670025_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Oud

(Type of Visit: U CCliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
isit: Routine I
Reason for Vutine O Complaint O Follow-up O Referral O Emergency Q Other to Denied Access
Date of Visit: Arrival Time: Departure Time: County: 6A),Q Ay✓ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Imo' oo ����jr-� � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle• : Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o FinishDai
Heifer
o Wean
Design
Current
D Cow
o Feeder
E
Dr, P,oultr,
Ca ari
Plo _.
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
Other
Discharizes 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 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes
❑ Yes VNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 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
�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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IZNo 0 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
in 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 environment 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 No ❑ NA D. 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 Vo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Elko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No D NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FA/No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Ot
21. Does record keeping need improvement? If yes, check the appropriate box belo Zes [:]No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ 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: ra I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z?�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:
❑ NA ❑ NE
[3 NA ❑NE
26. Did the facility fail 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 fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 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? r] Yes
<o ❑ NA ❑ NE
�No ❑ NA ❑ NE
zw o ❑ NA ❑ NE
Z2/No ❑NA ❑NE
NA NE
❑ NA ❑ NE
PoNo❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages.as necessary).
S onyh Put,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
Phon L>
Date: 1
2 /2015

Type of Visit: (D Cora iance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: / County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 7O,D D T(4x-G—P j Integrator:
Certified Operator: Certification Number: 2-5 07
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design
Capacity
Current Design Current
Pop. Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder Non -Layer
Feeder to Finish
Farrow to Wean
Farrow to Feeder D . I;oult .
Farrow to Finish I Layers
Design
Ca aci
Dairy Heifer
Current DEyCow
Plo Non -Da"
I 113eef Stocker
I 113eef Feeder
Gilts
Non -Lavers
Boars
IPullets
I 113eef Broad Cow
OtherI
Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ 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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cj /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 16tNo ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
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 E2rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes CNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �INo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Z1,
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]maps ❑ Lease Agreements ❑Oth r:
21. Does record keeping need improvement? If yes, chec he 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 l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes 0 NA ❑ NE
Page 2 of 3 21412014 Continued

Ia acili Number: jDate of inspection: R [
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZN o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes LJ No ❑ NA ❑ NE
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
dNNo ❑ NA ❑ NE
e❑ NA ❑ NE
N10 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations�or any ottier eotnn1ents --
Use drawings of facility to better explain situations'(use additional pages as necessary). '
t-6 �NAL,'�� svJc- F-oA--1 mPw,-rH,
Reviewer/Inspector Name:
Phone lD
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21412D14

Type of Visit: U pliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Co7RRoutine 0 Complaint 0 Follow-up 0 Referral t) Emergency 0 Other 0 Denied Access
Date of Visit: ! Arrival Time: Departure Time: County: j2�&_O Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Tip rj � a[�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: aY767
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
FTLayer
Design Current
Wet Poultry Capacity Pop.
Non -La er I
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3
6
Design Current
D , Paul , Ca aci P,o ,
Layers I
DairyHeifer
Cow
Non-Dai
Beef Stocker
113eef Feeder
Gilts
Non -Layers
I
Boars
Pullets
Beef Brood Cow
Other
Other
11 L_LOther
Turkeys
Turkey Poults
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?
0 Yes No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
\ Page I of 3 21412011 Continued

Facili Number: - — Date of Inspection:
Waste Collt etion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
❑ Yes
u lYo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
0 Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i rl(521
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are immediate integrity
N NA
NE
there any threats to the of any of the structures observed?
❑Yes
❑
❑
(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 environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JZ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes rNo ❑ 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 0NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes16
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2/No
❑ NA
❑ NE
the appropriate box
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check t appropriate box b�w. 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 ` ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes l_'J No ❑ NA ❑ NE
Page 2 of 3 214,12011 Continued

FacilityNumber:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes /o ❑ NA ❑ NE
25. Is+the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 7No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes V<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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes U<O ❑ NA ❑ NE
[] Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No
❑ Yes [o
❑ Yes Yo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any.:YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situation's (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone ?/ 3
Date: �_/, / ,
2112011

Type of Visit: GMom ance Inspection Q) Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up p Referral O Emergency O Other Q Denied Access
Date of Visit: ly 3 Arrival Time: j Q Departure Time: / ` County: WS1_6LJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Td CXD —NmCsFE '� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2SIb
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean
Design Current Design Current
Wet Poultry Capacity Pap. Cattle Capacity Pop.
Layer DairyCow
Non -La er Da' Calf
Wean
otoFinisEh
Feeder
(a
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D . Poultry Ca aci P,o , Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Gilts
Boars
Other
Other
I
L10ther
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 J/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [] NA ❑ NE
❑ Yes g �No [DNA ❑ NE
Page I of 3 21412011 Condnued

[Facility No ber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L+'J Ago ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
,,Structure I, Structure 2
3_d
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No [DNA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, 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 Q/1Vo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [] o ❑ NA ❑ NE
❑ Yes [2N ❑ NA ❑ NE
[:]Yes Io ❑ NA ❑ NE
❑ Yes Z❑ NA ❑ NE
r
❑ Yes ❑ NA ❑ NE
❑ Yes l—T
❑ Yes "`777L�/No"'
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists El Design [:]maps [:]Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility N ber: -9N Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I?fNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes &No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes V(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes E21/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes M/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?
❑ Yes mA
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
j.
Use drawings of facility to better explain situations (use additional pages as necessary).
Do
Name: L.
Phone: C M- 1383
Reviewer/Inspector
G[i
Reviewer/Inspector Signature:
Date:
l rk
Page 3 of 3
/4 11

Type of Visit: 0 Co ` fiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: %► Arrival Time: Departure Time: ® County: G%� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design C*urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Wean to Feeder I INon-Layer I
Cattle
Dairy Cow
Design Current
Capacity Pap.
Daia Calf
Feeder to Finish
v
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
De, P■ault . C•_a aei Ho
Layers
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Twke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
0
❑ 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
VN
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection: Y✓
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
E�(No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes EY<O ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes [2�40 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Ll No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VIN�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes � Zo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes To ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 5/No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: 57 77 jDate of Inspection:
20. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes raTNo❑ 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 I
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes LJr ❑ NA
❑ Yes ❑ NA
❑ Yes gNo ❑ NA
❑ NE
❑ NE
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or°any other comments I
Use drawings of facility to better. explain situations (use additional pages as necessary).. . ,L
Reviewer/Inspector Name:
Phone:(q%)7 76 --
Reviewer/Inspector Signature: Date:
Page 3 of 3
I

(ti
Divisi.an of Water tiah}.fir
Fac�lityNumberP (A a 0.Dtvtsion of Soil and Water Conservation`
4 F��� Other. Agency''.. �..�
E
f Visit QKCoLmpfiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 9 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: dl✓SL61� Region: _
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 Title: Phone No:
Onsite Representative: w0� 11^t�Cr��r1y _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 { = 11 Longitude: = ° 0 i 0
Uesignm CurrenfiDesign Curren tt
°Swine;
CapacityPopulation
Wet Poultry C apacity P opal ahon
❑Wean to Finish
❑ La
„ er
Wean to Feeder
n ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean,
Dry Poultrv� ,
❑ Farrow to Feeder
4
v ° e
❑ Layers
❑ Farrow to Finish
❑ Gilts
„;
❑ Non -Layers
❑Boars
El
;
~
❑ Turkeys
h0.er�k
,.. _., R
❑ Turkey Poults
❑Other
❑ Other
pt
Dairy Cow
_Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes • ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes [I No
❑ Yes DNo
❑ NA
❑ NE
❑ Yes E No ❑ NA ❑ NE
12128104 Continued

• Facility Number:
Date of Inspection l S l+
Waste Collection & Treatment ,�,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LXNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 E EVo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ffNo ❑ 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 environmentytbrat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ N
(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 rJ No ❑ NA ❑ maintenance or improvement?
Waste Application CJ
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No El NA N
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes D o [INA ❑ N
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
ElOutside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
E
E
NE
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
W
o El NA ❑ NE
No ❑ NA ❑ NE
eNoN ❑ NA ElNE
❑ NA ❑ NE
Comments (refer Eo question° #) Expla►n ;any YES answers andlor any recommendafions or anv other comments
Use.drawm s:of facility- to;better eg lain situations use,additio ial a es as:necessa . k
g h P p gf. ry)
Reviewer/Inspector Name
Reviewer/]nspector Signature:
Page 2 of 3
Phone:
,Y, Date:
N 4
72128104 Continued

Facility Number: Date of Inspection UP 1,
4' Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IdNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� o ❑ 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,[�'IGo
L✓� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
"
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ 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
I_I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
YNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 7Routine
Pliance Inspection O Operation Review O Structure Evaluation O Technical AssistanceReasonforVisit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Arrival Time: Departure Time: �� County: 6kyC-0v✓
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 16DA> N ZG-Pfi tJ Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o [= 6 Longitude: = ° = ` = "
Swine
Design Current
C•apaeity Population Wet Poultry
Design
Capacity
C►urrent Design
Population Cattle Capacity
Current
Population
to Finish
❑ Layer
❑ DairyCow
to Feeder
❑ Non -Layer
❑ DairyCalf
r to Finish
6
6
❑ Dairy Heifer
to Wean
to Feeder
w to Finish
EBoars
Dry Poultry
❑ Layers
❑ D Cow
❑Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Non -Layers
El Beef Brood Co
❑ Pullets
❑ Turkeys ❑ Turkey Poults
❑ Other
1149mber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection o /D
' 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
S /
Identifier: � vot-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
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
ElYes
�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
eat, notify DWQ
environmenta7No
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures 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
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElO Yes
f
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
Cl NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E�/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
[!3 No
❑ NA
❑ NE
'Comments (refer to quesdon-fl Explain=any YES answers and/or any recommendat ons or any�other comments
Use drawn s of facEli to.better ex lam si#uat�ons use additional a esWas necess
-- �..�.. _..�.._
Reviewer/Inspector Name �12h� L. Phone:
Reviewer/Inspector Signature: � �� Date: qh -he)
Page 2 of 3
l

Facility Number: — 5 Date of Inspection o /
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3/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
[3�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Y
❑ No
El NA
El 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
l<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge? '
ElYes
,1
CI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L"J No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V 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
Plo
❑ 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
M/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
2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3
12128104
R

Type of Visit O7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Iii �_! ° !J Arrival Time: © Departure Time: County: O&IS- 4d Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 100D T1PE,~i
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =o = r = Longitude: F-1 o =, = "
Design
Swine Capacity
Current
Population
Wet Poultry
Desigfflurrent Desi!nfflCurrent
Capacpulation Cattle Capaopulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
I
❑ Dairy Calf
® Feeder to Finish
❑ Farrow to Wean
23L 0
3' .o�
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkex Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Number of Structures:
Discharses & Stream Im2acts
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 I of 3
❑ Yes Ll No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes Q N ❑ NA ❑ NE
12128104 Continued

' Facility Number: is — 2 Date of Inspection v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 14 &ww
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2No ❑ NA ❑ NE
El Yes El No El NA ❑NE
Structure 5 Structure 6
❑ Yes ENo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ 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) dNo
9. Does any part of the waste management system other than the waste structures require Elyes ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eFlo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EKo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
d o
WN
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is lack
El Yes
VNo
❑ NA
El NE
there a of properly operating waste application equipment?
El Yes
❑ NA
❑ NE

Facility Na'ber: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
Rl No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
EYYles
❑ No
❑ NA
❑ NE
❑ Waste Applica ion ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [I Waste Transfers
❑ Annual
Certification
El 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
CNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LI�N0
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
ICE No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(2/NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
6 N
El 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
D o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
0No
❑ 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
Q 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?
El Yes
,.,�
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes❑
7No
NA
❑ NE
Additional Comments and/or Drawings:.,
Page 3 of 3 12128104

b? H 91
Type of Visit Co liance 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: 01LAW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1on0 A1&F&'J Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = ' = « Longitude: = ° = i =
Design Current Design Curren#
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle C*apacity Population
❑ We to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
El Feeder to Finish
loQ
'L6
Dry Poultry
❑ Layers
❑ DairyHeifer
El Farrow to Wean
El Farrow to Feeder
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Non -Layers
llets
El Pull
Gilts
❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
El Yes
_/
L�J No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�❑
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

n
Fscility Number: �ji 7 — j" Date of Inspection J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes d�o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ntal 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 L/1 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 EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application f
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes W No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 14% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2/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
[-2 N . ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[INA
❑ NE
18. Is there a lack ofproperly operating waste application equipment?
ElYes
VN ❑ NA
❑ NE
1.) aurt.bp P.T.K. pCL,,o1 -r., . Pt V_ ED qi 146&- 146dSf 'J6XT TG FXCL-o,
Reviewer/Inspector Name , I Phone:
Reviewer/Inspector Signature: Date: 4"
Page 2 of 3 12128104 Continued

Facility Number: GI —tit Date of Inspection z3
R ulred 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 E�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ,�,/
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes LEI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[,YNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Noo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
EIN"o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.,/
[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
L4 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
�TNo
❑ 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
ElYes
E 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
L� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNlo
❑ NA
❑ NE
Additional Comments. and/or Drawing's:
Page 3 of 3 12128104

Facility Number
dDlvision of Water Quality
Division of. Soil and, Water Conservation
Q Other Agency
Type of Visit 7compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit VRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 67� Arrival Time: Departure Time: County: Region:
Farm Name: _ _ .. Owner Email:. — .
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Title: Phone No:
Onsite Representative: 7—rg- -(�rG _ _, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 6 0 Longitude: =° 0=
-
Design Currents.:,"Design Current Design Current
Swine Capacity .Population Wet Poultry. Capacity Population Caft[e Capacity 'Populahon
-...,._.
❑ Wean to Finish
❑ Wean to Feeder
IN Feeder to Finish
av
I xrou
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
=:-Other.
s ❑ Other
❑ Layer ❑ Dairy Cow
. ❑ Non -Layer ❑ Dairy Calf
--- - — — ❑ Dairy Heifer
Dry Poultry El Dry Cow
❑N D
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
on- airy
❑ Beef Stocker
❑ Beef Feeder
w
❑ Beef Brood Cowl
Number: of Structures M:.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2- Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑Yes `No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
❑Yes
El No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
Leo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspectiond a�
W to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 4.146-00
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes U No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ElNE
ElYes 2"No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑4o ❑ 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 CrNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L�l No ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LQ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ��No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? ElLT Yes No ❑ NA ❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes Plfio ❑ 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):
Reviewer/inspector Name �/�Phone
Reviewer/Inspector Signature: Date:
Page 2 of f 12128/t?4 Continued

Facility Number: -'j, Date of Inspection Lffzd/�7
IYeguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? if yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes[4o ❑ 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 IMNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jd No ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
Ek o
❑ NA
❑ NE
❑ Yes
U<Zo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or
❑ Yes No ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes E. No ❑ NA ❑ NE
❑ Yes 53/No ❑ NA ❑ NE
❑ Yes o/N/w ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12128104

21!
Faciility Number 7
i
Q"Division of Water Quality
0 Division of Soil and Water Conservation
O Other Agency.
Type of Visit Zvoutine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `'/,j /OL� Arrival Time: f 0 Departure Time: County: 'PA/'s640
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: lvUrO ) x l m
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: 0 0 = ` = " Longitude: 0 0 "
__ .i 9`
Design Current Design Current ` Design CurrenU
Swine Capacity Population Wet Poultry Capacity Population Cattle CapacityPopulation; ,-
❑ Wean to Finish ❑ Layer
El Wean to Feeder ❑Non -La er
FQ Feeder to Finish 3 3" 1 3
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
ElNon-Layers
ElPullets
❑ Turkeys
El Turkey Pou!
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
is
Number of Structures:.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El 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 l of 3
❑ Yes UZ ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[INE
❑ Yes
[:1No
[IYes
9//o
❑ NA
❑ NE
❑ Yes
LJ,�4o
❑ NA
❑ NE
12128104 Continued

Facility Number: 61 —
Date of Inspection
;,-Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: GA6'dOAJ 3Z
Spillway?:
Designed Freeboard (in): ILO
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1E['N'c ElNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 12"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 2/No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
Ctrs
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ET El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
u N ❑ NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
& o El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo ❑ NA
❑ NE
r.
Comments (refer to question #):. Explain any YES answers and/or any recommendations or°any. other ,comments.'e
Use drawings;of.facility to better explain situations. (use additional pages as necessary): "
Reviewer/Inspector Name olll (/�{jL -- - 1 Phone: 1)0
Reviewer/Inspector Signature: Date: �' 6
Page 2 of 3 112128104 Continued

Facility Number: 67 — � Date of Inspection S L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Vo ❑ 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 El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CKOl []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 [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
�No
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
(<,.J No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E 1Ko
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Flo
❑ 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
21o
❑ 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
Piqo
❑ 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
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
�Q
lId No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2128104

S
Type of Visit Compliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: v Arrival Time: 130 Departure Time: County: _ �IV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r.o p jM -z e ad
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c ❑ d Q Longitude: ❑ ° = 6 ❑ N
lip
Design Current. rf �J>_ rDesign CMq�'� Designom` Capacit} Pgpulatwn,yet�Potiltry CapaciP,opabe u tapacity� Poplahon
❑ Wean to Finish T ❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf
g Y we a,: ❑
[Feeder to Finish 3�0 3� - Dairy Heifer
❑ Farrow to Wean
Dr}�P._oultry �` ❑ D Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish Layers El Beef Stocket
❑ Gilts ❑ Beef Feeder
❑ Boars ❑ Beef Brood Cow
Other # r', �S ` s..
�!iss�
r Number of Structures:
Ej—
❑ Other
❑
❑ Non -La ers
El Pullets
❑ Turkeys
❑ Turke Poults
Dischar2cs & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2(No
El NA
❑ NE
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
El No
El NA
[I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
El NA
El 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)
El Yes
El No
[I NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L� N
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
El NA
[I NE
other than from a discharge?
12128104
Continued

Facility Number: 6,7— S� Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ 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: tACaoA/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 ENo ❑ 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 Ef N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [- No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ok-SAT 561(6q)A
13. Soil type(s) S-+ AWS
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,,__,,//
L"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z114o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
L No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
use drawtngsfof facdity to better explain situations use additionalFpages,asnecessary"):
'11) dpoArC cQoo c n w S-r �, ,► � FOYLMS , 'f1LA0J F6n 1 f*'au. TS N 6W F0 nr►,S .
,C&6P pPte 6f AA/�UAL G& r, WX-rg RE cpa,0s
Run LOOKS G2.ERf,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: _ Y/ (a
12128104
Continued

Facility Number: Date of Inspection 05
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑,�Noo
❑ NA
❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis [I Waste Transfers
[3 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
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2"NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D No
❑ NA
❑ NE
24. 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
CYNo
❑ 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
,/
2 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
EfNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes/No
❑ NA
❑ NE
Additional Comriients and/or Drawings �
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit feel Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 7,Date of Visit:
Permitted 0 CCeertiSed (3 Con did all Certified [3 Registered
Farm Name: ..[/ �,ICQI//-��
Owner Name: `
Mailing Address:
Time:
O Not O erational O Below Threshold
Date Last Opera or Above Threshold: .........................
County: ��G U�. ......._._ . � ..:._ .... `.
PhoneNo: ... . .......... . . . ........... ............ .............-..
Facility Contact: --- ............................... ...... ......... - Title: ... ........... .................... .................. Phone No:
Onsite Representative:...../iP�.Q C----------- ------- ...-.-.... Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
&swine ❑ Poultry ❑ Cattle ❑ Horse Latitude A " Longitude ' ° «
vrreat , _
5wiae
Wean to Feeder
Feeder to Finish
Z00
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
(...Lagoons
^❑ Othex
Uesxgn ;;Gurreut
the —•_
Ca acr , Pii�ulaahon
Dairy
Non -Dairy .E
•� 3
apaciV I =
,,SSLW '�
Discharges & Stream Impacis
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
❑ Yes P'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes XNo
❑ Yes XNo
Structure 6
Identifier: ............................. - --..........--........
Freeboard. (inches):
12112103
Continued

Facility Number: — 2
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 maintenancefunprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
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 maintenancelimprovement?
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
❑ Yes INO
❑ Yes ?No
❑ Yes 0 No
El Yes /0 No
❑ Yes Q;,No
❑ Yes V.
❑ Yes �No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWN P)?
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes 21 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[] yes XNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes )ZNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes [io
Air Quality representative immediately.
YComments {re%rsto question#)Explaui aay YES answers and/or aay recommeadateons or anyothercommenu." F: w
Useof 6c� to°better sttnatao use addrtxonal es as necessa
�wm&S�, tl'� eacl►Ia n , � _ 1� p r'Y)�„ ❑ Field Copy ❑ Final Notes
4.�..'".^ "��t91�'.,a�
::_ ». j:k-c.'�,�""'�- _
m _r.. 3?. _.'?:r-'^: ��..�"`�r�_.,:. s`,.>.•.'s_"q'. wx"�"..°..^�....d...�:,�._.�;',.°»,.._.s: r:;:.�.:......,
r
s� 19/4�� 02 7Ci:�z�
Reviewer/Inspector Name.' `, W
Reviewer/Inspector Signature: Date:
12112103 Continued

+ Facility Numbers —y Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ja<o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, design,
❑ Yes o
checklists, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �To
❑ 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?
❑ Yes 21/No
25_ Did the facility fail to have a actively certifiers operator in charge?
❑ Yes PIRG
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes �No
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ YeseNo
28. Does facility require a follow-up visit by same agency?
❑ Yes J;�o
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .,dNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Q"�cs ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P-f4o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes P-No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes Lafio
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ,[ NNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 0'&o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall XInspection 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

ign Current
IType of Visit oCompliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit jq Routine O Complaint O Follow up O Emergency [Notification O Other ❑ Denied Access
Facility Number Z 5 Date of V;sir: 5 % 02 Time: 1 l O
Not Operational Q Below Threshold
13Permitted 13Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... _.......
Farm Name. G�at!G?' Q:1 �i✓..!�x_r.. ..�........ County:... Qnsloi0{....................
r
Owner Name:.-- m �r!-t_.___ h►Y_Ie7---------------------------- Phone No: -------------- ---------- - ---------------
MailingAddress:......-.........................................................................................................................................................................................
Facility Contact: .......
....................... Title: ........._.........:....................
Phone No•
Ons ite Rep resen tative:
_ d _ �1-c ,n__-.___-_-_--------_-___
Integrator:_i
At_.15zL_ .______.
Certified Operator: .................................................. .......................................................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle 0 Horse Latitude �• �4 Du Longitude • 6 0`
Desig
Swine Ca acl
Current - _ _ ,Design
'opulation::.`poultry Capacity Po
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Cattle
Non -Dairy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ONO'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes N[o
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 fd'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... -- - -- -- --............................ -... -----•--•- .............. -•--•-----•--•-----•--•- ..
Freeboard (inches): S2

vJiu.3ivl
Facility Dumber: — 2 S
Date of Inspection S ? pZ
t.unlinueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding,,E]'-PAN ❑ Hydraulic Overload
12. Crop type W h eat 4 , 'e Ll C eti
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 or other 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? (iel irrigation, freeboard, waste analysis & soiI 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 21"No
❑ Yes l"Vo
❑ Yes XNo
❑ Yes 'No
❑ Yes )ZrNo
❑ Yes j2No
Xycs ❑ No
❑ YesZENO
❑ Yes ONo
❑ Yes ONo
❑ Yes O'No
❑ Yes O'No
❑ Yes ffNo
❑ Yes J21'114o
❑ Yes _VNo
'XYes ❑ No
❑ Yes ETNo
❑ Yes _04jo
❑ Yes ❑ No
❑ Yes-,ETNo
❑ Yes ,3Vo
❑ Yes .ENo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
=.- § "13.__-11L
Cminenis(refer-to.qu_estion.#).UExplarn:anyYES ans►vers and/or an 1� ecommendations;or_anyOEhWer comroen#s. wLEM
Use amga tysto betterl„atn situafov(nse additional°pa es as ecessa :.: ❑ Field Copy ❑ Final Notes
I q > —There i s tl e t-v AJ* -v141 y .s : S 0('14ed W; 411 •'L di er Y 3 o f Ae 4' p®l r L h�1' a v�
A,evevt�s
Wyt�`c4 aG1L-�r/eU� �n J vl �Yta( �rv9U5� Zd4 J. ly%✓'• Th>�Pe SaI�S
)he le s v M5 &4t 6k -d1r Sa,,y /e
-7Fkr
t��%c� evE�-�u411,9 e�lav�E �j�G� dG- CA II f/b/ol . f,-e, ot_s q►�glr_s► 3
days
;Pj
✓
C3 G-�a bey Zoo I ,
Reviewer/Inspector Name Y r --r mow
-Date:
Reviewer/Inspector Signature: %' S r% O Z
."g':-';�5.--...-7 .... _.-.'.•,.-rt'-^5�.7'..c�.:�.r:-.T:t'%�2Tx4:f.`'`..�`�..^�`"!.,???L^���—;:C[�s;a'v:-:rr.-.^X='•: ;.}7':4��,;�-a---r�-+cr..-sr_r. �.-svE-.ti�rac. ycmx-r_.—�.-c�..r. r-r--� ,.. _, .�...

Facility Number: Z5 Date of Inspection S
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments .and/or _Drawings: b;
.say 1 -e�� �eP o r� ex i s4-5 , �
�.� -A ;,3 e v l -4 k n o c.,) 110 �e 01 k ties t
LL
R"e Sor'1P iesvJ-Is �vi The yef,o-.� �a�e W►44 44& da�e 4n jf jr
r)C aVe;11]elb)e .%l- 1'4sineG4,0-1 4lie✓e b� Yngk;.,I VPrr�`� �t�►�•1 d,ff'�Gv�.
B-e s✓T'P 'i0 hevc .59;� -/�� eoeA year �7d bgvg d64amen-�cr��0"1
eivet'h4ble loG veeif';GQ4i0h
t
Ig. con4:teedD A1,-e4 fo rise -/4e b+e9 ;nn"h5 Plano RvRl'IQ61e
g1(ewgnCe -ter tvheQ- $�' er g,90 %bsl a6re and -r<cs scybegw
'
6� %2 AI ACrE do? A :r✓{R-2-Y -re � ]�vI/S S-Ardv9A 11,
r.Th:9p�h cvfrevl�/y Us;�� !off Jds/Gore 1v1d 112 lbslatfe
Ay ctw on V //., l - y and 1z -16 .
Yn IA/.l r7'v- f%em
�1. Qv�resflf}ltCq�►O� D�' ��9'� Ave?dz? le 4/rf,- c�C" eeco."'ea d'vJ
0& 'kp 2001 --'Z0aZ-&�WheeT) Grof -
T�,�r 1a:n allows 8g hs/Rrfe , whale R1, 31or lbs/gcte ct-4!z.s
bare 4f 1
05103101

N,�

�% Ihv�ston of Water Quality
_ Q Dinsion of Soil and Water Conservation
x _ � Ot13er- N Y E S
S
Type of Visit Acompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit )5 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number gate of Visit: ert afJ v Tune: l{ia o Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ...... ..`..f�Q``1............................................................................ County:..-.l1v.L.N�.............................. .............. ......
Owner Name:................................................... ..........
Phone No:
Facility Contact: .............................................................................. Title:............... Phone No:
MailingAddress: ................"...........-......... ---...-.........-..............-.._..-.....-.............................
---•-"......... ....... ........... I ...... I.......
OnsiteRepresentative:.....\U............. `.�..-..........--.... ............. Integrator; 4.... ........
.....��' .- .........................................
Certified Operator:
Location "of Farm:
................................. I ....................•..... Operator Certification Number:
'r
❑ 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 '3 �0 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
[] Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lago»n Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b" ]f discharge is observed, did it reach Water of the State"' (If yes, notify DWQ) ❑Yes ❑ No
c. if dischar�,c is observed. what is the estimated Ilow in gal/min?
d- Dees 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 �TNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J�(No
Struc:turc 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ..................................
Freeboard (inches): an
5100 Continued on back

Facility Number: 4� - 2 S Bate 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,
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type SGv�Ps.•Y-�i L-�
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?
:: Nd -yiolaii6ris'or• &ridencies -Were noted- iiurin ' this'visit' - :Y:ob will 4-&Oi.e iio i.0rt. h&
correspondence.a�vufthisvisit.:...•.-.-_-.-. '-'-*-•.•.'.•-'-'- .
❑ Yes 6;rNo
❑ Yes WNo
)Yes ❑ No
❑ Yes COO
❑ Yes EfNo
❑ Yes N'No
❑ Yes XNo
❑ Yes LNo
❑ Yes Z No
❑ Yes 1�fNo
❑ Yes �ZNo
❑ Yes MNo
❑ Yes ,D 'No
❑ Yes XNo
x1Yes ❑ No
❑ Yes 9No
❑ Yes [S,No
❑ Yes 'N No
❑ Yes OrNo
❑ Yes �!(No
❑ Yes tqNo
❑ Yes �ZNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
iUse drawings of facility to better explain situations. (use additional ypages as necessary):
A.
Cv YV-,Q_� o� 0.L 51 d am, t �d l 1 C � f � -(- , f{->� dr c.; t.
L�kt � r 7G� t— C L— + -�-i ►— mh o��� c�
�s.5�ye �a$ fQ_ q5c, tFP tr-�ih.� T Ccr t ti n�eG1� 14 g
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:` o�! �Q ( 5100

Facility Number: 6r7 Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below kYes ❑ 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 ;t�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 eNo
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 WNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j No
32. Do the flush tanks lack a submerged mill pipe or a permanent/temporary cover? t(Yes ❑ No
AddMonal. ommen1 an or. rawtngs.
t
5100

f
'Division of Water Quality
ivision of Soil and Water Conservation
O Other Agency :.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number a Date of Visit: 7 W Tijne: Qb Printed on: 7/21/2000
O Not O erational O Below Threshold
[] Permitted JyCertified 13 Conditionally Certified [] Registered Date Last Operatteedj or Above Threshold: .........................
FarmName: .. V�!Gec, ....................................... Count°:.....v.^rF.G.......................... ................ ......
OwnerName:...............................................................................................
Facility Contact: .............................................................................. Title:.......
Mailing Address: ............................. ..........
—...._.............................................
...................
........
Onsite Representative: ..... 1.0 ......,. \�'. ... ............................................
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
Phone No:
.............................
Phone No:
...........................................I..........`............... ........
Integrator:......... �`-'�
..............................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C�f Longitude • �t 44
Design Current Design Current Design Current
Swine Capacitv Population Poultry_ Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish ❑ Non -Layer I 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 ❑ Lagnnm Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. 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/tnin'?
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 OrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structurc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:........................................................................................................... ...... ......................................................................................................
Freeboard (inches):
5100 Continued on back

N

1~aciliiy Number: —
Bate 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
0No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
CR�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
9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
531No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
&NO
elevation markings?
❑
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
CR�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ERJqo
12. Crop
type SAY �,�j1-,mot
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
J9No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
8(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
DfNo
16. Is there a lack of adequate waste application equipment?
KYes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
gNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
0,Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CR'No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Wo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Dd�No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes MNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 1910
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
:: N,6-yibihtidiis:ok. defcienciies -were noted• diWir'ig this:visit'.• Y:oit wiii•reeeirye riq further -:.
cor:resporidence: about this visit. - : • : .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situ lions. (use additional pages as necessary):
L4
1 i
` F lvl%t Irk Sa a Qv CYAiRr l�1 R Q
Reviewer/InspectorName � �3 V_
Reviewer/Inspector Signature: Date: 5100

Facility Number: — Date of luspection EJ jA GO 1 Printed on: 7/21/2000
Odor Issues `�*`��
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below WYes ❑ 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 [R`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes D(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? i� Yes T❑] No
�L_'( IQC' k- -1-' 4,1' ks'
GLGPS � `T1 V4_1
AE
5100

IO Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review ,® Other
Facility Number rj 2 S Date of Inspection J Z OU
Time of Inspection / Q 24 hr. (hh:mm}
© Permitted [] Certified 0 Conditionally Certified © Registered 0 Not Operational I Date Last Operated:
Farm Name: ........ Oj/2.'^ a rq ✓ r'1 >' County: ... Q ✓1 x"ku.........................---........
Owner Name: e /' '^ „ .i l� �JQ,VI Phone No ....
......................................
Facility Contact: .......... Title: Phone No:
........................................................................................................
MailingAddress :.........................•---....................... ..................... ......................... .....
Onsite Representitive:...!..:.l.. G�1 Qf �� �' f..!�'`�. ��. Gt lC��... Integr2tor:.&Q.1.1A.W:/'.1 ................................ I...............
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude 1 •6 Longitude a ° 1&
Swine :.
Design , Current Design Current . Design ;Current
_Ca" act Po"'iilahon Poultry Ca aci _Po u atiorr Cattle
_�_ :;Ca ` acity=zPo•"ulation-
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ;'' ❑ Non -Dairy -
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder °
❑ Farrow to Finish Total Design Capat ity
❑ Gilts =
❑ Boars - _ Total`SSLW-
Niimber of Lagoons i ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
W -
Holding Pondsa Solid:TraW, ❑ No Liquid Waste Management System }
w
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j
Freeboard (inches) . ......... ............................
5. Are there any immediate -threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

F;kgity Number: 7 — Z Date of Inspection .
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require 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?
I I. Is there evidence of over application?- ❑ Excessive Ponding ❑ PAN
12. Crop type
2.z DO
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
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: �Io-viola(ions;or• deficiencies were pi;) *O- oWi'4g �bis;visit. - ;Y;oit Will-t&e iye tid futther .
.-.•corres ofideiice:aboufthisvisit: ............... ....:.:...:.:.............:....
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 19 No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): Explain any YES answers.and/or anyrecominend`ations 'or'-
�'j
'i.
Afiy other_r
Use drawings of facility, to better. explain situations (use'additional pages as necessary}
�hs� eC�i4L, Gt'nG�t/G�e� /'✓L >rej�Q01?SQ 7n a �c�of � � gi?�i,2� % �
►'V7 4 Al e w jFi've,- - A f ,® a V iG%YZ Ge /Ol tv4 s Ae %aI v ,,,
ASS 44tr!lT�j !n/qs .�r1(.lvlUl-
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,O Date: .5/ ZZ/p

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 2-5
Farm Name: q�G�ov=�rw�S
On -Site Representative: -T-bt�*w
Inspector/Reviewer's Name: i f
Date of site visit: 3
Date of most recent WUP:
Annual farm PAN deficit: ? pounds
Operation is flagged for a wettable
acre determination due to failure of
. Part 11 eligibility items) Ft F2 F3 F4
� Operation not required .to secure WA
determination at this me based on
exemption E7 E3 E4
Operation pended for wettable acre
determination based on PI P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7.-stationary gun system wlportable pipe
PART I. WA Determination Exemptions. (Eligibility zailure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
I/ E2 Adequate D, and Dz D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, 'including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibiiity checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part 1II).
PART 11- 75% Rule. Eligibility Checklist and -Documentation of WA Determination
Requirements. WA Determination.required.because.operation failsDn_ e of the.eligibiiity
requirements listedbeiow:
F1 Lack.ofzcreage=whicnTesultedin�ver-mpplicaiionmf_wastew�tAr_(PAN) onspmy.
fields) �ccordinofofarm'sdastiwo--yearsmrimaaf;on7e;;ords.--
F2 Unclear, illegible; or lack of information/map.
F3 Obvious -field limit2tons-(numerous-ditches,ffTlur :to:deductzequired_.-
buffer/setback:acreage;.or25%:of1ctal2creaoejdentirfeddn7LAWMP _includes
small, Jrregularly shapedfelds fields -t
han less-1han
2 acres for.-stationaryspdriklers).
F4 WA determination required because CAWMP credits - ield(s)'s acreage -in excess
of 75% of the respective field's total acreaae as noteri in t=hla a-� Ill

Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE of TOTAL CAWMP
FIELD COMMENTS3
NUMBER
NUMBER'z
IRRIGATION ACRES ACRES
%
SYSTEM
rtcsRu t'AusysC�c.M - styusdtu, Puss,custe, vs.Nuusissusstuasa tssay Liz ubzu its pid[._ ui sttNu numoters uepeno[ng on L.Avvm-
and type of irrication-system.- If pulls, etc. cross -more- han one field, inspectodreviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUM$ER2 - must be clearly delineated anznap. — --
COMMENTS' - back-up fields with CAWMP acfeage.exceeding 75% of its total -acres and having Feceived less than 50%
of its annual PAN as -documented in the farm'sprevious-two years' (1997 & 1998) of irrication-records,-cannot serve -as -the
sole basis -for requiring a WA Determination::.Back-unfields-must be -noted in the -commentzeriionZnd must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
Pi
Plan lacks -followinainformation:
P2 Pian Tevision 'm2y:sabsfy_75% rule based on adequate overall PAN deilcii and by
adjusting -all field -acreage--to below 75% use rate
P3 Other (ielin process of installing new irrigation system):

- 0 Division of Soil and`mWater Conservatjon Review.=x
y = Division of Soil and Water Conservation -,Compliance Inspection
-
®'Division of VYater Qerahty Compliance Inspections
DOther Agency Qperahan Review
10 Routine Q Complaint Q Follow-up of DWQ inspecti
Facility Number 2�
Follow-up of DSWC review 10 Other
Date of Inspection I3J
Time of Inspection ES 24 hr. (hh:mm)
© Permitted [3 Certified [3 Conditionally Certified © Registered JE3 Not O erational I Date Last Operated:
Farm Name: ...........[r•! 7•�r!'I ..........g......!"�............................................ Connty:....On.jlOi.J.....................................................
Owner Name: ...................................... %) i y�
�.g ....." t........................................... Phone No: .................-.....................__.........
�—
V P...._
Facility Contact: ....... .� �...� .. ...��... ......... Title: ................................................................ Phone No:
Mailing Address:
Onsite Representative:...rv�ytY...................... Integrator:
Aj.e..&t4.e_AC ...............
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
r...................................................................................................................... _........................................................................................................... _____............ _......................
�
Latitude • �° Longitude • �° �'� __
Design Current Design Current ; _ Design : Current.,
_ Pou_Er3"CtSwine.Capacity Population Capacity:�Populationate Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
-Number of Lagoons Subsurface Drains Present Lagoon Area Spray Feld Area
Holding Ponds / Solid'Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is ohserved, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. -Is storage capacity (freeboard plus storm. storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -r,. ��Ili
Freeboard (inches): ........ 3..!-................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: & q - 245 Dale of Inspection
('
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
[]Yes
[:]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
I0. 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)?
❑ 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
Retjuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0; �'Vd •yibNti 6iis ;oi-• deficiencies -were noted di.kriug phis,visit: • Wk will-reeeiiye fio further - ' - ;
.. corresnoncfence. about thus visiit_ . . ....: : : : : : : : :............... ' .... .
3123/99

-i-

:Division of Soil and Water, -Conservation `Operation Review 1_
13 Division of Soil and Water Conservat<on'-,Compliance Inspecon
Division o€ WaterQualdy Compliance Inspection
. d Mer Agency Operafaon3Rev�ew `z:'
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-uo of DSWC review 0 Other I
Facility Number
© Permitted © Certified © Conditionally Certified [3 Registered
r �G�a er F.rmS
FarmName:........!�1.a1.................Y..............G1..............,................................._..........
'"leV,Vih 7 " 2ln
Owner Name: ...........................
Facility Contact: ..................................................---......................... Title:
Mailing Address:
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
io Not Operational I Date Last Operated:
Qh3fa
nty•
Phone No: —..
Phone No:
11 ,
Onsite Representative: 4Rd .+... ....,2Ir1 Integrator: ... Q u,Q1
...
Certified Operator................................................................................................................. Operator Certification Number: ...... -...................................
Location of Farm:
i
........................................................................................................................................................................................................................................................................... T
Latitude �° ��� Longitude • �� ���
Design Current : r - Design Current Design Current
Swine Capacity Population' : Poultry Ca acity-,Po ulAo-n Cattle Capacity .Po ulatian
- .._..
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish j9 ❑ Non -Layer ❑ Non -Dairy
1 -7777-
E] Farrow to Wean
❑ Farrow to Feeder ❑ Other
n
❑ Farrow to Finish Total Design' Capacity
❑ Gilts
❑ Boars _ __..._ _ TotaLSSLW
Number ofLagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding -Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 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 D1VQ) ❑ Yes bdNo
c. if discharge is observed, what is the estimated flow in gal/min? Jn AR
d. Does discharge bypass a lagoon system? (If yes, notify DW ) Yes [N No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes TK No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JS No
Waste Collection & Treatment
4. Is storage. capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes %No
seepage, etc.)
3/23/99 Continued on back

l• r
�
ZI
�
�yy
,t
t
�5
F
1'
s

Facility Number: 7 — :2-5, Date of Inspection
6. .Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes �TNo
(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 k No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PjNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding El PAN El Yes 5rNo
12. Crop type Iic6 l'f bike', T ,5-1?
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1KNo
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?
W Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
I& 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; �4•yiolatidins or• &fld ncies •Were noted• ducting this;visit' • Yoit Will•reeei*e Rio further. • ;
' cori-esp6iideic' ' ab' A this visit. .
#):Explain nESanwers and/orarymnol—i:ny
Comments '(refer tgnestion Ya
❑ Yes KNo
[]Yes IffNo
29 Yes ❑ No
❑ Yes ]%No
Wyes ❑ No
❑ Yes 25No
❑ Yes g No
❑ Yes IgNo
❑ Yes 0 No
❑ Yes JO No
❑ Yes JK No
lse Qs of facilr to better ex lain srhralions use addrtidiial a es as necessary) ✓ ° s
m .- ..
I
CO10y
of Ccf4:,%oA4,e
OIr Ca ver'T X110 a Id be kepi wl /t,�ordt,
`
I q.
I<eep
Waek/� oh
-r"retborrd Y'eGor'dS. New "S4e a rl4l rls kke#'ew.
Reviewer/Inspector Name_G h Q _
1,�za
Reviewer/Inspector Signature: Q� Y1/L,t Date: 9 2 91
3/23/99

10

Facility Number: — 2 Date of Inspection
y
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
JA No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
2§ 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
jM No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
3/23/99

V-/
Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Mervin Thigpen (Watchoveaa Fad 67 - 25
ff SR 1237
Mervin -Thigpen. 128 Kirby Thigpen -Road. Pink FE11
NC 28572 910-298-4618
9 / 29/ 99 Names of Inspectors ZaWd Khan _
V ncgnt Lei? da
13 - 15 Freeboard, Feet 14 -16 inches
136 800 Top Width, Feet 4-6
2 to 1 Downstream Slope, aH:ly 3 to I
X Yes No Upstream slopes have
_ Cracks and bulges at various places, _
Yes X No
Yes _X No
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? X Yes No
Engineering Study Needed?
Yes - AL— No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes �Y _ No
Other Comments _
N a close watch on this TLagoon,--

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
tR Routine O Complaint O Follow-ue of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of inspection �-L ✓ 1
"j Z
Time of Inspection 24 hr. (hh:mm)
registered ertified Applied for Permit ©Permitted [] Not,O eerational . Date Last Operated: ..........................
YV j'�� bU� '`County: DISC O
Farm Name: `�.........................................................
.... �......................................................................................
Owner Name: + �� t tJ T/-� t C PtS� .. Rhone No: aZ � `� 1d ..........
...............................................................................................................:........................................................... ..
Facility Contact :...1n . ............. Title: (..C- ....................................... Phone No: ................
MailingAddress:......... .....6-9B..y....... TH..< pc.......9D ....... .....:.............. ............... ....... ........... ...................................... .............
.............
Onsite Rep resentative:....D.��............. ........................................ Integrator:..... Q.[� a
.............................................................
Certified Operator ,.�.....��,�: ..... ? .................. Operator Certification Number -
Certified .............
Location of Farm:
LatitudeLongitude �• �"
General
i. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation? '
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in -ai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7..Did the facility fail to have a certified operator in responsible charge?
7/25/97
0
❑ Yes
qNo
❑ Yes
kNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes Wo
❑ Yes C�(No
❑ Yes b(No
❑ Yes P(No
❑ Yes No
❑ Yes , No
Continued on back

Foci ity Number:
n
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ;5,N0
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
......................................................................
'Freeboard (ft): ...............Z...:........
10. Is seepage observed from any of the structures?
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 ...C.0j.4i..r..... �lu.V.1/`..t.....
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"
[� No -violations or deficiencies werenotedduring this visit.- .You4ill receive no further
correspondence iiWit this:visit:-
❑ Yes KNo
❑ Yes EkNo
❑ Yes kNo
XYes ❑ No
❑ Yes *'No`
❑ Yes
J�LlNo
❑ Yes
❑ Yes
1kNo
1�<No
❑ Yes
�k%
❑ Yes
No
❑^
k1\10
lYes
'es
❑ No
❑ Yes [R'No
❑ Yes EKIio
❑ Yes '�o
Coent7aents (refer #p question #). Explain;any'FS answers and/,or ary recommendations or -any other commentse
Use drawtngs of facthty to better:eaiplain situaticips (use additional pages as necessdrv) `' >r
13.
Zz. Y AJ--j S,c _ pLJ- A-u.- NI_P_ Faetils
7/25/97
7zoReviewer/Inspector Name FAT ., �, j
N
Reviewer/Inspector Signature: a;c Date: /if

14D Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection FZ;Y3TJE
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: El Registered 0 Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
;ff Certified [I Permitted or Inspection (includes travel and processing)
E] Not Operational Date Last Operated- . .....
Farm Name: County:
M'?milLand Owner Na e: .&tA_Ab_ �R ?_ L. . ..... __ Phone No: 0
Title: .. Phone No: ..z
Mailing Address: b, ,+4V . ...... —A -il L. . ..... Z-K 5- 7 Z
Onsite Representative: ... . ..... . . ...... .......... Integrator:
Certified Operator: f_UqP_.X) . . ......................... ... . ...... . . ..... _­ Operator Certification Number:
Location of Farm:
... Ck ............
................................ ..... . ..... . . ........................................ . ........... ........ ...... ................... . ...... .. I .... . ........................... ................................... . ................
Latitude Longitude
Twe of Oi)eratL and Design Canacitv
Wean to
Finish
0 Other
Subsurface Drains Present
Lagoon Area I HESnra
General
1. Arc there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon D Spray field D Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancelimprovement?
Field Area lw
................ ............................ -
0 Yes GWo
[]Yes [ENO
❑ Yes 93'No
❑ Yes MNo
E]Yes
BNO
0 Yes
[allo
0 Yes
Q-Ko
D Yes
3 No
Continued on back

Facility Number: _ ,a
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La;onos and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
2.1
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?
❑ Yes 0-'No
❑ Yes
QNO-
0 Yes 0-96
Structure 5 Structure 6
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 .....-6 Vk- ..... ................... _.......................... ...... .............. .................. ..................... .................................
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?
For Certified Facilxtics Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ❑ -
❑ Yes 0-ro
❑ Yes ❑ No
❑ Yes L]KO
❑ Yes ❑-N-o
❑ Yes 0,90
❑ Yes O'Vo
❑ Yes O-No-
❑ Yes 0-90
❑ Yes ['Io
❑ Yes [moo
[e Yes ❑ No
❑ Yes B NO
[►Wes ❑ No
ivo♦1ns'or an other comments `-
P1 A.tj tjo"r AvaL vn'l S L ...0 fia_5r-O LV„r,,p lf--Ft
OV`fr- AEC (.'V� �"'rv!t i
Reviewer/Inspector Name ,::��� �� �,.�; . ram. :... � � ,.z�. ��� a�� w..�- � ...
Reviewer/Inspector Signature: T4/af5 .^J 6.,Z1- Dates G%i 3f 9
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

is
•
Site Requires Immediate Attention: 6
Facility No. 6 7-
DIViSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SrM VISITATION RECORD
DATE: 1995
Time:
Farm Name/Owner. . 11VA76N4 a
Mailing Address: _lam a e
County:
Integrator: nZ ',
On Site Representative: 7� �7-yam
Physical Address/Location: _Ll?,
Type of Operation: Swine �
Design Capacity: 3
DEM Certification Number: At
Latitude:
Does the Animal Waste Lagoon h;
(approximately 1 Foot + T inches)
Was any seepage observed from d
Is adequate land available for sera
Crop(s) being utilized:
Does the facility meet SCS minim
Is the animal waste stockpiled wit]
Is animal waste land applied ar sp;
Is animal waste discharged into w;
similar man-made devices? Y
Does the facility maintain adegnat
spray irrigated on specific acre
Additional Comments; .1
.. R
,-,-e 7f
Inspector -Name
,eb pine/-�iJ/, //C 15 7.;L-
Phone:
Phone:
/a77
! 47_ _ 54"
Poultry Cattle
Number of Animals on Site: > ; �'-5
DEM Cer-tification Number: ACNEW
Longitude: -71-- 4b 23' Elevation: Feet
Circle Yes or No
e sufficient freeboard of 1 Foot + 25 year 24 hour storm event
e, or No Actual Freeboard RFr_ Inches
lagoon(s)? Yes Was any erosion. observed? 1( r No
es No Is the cover crow adequate?, � or No
n setback criteria? 200 Feet from: Dwellings? Y- 1 9
or No
100 Feet from Wells? efts or No
n 100 Feet of USGS Blue Line Stream? Yes o<-
y irrigated within 25 Feet of a USGS Map Blue Line? Yes o N�
ers of the state by than -made ditch, flushing system, or other
N If Yes, please Explain.
waste management records (volumes of manure, land applied,
ge with cover crop)? Yes o N 0.
Signature --
cc: Facility Assessment Unit
9I0' 29,jd
Usc Attachmcnts if Needed-
11-I UH d 140 c� � h;r ? T se, C 'F,n '