0 Below Threshold
Pf Permitted O Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold -
Farm Name: &C & County: PZ--;---i
Owner Name: 0 Ecr_ag !� &:) Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 0td:rf.,a hk) Agri
Certified Operator:
Location of Farm:
Phone No:
Integrator: _01 OLLS
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 6 " Longitude 0 6 Du
Wean to Feeder
Feeder to Finish
Farrow to WeanFarrow
to Feeder
kN
Farrow to Finish
Gilts
Boars
_
Subsurface Drains Present EAU Lagoon Area
No Liquid Waste Manneement Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 20
05103101
❑ Yes ;eNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
Structure 6
Continued

i e
Facility Number: 3 Z — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? c
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
ElYes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
2 t. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,ICJ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer.'td question #} Expiarnlanv YES answers and/or any recommendations or any ather'comments v
%o x
Use'drawings of fiicihQ-to better explah additional pagesx`as necessary�a ❑ ❑
,situatt6ns,(,use Final Notes
a ; f Field Copy
'Y ..-�: _ -,.+ .? 7 x:: -r
L�i��'� G�J,4-5�� �Pr°L����a.� GtJ,�s h.�/G- �i�� a✓,o�.✓� u/,�s �,
�i►'! E �i45�jr / ON�2i�� �ir/ ��-'`�` � i`�uc � �� f%NO 3
Reviewer/Inspector Name u
Reviewer/Inspector Signature: Date: U
05103101 1 Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes [:1 No
[:1 Yes [--] No
El Yes El No
0 Yes El No
El Yes [] No
El Yes El No
El Yes [:1 No
Addid.onaljCommehts and/or, Drawiings:-.
'W P)V)Cr
O,OA
14146,�9
A?,oO9,(— 72F* V 41vo
0 46(AzIer-76 4AIo rleln
05103101

Type of Visit 9D Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (6 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number hate of Visit Time:
Not O erational Below Threshold
Permitted © Ce ed [3 Cond' 'onally Certified Q Registered Date Last Operate or Above Threshold:
Farm Name: 9FZ C _ _ _ Count:
Owner Name:iZ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: 0 r—x 2 6& &Uj gR�s Integrator: ��-
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0• 0�
Design Current Design Current Design Cnrrcnt
Swine = Ca acitv_ Po a18Uan Pou _. _C `acrty ..'Po ulation__m. Cattle. _ ."Cs acrtr Po alitton
❑ Wean to Feeder ql.? ❑ La er Dairy
Feeder to Finish s;°' ❑ Non -La er Non -Dairy -
,ry
Farrow to Wean
❑ Farrow to Feeder M ❑ Other _ W
❑ Farrow to Finish m
r To#al Design Cap�ctty
❑ Gilts
❑ Boars
Tatai SSL,W
Number qf Lagoons j ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Fie1d Area
a Ponds? SohdaTraps ❑ No Linuid Waste Management System. _.
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
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 stone storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes VrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes No
❑ Yes ONO
Structure 6
Continued

Facitity Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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 a Certi
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?
I5. Does the receiving crop need improvement?
16. 1s there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ V", 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?
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes A, No
❑ Yes FfNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
�No
❑ No
❑ No
9,ZNo
No
❑ Yes �No
❑ Yes
[�No
❑ Yes
X No
❑ Yes
X,No
El Yes
//�No
❑ Yes
1�fNo
❑ Yes
PNo
❑ Yes
No
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C Mirienti(i4erto_gttesteon #j Ezpla€n"anw S-ansvvers'aatiior any.: recommetsdations gr any-.other.":coimhtents. � T
� �
Use'dra�virtgs of faciltty tc� Iietter,ezplant°settrattons Riseit 60,1al pages°as necessary) [I Field Cony ❑Final Notes
„.,:J -
i�
n) Ego 'vMZ S or-L CsT REIPMT.
Reviewer/Inspector Name _ (p `"
Reviewer/Inspector Signature: Date: lio&
05103101 l� I Continued

Facility Number: — 31 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure; and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes [ No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
:additional Cominents;and/o€ Drawin6s:>-
500AI 4:5 O11VDr7-;-'©PJ-'!; Ptplly)_117�_
05103101

tvtsibs of Water Quaility
• -
Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: F FEE -
I Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .. County:..... 11..................................................
OwnerName: .................................................. ............................. ............................................. Phone No:.....................................................................................
.
FacilityContact: .............................................................................."I'itle:................................................................ Phone No:...................................................
MailingAddress: .. ..... ......................... .......................... ............................................................................ ..................................................................................
Onsite Representative: 'r................. ._ Integrator:... 4-end S
Certified Operator: ................................... Operator Certification Number:..........................
.................................................................... ................
Location of Farm:
I,W
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° ��� Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish p JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes )No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. II'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 too
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes PP No
Structure 5 Structure 6
Identifier: ....
Freeboard (inches)
5100
Continued on back

fF'acilit� Number: —�13 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 4 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 gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 9Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �(No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [Xqo
12. Crop type ��+r�`— � gtir`s=7Q S�" �1 ot�ctt rtv�✓J�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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: * •yiolatioris;or- deficiencies *were hated- dia:ing �his'visit. Yob will -teeeiye iiti fuit they.
...corresnondence'.A0' Ut;thisvisit':'::':':::':'::::':'::': :'::':'::':::'.:.':'.:.: .
❑ Yes )<No
❑ Yes *0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WVo
❑ Yes WNo
[:]Yes C<No
❑ Yes 11ifNo
❑ Yes XNo
❑ Yes KNo
❑ Yes O�No
[-]Yes P<No
❑ Yes S4rNo
❑ Yes Id No
❑ Yes 'Z"'I"No
Comments (refer to gtrestion #): Explain any YES answers and/or any recommendations orany other toniments`
Use drawings of'facility- to- better eg_plain.situa_tidns (use additional.pages-as Qecessary)
A.
C>�e�S
3�a61,
ILo
Reviewer/Inspector Name -
Reviewer/Inspector Signature: �-, _k - - Date: ;nG ( 5/00

Facility Number: 131 Date of inspection 1 Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation? J�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �NO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional'Comments'andtorDrawings:
kc)
\0 d� � e3
5/00

Facility Number 3 J '/ Date of Inspection 'j Z b D 61
Time of inspection 24 hr. (hh:mm)
$Permitted [3 Certified © Conditionally Certified © Registered 113 Not Operational I Date Last Operated:
Farm Name: —.......................
Owner Name: fix.. C r �d tni' Gt Phone No: .......................................................................................
'.......................................... � � ......
Facility Contact:.............................................................................. Title:.................... Phone No:
MailingAddress:..................................................................
Onsite Representative:., ,-rd 1✓ S r G r r!........................................r...........
... e...........'......................�:�..................................... Integrator:...........`....... . tl......
Certified Operator: .................................................... ......................................................... I... Operator Certification Number:..........................................
Location of Farm:
Latitude =• 6 « Longitude ' ' 46
Current Do
❑Wean to Feeder
Feeder to Finish
�Zp
3
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
M %Number. -of Lagoons
Hold�ng Ponds /-Sohd'Traps
urrent�=
❑ Dairy
❑ Non-D
Subsurface Drains Present 1E0 Lagoon
No Liquid Waste Management System
Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JZ 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 gallmin? yl
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 ;3 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Eff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Freeboard(inches)...............................................................................................................................................
........................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Ef No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection Od
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ;'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?' ❑ Yes *J�rNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 13No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes e5 No
Waste AF)nlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 21No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes RNo
12. Crop type �r,��d �q s-�U G , ,SrtR I G r4 t .1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,9No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? QrYes KNo
pv,
15. Does the receiving crop need improvement? Yes 7 .134 Yes 4*No
16. Is there a lack of adequate waste application equipment? ❑ Yes Of No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑ Yes No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ff No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes `;9 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 21 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes JO No
24. Does facility require a follow-up visit by same agency?
❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
�' No.001htioris'or di f ciertcii?s •mere rtQted OiW d fhis;visit. - You Will i�eceiye Rio further:
corresp ondence: about this visit:
Comments (refer o question #) i Explain any YES answers and/or any recomfnendatrons orany other comments.
Use drawings of faeilrty tobetter explain situations (nse arldibonal,pages as `necessary}
)Anp,-DVe eYmvdq e-vor Id G' -:1:'.1 roVe,
IDLti/ ArC�Ors iry S,Or�y� ti�Id S .
lJ
Reviewer/Inspector Name
Reviewer/Inspector Signature: A,, q Date: 24 OG.....

Facility Number: Date of Inspection I '//LIn/dpl
Pdor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
ONo
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
0 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
tKNo
31 _
Do the animals feed storage bins fail to have appropriate cover?
Cl Yes
O No
32.
Do the Bush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
PErNo
3/23/99

Facility Number 31 713 Date of Visit 2/18rz000 Printed on: 3/23/2000
Not Operational O Below Threshold
Permitted ®Certified 13Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: Bri-.Nklt..............................................................................._........................... County: D.uplin................................................ '.N. MQ........
Owner Name: Dxxler.B ............................... Edwards .................................................... Phone No: 110=298639.11 ..........................................................
FacilityContact: .............................................................................. Tide:................................................................ Phone No:...................................................
Mailing Address: 323..WA1ard.Edxr'.ards.Ruad........................................................... BeulavAe..NC ...................................................... Z85.1a .............
Onsite Representative: ........................................................................................................... Integrator: CarxnWAY.oAdj.Jjm .............................................
Certified Operator. Reiter .................................... Edwud& .......................................... Operator Certification Number: .1b. IQU .............................
Location of Farm:
® Swine ❑ poultry ❑ Cattle Latitude 34 • 55 1 r7B__J• Longitude 77 • ®° 52
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (frceboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................................................................................................................................................................
Freeboard(inches): ............... 2Z ............... .......................... . ........ ................................... ............. . ............. . ...... ....................................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6

Facility Number. 31-713 1 Date of Inspection 211$12000 Printed on: 3/23/2000
5. Arc there -any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)7 ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
l S. 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?
o ir%olations tir:d ficiericies ivere:rioteii:during xiiis •visit:: Vbu �vUreeeiVe :nn hirk ie:r
.........................................................
.'�nrracatirin'tlAairw flheti�it'tRi�.v�cii. .'.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Freeboard Check. Farm manager gave me permission to go on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
AL
.:
e =: J
R viewer/Ina ector Name
1"A8>E'? �� '��1�'" �' � r %4 �`�'�� �< s'zns� �:# s'a:">.`":#-=s<�<>� %�s'>`?->.v<

Type of Visit OQ Compliance Inspection O Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O• Other ❑ Denied Access
Facility Number 31 713 Date of Visit 2118R000 Printed on: 3/23/2000
O Not Operational O Below Threshold
® Permitted M Certified U Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
FarmName: Bjni-.Nk............................................................................................................ County: Dmp ia--------....................------------------. WIRQ........
Owner Name: )jxUcr.B�................................ Edwa':da.................................................... Phone No: Q.? Q-�9�c�i? 1 �..........................................................
Facility Contact:.............................................................................. Title:........................... ...... Phone No:
..................................................................................
Mailing Address: 323.W1&rd.Edwarda.RaaA........................................................... BoLulavAcM ...................................................... 7.85.0 .............
Onsite Representative:........................................................................................................... Integrator: CA rx'.aYimds.J=.............................................
Certified Operator: Dextex.................................... Eftudat.......................................... Operator Certification Number: .16,36.4 .............................
Location of Farm:
® Swine ❑ Poultry ❑ Cattle Latitude 34 " 5511 23 u Longitude 77 '" 446 F-5-2---I"
❑ Wean to Feeder
® Feeder to Finish
3520
❑ 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 ❑ 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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... .
Freeboard(inches):...............2Z............... .................................... ................................... .................................... .................................... ................. I ..................

Facility Number: 31-713 Date of Inspection 2/19/2000
_ 1 P Printed on: 3/23/2000
S. Are 4iere any immediate threats to the integrity of any of the structures observed? (let 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired 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? (let 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?
(id discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
-So• 'Wahi iis: tir:ditkiericies•vvere:noieii:dnring Oiiwish:: -Vriti ��i:riiezvt ao fiift ier
.........................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Freeboard Check. Farm manager gave me permission to go on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewerllns ecto r Name

' E3 Division of Soil and`Water Conseation :Operation Review
w ry,
kw
[],Division of Soil and Water Conservation ,Complianee lispection `
Division of Water Quality Compliance lnspection — t -
13 Oter Agency. Operation Review
x y
a.
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-uE of DSWC review 0 Other
Facility Number 3 Date of Inspection i}~
1 Time of Inspection F2rst4S177 24 hr. (hh:mm)
9'Permitted [3 Certified © Conditionally Certified Q Registered JE3 Not Operational Date Last Operated:
Farm Name: ................ +' NiC-� ..................................................---.--.............. County:..... 3'.
{f`...................... ...........
OwnerName: ....................... lv&ky.................G s ..........---............... Phone No:... ? ...�`1..nv--1.7........................---.. ............ ..................
FacilityContact:........................................`...................................}Title:..................... ................. ,,Plhone No:.............
Mailing Address: ... .3 ....... [ .Iki?R...... 1whrYtS.... (,lie......... .... Cltt&4lJ.li�C. luC............................ ..... 245a.........
Onsite Representative: .......... .bkx. r........ ej.. ...... Integrator ca-VY-64's....................................................
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude • Longitude �• C` �«
W
Design Current _=- "=
_Design` ; ` Cur"rent =
Design Current
Swine. c
ulaopoultry
-aacitCattle
Capacity Population
❑ Wean to Feeder
-
❑ Layer
❑ Dairy
eeder to Finish
3
; �'
❑Non -Layer
❑Non -Dairy
Farrow to Wean
--
-'
❑ Farrow to Feeder
❑ Other
G
❑Farrow to Finish
Total Design Capacity
_ jd
[]Gilts,
-'
❑Boars
_
-Tota1-SSLW
Number of -Lagoons- �. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Eoldin
� g:�Pon�ds'/Solid Traps No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A5 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes j5No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes EpNo
c. If discharge is observed. what is the estimated flow in gal/min? N
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ;9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PNo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: pQ
Freeboard(inches): T. ............................................................................................................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes B No
seepage, etc.)
3/23199 Continued on back

141,cility44umber: 31 '713 Date tit' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j ] No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? P9 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level .
elevation markings? ❑ Yes 19 No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ERNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
0 No
12.
Crop typem6y Ap 710- Snd �� Qra un
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
21 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
qj No
b) Does the facility need a wettable acre determination?
❑ Yes
rpNo
c) This facility is pended for a wettable acre determination?
❑ Yes
0 No
15.
Does the receiving crop need improvement?
Ye12�s
KPNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�RNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EpNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
$3 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
viol'atiQns:or iiefeiecies were noted during #his:visit; You wiil r'eceiye Rio further -. •.
rorres�6fideiice. ab'OUf this .visit.. .... • • • - • - - • -. .. _ ..... .. .
Comtnents-(refer to .question #): -Explain an3
Use drawings offacility to -better explai i`situ,
`i. 11%r.-L�- Jike UXII of ka br. ko
ey
,k, t� sn cl S 6,cco4 ;,, �o
lq. t •a wrtil .- rec-w6s skovld be.
..way,.-........
ins ,(use:additionaf.)
Ild 10,0- w.otLcd ,
lations oir any other eomltnents -
Reviewer/Inspector Name 3 - + x �W'LL ±r i
Reviewer/Inspector Signature. Aj4___ _ Date. f GjC�
3/23/99

Cacilkj%Number:
[late gal' 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
EA 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
E4 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
3/23/99

Division of Soil and Water Conservation [3Other Agency
P Division of Water Quality
Routine O Complaint O Fallow -up of DWQ inspection O Follow-up of DSWC review O Other
Date of inspection �9
Facility Number 1
Time of Inspectibn t S 24 hr. (hh:mm) .
© Registered ® Certified [3 Applied for Permit RPermitted JE3 Not O erationaf Date Last Operated:
Farm Name:................. ft.. fn!_� �5...... Arx........,........j...................................... .... county: ...... �LIY�.................................
Owner Name: ........ .......... �.4.1.5�'�!:................. ..... EAu w ! ... Phone No: ,Kjj 7si I t, ....................
FacilityContact: .............................................................................. Title:......................................................... .. Phone No:............................
Mailing Address:.....,S.9-.2 ...... W.i hAd...... L_:dulArt}5....................................... .......... Se1,$ Jh4A..j..N...L...----.----.--....................... Ig..........
Onsite Representative:...............�...... ................. Inte rator•........
Certified Operator. ......................................
Location of Farm:
Operator Certification Number, .............................
.......... _.......... ----•:kL.J_--k� .....^^A.1 a....nmr M,... oX.... ... .......................
............ .... . .... ..... ..... .... ....................... ... ............................................
Latitude 0 & 41 Longitude • ` 0"
Swme l i
❑ Wean to Feeder
19 Feeder to Finish
3g
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
;., ❑ Gilts
❑ Boars
. ... .................... . ..... . . . .
Destga Current Destgn
Poultry Capacity Population Cattle Capacity''I
❑ Non -Layer I I — ji 10 Non -Dairy[__
❑ Other'
Total Design apactty C
Total SSLW ,��
Subsurface Drains Present JJLJ Lagoon Area J❑ Spray Field Area
No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ( No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ( No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaUmin? q
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 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [J) No
7/25/97

Facility Number: — ?
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,HoldinE Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ............ :...................................................................................... .. ........................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste A lication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................_
...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No violationsor'def'ciencies:were-note_d'd firing this.visiC You4MI receive hoiltiril er.
correspbadehce about -this: visit:- : ;
❑ Yes R No
❑ Yes W No
❑ Yes ® No
❑ Yes ® No
❑ Yes 2 No
❑ Yes 0 No
❑ Yes [R? No
❑ Yes ® No
❑ Yes R No
❑ Yes No
❑ Yes No
V Yes ❑ No
❑ Yes IN No
1P Yes ❑ No
Yes ❑ No
2�, L'ofvccj( PNPJ ra�c 56 J be 14kU TrI 6" I.COV�s.��-
smcr�! cScb.Cv slrwt)lego cJ U I ,, � CKb or..M"'O' daki ;
25 tk-�Mr °tle"r°`�'�'
A �W Aimba_ a�. s �1 ��„y� 4 2s�bs�ac.
7/25/97
Reviewer/Inspector Nameqa
Reviewer/Inspector Signature:
Date:
o

[� DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspectionmn­
.
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection Q7
Facility Number 27ETime of Inspection '� 24 hr. (hh:mm)
13 Registered d Certified © Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
Farts Name :....... ....M1d....................... ...........
......................................... County:....... t.f...................................................
Owner Name: ........ x.lr...�.c�t ... Phone No:....ti1o�..?-9s� :..t1.� ....................
Facility Contact: c& . Title: .ht.r................... .... Phone No: . ,
y zS�g..........
Mailing Address: 3. 1....1J:.1jkJ4.....6.j.WG.tjs.......Q-.:................................. ...��!?.141�1.��S.t..JCS,�.............................................
Onsite Representative:...... 5 ...... Ed.AJ d-r....................................................... Integrator; ...........CCitW.1..3.......................................................
Certified Operator: ........................................... .. Operator Certification Number,...-.
Location of Farm:
(...........uti5�......... m.....$tiavi fie.:..Tu�x�...�....��^.... ..........1.7.3 ....:fir..n,...r.5.....t��rrox.�.....Q.,...... w
....... t A ....... we$A....�P-_.(].14+'S................................................................................................................................................................................... .
Latitude �+ �5`�C =°' Longitude �' ®'
Design Current Design Current Design Current
Swine Capacity. Population Poultry Capacity Population Cattle. Capacity Population
❑ Wean to Feeder I0 Layer ❑ Dairy
Feeder to Finish I❑ Non -Layer ❑Non -Dairy[
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity 5
❑ Gilts
LEI Boars Total SSI:W
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Presentj ❑ Lagoon Area JEI Spray Field Area
❑ No Liquid Waste :Management System
General
1. Are there any buffer-, that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If dischar�,e; is observed, did it reach Surfacc Water? (If yes. notify DWQ) ❑ Yes ®"No
c. If discharge is observed, what is the estimated flow in -al/min?811
d. Does discharge bypass a lagoon systein? (If yes, notify DWQ) ❑ Yes EjrNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes E9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? El Yes ONo
5. Does any part of the waste management system (other than lagoonslholding ponds) require ElYes 24 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 5&No
7. Did the facility fail to have a. certified operator in responsible charge? ❑ Yes fin No
7/25/97 Continued on hack

Facility Number: j — j
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,11olding fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
......... _..I ...................... ................................... .......... I ....... .................. ................................... ........... I .............. _........ ...................................
Freeboard (fty .......... iF :.;?�............... .................... I ........ ....... .
10. Is seepage observed from any of the structures? ❑ Yes IM No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement!
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .........CQ s. `.. .2�rrr+u fiR................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17, Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a tack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23_ Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or. deficiencies were noted- during this.visit. - You .will receive no further
correspondence about this visit:
Comments (refer)o question #).: EXplain any YES answers and/or any: recotnmendaii
Ud se ravnitgs of faedity t6 better explain situations. (use additional pages as;necessaF3
12, 6%V% ,r "%J out WGAIS 4 1&ym- 56AJ b- "tJed .
i$- C&SW cnr c�, ir, rtilk A-cl& S61a foe �r+.ro+Jek,
Lz. kpprr, ya or. rc(,ovj% ,6vj� � e �� b� �LL , ruv,vwm.ya��
g?Pci }+GG �i GriS ("►L.AA(oJC�►G� OkL� 6A i 10— "�DJ U 6 �6 , 5 i -
3. IJI�a s V� t�iZ A On plkv� ikOA & 0k•. iik
-
❑ Yes E@ No
IV Yes ❑ No
[I Yes RNo
❑ Yes K] No
❑ Yes Pq No
❑ Yes 9No
R Yes ❑ No
❑ Yes Pq No
❑ Yes bi�No
❑ Yes V No
Yes ❑ No
RYes ❑ No
❑ Yes ® No
❑ Yes No
14e j J r% m 6Rr -. l vi4-ov\
7/25/97
Reviewer[Inspector Name
Reviewer/inspectorSignature: ���_ !� Ir��.1 -� Date: q/t�JQ I

•
Site Requires Immediate Attention:
' Facility No. 1
DIVISION OF ENVIRONMENTAL MANAGEMENT is F-%,i
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 -2-' 16 , 1995 •
Time: 1
Farm Name/Owner: n k2 'A
Mailing Address: 3 a 3 `J t � rt-D E 1) t--� pyc 3 rw . ►'� `' J
county: P t --A
Integrator: t: LA'(L- SL4Z'ru. S Phone: '0ka—
On Site Representative: rz KI'M '�a"`r'�� Phone:
Physical Address/Location: tm C.s iZ 1 a 3 w- i ru-- 1 j LJ `1 a
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: 3 Number of Animals on Site: S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' 34 Longitude: `17 ° + 1 _" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ffrcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboard: �O Ft_ Inches
Was any seepage observed from the agoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? or No Is the cover crop adequate? Yes or(o
Crop(s) being utilized: usp-s"n4L r-.1(- `i S - I (_ C Nf.w .F rt �
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ceso No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orC)
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 state by man-made ditch, flushing system, or other
similar man-made devices? Yes r If Yes, Please Explain -
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) . Yes r No
Additional Comments:
Inspector Name
_ Bs �_j
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

r
Site Requires Immediate Attenti n:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: -���� , 1995
Time:
1!3
Farm N
Mailing
County:
Integrat
On Site Representative:
Physical Address/Location: .
Phone:
Type of Operation: Swine Poultry Cattle Ti v, ism
Design Capacity: L6 Number of Animals on Site:�� c� -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude 7' S _" Longitude: ' �' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)rr No Actual Freeboard: �O Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or( Was any erosion observed? Yes o�o
• Is adequate land available for spray? ers r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: S.� �- < rqZ + �� Q�5f
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? l e or No '
100 Feet from Wells? s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or i
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o oNd If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
• Ins ector Name
t <,�
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Imo-,.-:diate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
/Time: < .
Fazio Name/Owner: /� / � — AF6
Mailing Address: _
County:
Integrator: r OI Phone: gf��1` 30 ?
On Site Representative: e, Phone:
Physical Address/Location: m Zelz�z
Type of Operation: Swine L2 Poultry Cattle
Design Capacity: '� _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Longitude:''" Elevation: Feet
Circle Yes or No
Doesthe Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
IS (approximately 1 Foot + 7 inches) 6 or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or"No Was any erosion observed? 9e or No
Is adequate land available for spray? e or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: LI1 0 A ; S
Does the facility meet SCS minimum setback criteria. 200 Feet from Dwellings?)(e' or No
100 Feet from Wells? eeslor o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 06
Is animal waste discharged into waters of the state by"man-made ditch, flushing system, or other
similar man-made devices? Yes oARo If Yes, Please Explain.
Does the facility maintain adequate was a management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? e ff or No "
Additional Comments: R��h iS ll P, w � wiz.b l,tu.f _IomP Proffph avt
Inspector Name
19-
cc: Facility Assessment Unit.
Use Attachments if Needed.