670029_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: 9) Coq(pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 3o County: DIVSt_.pyJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Jl� GfC�/bo{� . ayas
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number: 16731
Certification Number:
Longitude:
Design CurrenCur t Design rent
Swine C+apacity Pop. Wet Poultry C►apacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Drs P,oultr, C_a aci Plo P.
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Now
F
01 Other
Turke s
I ITurkeyPoults
I 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesgNoo NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. 4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ( i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or Improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes M/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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Eo
❑ 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 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E14
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 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 provide documentation of an actively certified operator in charge? Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes E(No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes WNo [] 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
No
NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No
NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
NA [] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
o
NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility follow-up by the
[] Yes
Yes
No
NA NE
NA NE
require a visit same agency?
Comments (refer to question #):'Explain any YES answers and/or any additional recommendations or any.other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho(e.. chb b 3 [)
Date:
2141201

(Type of Visit: UC pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I{ County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ko f wdo �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1& 2 3 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design C+urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Z& 1(0 Q t)
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Drr P,oult .
.
Layers
Design
C_a a�i
C_a a�i
Current
P�oP,ouit
Pao
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
10ther
Beef Brood Cow
Other
Other 01
Discharges and Stream Impacts
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 DW R)
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 ErNa ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
❑ YesE<0
❑ NA
❑ NE
❑ Yes
fNo
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facility Number: - Zrj Date of Inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DNA ❑ 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 l_E < ❑ 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
To
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
EfNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]moo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to
❑ NA
❑ NE
maintenance or Improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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
QINo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ClrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[] N
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No .
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesF3'N__o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesF31N"o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[FO
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 01 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-N6 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�"No�} ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes d'�❑ NA
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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signatur
Page 3 of 3
[:]Yes �No ❑ NA ❑ NE
❑ Yes LJ NO ❑ NA ❑ NE
❑ Yes ['`No ❑ NA ❑ NE
❑ Yes [? Io ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No . ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Date: Et j
l/4 0 5

Type of Visit: 0 Co Hance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: v Arrival Time:® Departure Time: County:C�USLARegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: QO(Z.Wd6D JAZE5
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: - Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Design Current
Wet Poultry Capacity g.m
oP
Layer I
Design
C+attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
INon-Layer I
Dairy Calf
Feeder to Finish
2WO
18C)()
Dr, P,oul Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes • No ❑ NA ❑ NE
[—]Yes [:]No
[:]Yes [:]No
❑ Yes [:]No
❑ Yes En_�o
El Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: (fir] Date of Inspection: N901t
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes iso ❑ NA 0 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
identifier: UCycoiO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3D
Structure 2 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 ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;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 ❑ NA ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0 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?
❑ YesYNo
o
❑ 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
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[ Zo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: 1-1
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 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 21412011 Continued

Facili Number: - Date of Inspection:
ti
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes dNo ❑ NA ❑ NE
[:]Yes ENo ❑ NA ❑ NE
❑ Yes
3l. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
��No ❑ NA ❑ NE
ICJl� ❑NA ❑NE
EVNo ❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (referto question ft Explain any YES answers and/or any additional recommendations or any other comments'.
Use -drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�JC� jJ A Phone:
I ID / J
Date: la --I') k (P
2/41 011

(Type of Visit: Q Conppliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency p 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:
Onsite Representative: 00RU'1w1> 1 ]A rm5
Certified Operator:
Phone:
Integrator: JJ�
Certification Number: �Vr
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design C•ucreat
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
jNon-LaySr
Dairy Calf
Feeder to Finish
Design Current
©, P,ou! Ca achy P,a ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
oth
Other
Turke s
rkey Poults
other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
[—]Yes ❑ No
[]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes Vx'V
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes
[] 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: &4
3
v»
Waste Collection &Treatment
4. Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Structure
LL
gL`-dm
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?
No ❑ NA ❑ NE
[:]No ❑NA ❑NE
Structure 6
�Yes No ❑ NA ❑ NE
❑ Yes [/No ❑ 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes VINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [.'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination? TTT
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
[; -
❑ 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
�Ko
❑ 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
[:I,
❑ 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
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. 1, ❑ Yes YMO
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
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.
❑ Yes . No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
NA
❑ NE
WNq❑
❑ NA
❑ NE
zX NA
❑ NE
❑ NA
F❑
❑ NE
No ❑ NA
❑ NE
(Comments (refer to question # ): Explain any YES answers and/or any additional recoimmendations or any other comments l
Use drawings of facility to better explain situations (use additional pages as necessary}.
Reviewer/Inspector Name:
Phone:( 41h 1 /7 L. "
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: Q Co�gpHance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:UW17_1Arrival Time: Departure Time: County: b 405L,OI-j Region:
Farm Name: Owner Email:
Owner Name:
Malting Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A&2 pL� j ajzs
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity P.op.
Wean to Finish
Design C►urgent
Wet Poultry @apacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I I
Dairy Calf
Feeder to Finish
O • LVj
Design Current —Dry
D . P,nul C•_a aci P,o
Layers
Non -Layers
Pullets
Dairy Heifer
Cow
Non-Da*try
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Beef Brood Cow
Qther
Other
Turke s
Turke Poults
Other
Discharges and Stream_Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E5/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�703.
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Plumber: jDate of Inspection: a3l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: QAG-cc J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes [jNo ❑ 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 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes EiNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 YNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ 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?
Rectuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes QAo ❑ NA ❑ NE
❑ Yes [] ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes [o ❑NA ❑NE
[—]Yes [NNo ❑ NA ❑ NE
❑ 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? ❑ YesWNo
o
❑ 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 Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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
to
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
W" ❑NA ❑NE
N ❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use.draivings of'facility to better, explainsituations(use additional pages"as necessary). "'
..'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(`"110 1 % "TW 8 4
Date:
21412011

34u
lDivision of Water Quality Y
FaciIgt Nunlbe , .0.Division of Soil and Water,'Conservation
OOO
her:Agency
­.A
a-� ..
Type of Visit ,comet liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (;Outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 Arrival Time: tP5 Departure Time: County: 005L-11�%.J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title:
OnsiteRepresentative: l�crtwra� DAvJXS Aua,+' Jlgyxs
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e 0 i 0 it Longitude: = o = 4 = u
Design ,Current ' De"signCurrent f 110" agp Current
4Swme� Capacity
� w �
;Population Wet Poultry Capacity._Populationw Gat#ler -'Capacity�. Population
w -
❑ Wean to Finish
❑ Layer ❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer :; ❑ Dairy Calf
® Feeder to Finish o'
❑ Dairy Heifer
El Farrow to Wean
❑ Dry Cow
Dry Poultry,
❑ Farrow to Feeder
""' ❑ Non -Dairy
: El Farrow to Finish
❑ ers El Stocker
❑ Gilts
N
❑ on-ts ers ElBeef Feeder
El
❑ Boars
Pullets ❑Beef Brood Co
""�- �� -, ❑ Turkeys
❑Turkey Points
Numb tractor
❑ Other ❑ Other S e,
�a�f
-
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 M ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑l No
ElYes
CJ No
❑ NA
❑ NE
❑ Yes
12No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number: (p — Z9
W,-+_ste Collection & Treatment
4.:Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �$
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
�(
LI No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
L' Nhro ❑ 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
;2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lkvo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E3/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[-INAEl
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,FTNo
Ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
r�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
o
❑ NA
❑ NE
Reviewer/Inspector Name ,w �}.1rJm.��Gtr +(c{ :
., ��. �,. .. .. Phone• a L t7
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
l9Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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.
❑ Yes
O No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yietd ❑ 120 Minute Inspections ❑ Monthly and I" 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
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
hio
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�fo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L�N
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 <*
❑ 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
CJ 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
CNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Dlo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of VisitT,omm Hance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ( outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0AJJ"yJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: _w 6 k'k pis D A ' ` -DS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 0 Longitude: = o = 6 = it
Design
Current
Design
Current
Design
Current
Swine Capacity
Population
Wet Poultry Capacity
Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish
d 60
❑ Dai Heifer
❑ Farrow to Wean
Dray Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turke Poults
❑ Other
Number 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 1QNo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: (p'� — aO I Date of Inspection ZG a
jste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes M No ❑ 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
�I
Identifier: L A tr-s�L1GV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 440
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo ❑ 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 thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No El NA [I 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 El Yes Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No NA El NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. El o ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
VN❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
XNq/ El NA El NE
No ❑ NA ❑ NE
Coiitments (referY,to question.#): Explain any YES answers and/or any,recommendations or any other comments �- � ,.,
.Use drawingkof facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Phon
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 12/2VO4 Continued

{
•cility Number: Date of Inspection a
IkAuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes C24o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PTo
❑ 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?
El Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Il N
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CJ N
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
' No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0-Mb
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P'No
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ 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?
El Yes
o
❑ 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
Ek<o
❑ 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
2f'X
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
Yes
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Fri
Page 3 of 3
12128104

M
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director - Secretary
October 13, 2009
Norwood Davis
Norwood Davis Farm '
1182 Ben Williams Rd
lP j
Richlands, NC 28574 - —
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS670029
Norwood Davis Farm
Animal Waste Management System
Onslow County
Dear Norwood Davis: .
-The Division of Water Quality (Division) received your sludge survey information on October 8 _
2009... With the "Survey results,' you requested an extension of the sludge survey requirement for
the lagoon at.the Norwood Davis Farm facility. :Due to theamounts of.treatnient volume—­
.f -
available, the Division agrees that a sludge survey is not needed -until 2013.:... .
:The next -sludge survey for the lagoon at the Norwood Davis. Farmi facility. should be•performed
before •December 31, 2013. Thank you for our attention to. this matter., if you have an
questions, please call me at-[phone]:
Sincerely,
Miressa D. Gamma
Animal Feeding Operations Unit
cc: Wilmington Regional Office, Aquifer Protection Section R' CPXVn:;! j
Central Files
OCT f 5 2009
BY;
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 T��One t
Phone: [phone] FAX; 919-807-6492 , Customer Service: l-877-623-6748 L N ©fth Carol inil
In€errei: wvrvr-newaterquality.arg Naturally
A4i Equal :rpolunity 1 Af rmalile Action Employes j`aLI�

1
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Type of Visit Qto fiance 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
Arrival Time:--t•-t—� Departure Time: County: Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: a
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = 0 = 4 Longitude: = ° = ` 0 «
Design Current
Design Current
Design Current
Swiue Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
IEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ DEY Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
El Layers
El Stocker
El Gilts
El Non-Layers
ElBeef Feeder
El
El Boars
El Pullets
El Beef Brood Co
❑ Turkeys
Other
El Turkey Poults
❑ Other
El OtherF
Number of Structures:
Discharses & 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 21 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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
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
dNo ❑ 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
at, notify DWQ
environmenta;rNc
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures 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
2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ld No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El 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
Ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
hfo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
al.) FAQ? AJT(;r TSa_� Td 5 AKALA, 6kA-1:0 S?LtT� W.-q)0 , N o CXCL.D
JuOWT f.6okWG- jtoT6 WATW 5�51E0-­ rao.- c4)5(-LVA1T__0AJ,
APP OF V%40" ND,) So 11,
Reviewer/Inspector Name 06NU_L Phone: p —
Reviewer/Inspector Signature: Date: 9101L O
rage Z. of j ■1.1140ivy a vi+sir9"C7

`r
Facility Number: (; — Date of Inspection o
Required Records & Documents
19, Did the facility fait 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 CdNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
F2 Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,/
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E!(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
9No
❑ 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

it
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: jJp Departure Time: C] County: dAJWJV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: AIJI)2 DA11T' Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = d = Longitude: = o = 4 = «
Design C*urrent
Design Current
Design
Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
10 Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
26Y6
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys_
Other
❑ Other
❑ Turkey Poults
❑ Other
I
I
umber 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?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
CR'No
❑ NA
❑ NE
❑ Yes
V(No
❑ NA
❑ NE
12128104 Continued

11 Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1 A 6v dk)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
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
❑ Yes ❑ No
Structure 5
El NA [I NE
[I NA ❑NE
Structure 6
❑ Yes WNo
No ElNA ElNE
ElYes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes
El ❑ 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 El Yes �f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dN ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
rNo ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
;GOmments"(CCfeC t0;(]UeStlOn,#} Explalnaany YES'answers'and/or any iecotnmenda#rans;or any other comments.r
r : - - y
Use dtyngsof faeEhti�to betEer,explam sttuat (use addiEionalEpages�as�n�ne
ReviewerlInspector Name Phone: q a
Reviewer/Inspector Signature: Date: Z 6�

.y
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi n g ❑Maps El Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to in and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes/No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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?
ElYes
dNo
❑ 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
�[:]
NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments.and/or Drawings:,
Page 3 of 3 12128104

Division of Water Quality
Facility Numberj'� i O Division of Soil and Water Conservation
O Other Agency
hype of Visit
Co pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
leason for Visit
46 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 3 1 7 Arrival Time: Departure Time: County: Gr+%i(Mab Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: No72 doo DAU_±S Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o = = Longitude: = c = � =
Desigu ° Currenf Design Current Design
Swine Capacity -Population Wet Poultry Capacity Population Cattle Capacity f
❑ Wean to Finish _
❑ Wean to Feeder
Feeder to Finish. ia
N d 06
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
:Other
❑ Other
❑ Layer f ❑ Dairy Cow _
f;, ❑ Non -Layer ❑ DairyCalf _
--- -- _ ❑Dai Heifer
Dry Poultry ❑ Dry Cow
El Layers
❑ Non -Dairy
k ❑ Beef Stocker
❑ Non -Layers
❑ Pullets ElBeef Feeder
❑ Turke s ElBeef Brood Cowl
❑ Turkey Poults
❑ Other "Number ,of Structures ;r:
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
rren
ilafi
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:1 NA
❑ NE
❑ Yes
❑ No
❑ Yes
U]"No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104 Continued

Facility, Number: — Date of Inspection '
rite 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: IA &66
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3 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 VNo ❑ 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 Uf ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ['No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes GJN El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes u N El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ElNA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes LI N El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary).
Reviewer/inspector Name AIWJ 1 Phone: TOY6 —
ReviewerlInspector Signature: Date: 3 0
➢""o 7 nrI 12MA)d enndnued

Facility Number: Date of Inspection D 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWNIP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
IJ N ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
u No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo, ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Co ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�.�,
�'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
ONo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Co❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality x
`• Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
R
ype ofVisit ZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
eason for Visit O Complaint O Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 3a 0 Arrival Time: Departure Time: County: (WA413L— Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Adlt o-y Dwrs Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Longitude: = o = i
Design Current Desigd Current::, Design Current
Swine . Capacity Population Wet Poultry Capacity Population Cattle %Ca Population
❑ Wean to Finish t. EON
er
❑ Wean to Feeder =-La er
® Feeder to Finish I RG q0 I P.YbO �.
❑ Farrow to Wean Dry Poultry _
❑ Farrow to Feeder
El Lavers
ElFarrow to Finish
ElGilts El Non -Layers
❑ Boars
Other
❑ Other -
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Siructures _ � 'Y
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ] of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
DKo
❑ NA
❑ NE
❑ Yes ENo ❑ NA ❑ NE
12128104 Continued

5
Facility Number: - —
Date of Inspectiond o
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?
Structure 1 Structure 2 Structure 3
Identifier: LA 60 0d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(iet 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 E No ❑ NA ❑ NE
❑ Yes eNNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment71teat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYeso ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E(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 hd No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L/ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[;[/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
2N"o
❑ 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):
A 6 a A V6 -
x. j r1 Er �pY C' C
(AW 4'.l7flub�LP rolt 4- 5TOU4V6- Fd-R-wt IAA/4r6& V6U/RDY
Reviewer/Inspector Name --- — Phone: Q4 - u4r
Reviewer/Inspector Signature: 94M jW901 Date: 3o ab
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection a� 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? CYes ❑ No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,ZNo
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
{[1 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
,.,�
2 No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 i. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
n 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
ONo ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

G -) H ;"T
Type of Visit b mpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Ct1SLar<J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: WatzpawDo & rs
Certified Operator: ADD y OAJr f
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = O a 6 ❑ Longitude: = ° 0 i ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et4 F:::::4
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
24o q 0
706
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E�No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
❑ Yes
Vo ❑ NA
❑ NE
❑ Yes
7No ❑ NA
❑ NE
12128104 Continued

Facility Number: &I — 9 Date of Inspection y rW 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UfNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 11AGozn1
Spillway?:
Designed Freeboard (in): y0
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
E NElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
/o
❑INo ❑ 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
[�lo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[�N ' ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) �F_2M U'04 C G � 414) 5�v rcSC_d c W
_
13. Soil type(s) AJTR 1)&L f- C- LJn1CNR LIP, G7 'fvlL 1-I L d j A
T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes YNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes allo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 1j] o ❑ NA El NE
18. Is there a lack of properly operating waste application equipment? [I Yes IJ No ❑ NA ❑ NE
1✓56 ro rt..n1 s PA_0"j_PE v
rAfi*,, TtJ (;a- D 514/4
Phone: �9�a 3�S U� x
Reviewer/Inspector
Name 1 "" ZZ
Signature: i Date: q N Ij5
12128104 Continued

Facility Number: (j'7 — 9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other �/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
✓L4No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E2(No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[ I No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[(No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�,��((
[ No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
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
24o
❑ 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
[Y, o
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
U No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
12128104

b
Time:
Permitted 13 Certified [3 Conditionally Certified E-3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ------ — ------- — County: - --- -------------------
OwnerName: --.--J— Phone No: ................ ... ... ........................................................... ..
MailingAddress: ........................................................ ................. . ....................
Facility Contact: Tide: . ... Phone No: ... . . .............................
4_•Integrator. Onsite Representative:- Adi 0 �..9��
i . ..........
7
Certified Operator Certification
Location of Farm:
)n Swine [] Poultry [] Cattle [:1 Horse Latitude 0 4 44 Longitude 0 C 69
S 16 -:p r
apacity- A. .0--fda on-7
pacl PQiation
0 Wean to Feeder
0 Layer ❑ Dairy
NA
EEO
Feeder to FinishNon-Layer
4/-0
I[] Non -Dairy
E] Farrow to Wean
a�
10 Other
❑ Farrow to Feeder
JI-4.
0 Farrow to Finish
�7 M"N -apidt ToW4D6dkhC
U
E] Gilts
Boars
tk'� `7661 SSL Wri 0-
j0
L
k
-66fi­s
Al Lagoons
-g
so
3Fw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [3 Spray Field E] 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 gallmin?
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? [I Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
0 Yes 0 No
El Yes El No
0 Yes 0 No
0 Yes Ej No
• Yes ;;rNo
• Yes JZNO
0 Yes P"No
Structure 6
Identifier: .................................... . . ....................... . . . . .. . .... . .......................... ... ....... .................. .... ............ ............. ..... ............... ...... ....... ...
Freeboard (inches):
12112103 Continued

.11
aciliq Number:&I — 0 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .040
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 01No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [:]Yes ZrNo
8. Does any part of the waste management system other than waste structures require rnaintenancerimprovement? ❑ Yes ONo
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 2�No
l I. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes.)�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ opper and/or Zinc ,
12. Crop type
13. Do the receiving crops differ with those designated in (e &rtified Animal Waste dandgement Plan (CAWNT)? ❑ Yes j2fo
14. a) Does the facility lack adequate acreage for land application? [I Yes ,F]"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? gYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes o ff 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 A!rNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes'0*%
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;B'Ko
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �No
Air Quality representative immediately.
- larn as YFS answers and/or recommendatsons or an other caminents. omments (prefer to questron #)Exp y : a CY
-Use drs � of faccrhh to better la;n sttnations. use addrt,onal as necessa wwgs , _ty exp (
pages rY) ❑ Feld COPY � Final Notes x��.
�
-- -&;�-7ea-R
�d o o,B
pv,�,q ,�5b &AA1'J A40
App&"-7
�Gdle�M�nl/� rQa..,� �G$cc.rr_- �U 0, �0012 1�
pc-,0,, �Q fif 5Zl�� �7 �'-R�4-Zr✓.�R �G L �o
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q
12112103 %_111 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 'POPo
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ONO
❑ 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 ,"No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ZNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes I'No
28. Does facility require a follow-up visit by same agency? ❑ Yes '11�0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONO
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 'ZNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes �io
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ,21No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
yl��o R
D�F2 soMF �� %f� GV�I�57Zo�✓5 D�
A 1v 4 &,- ,
12112103

Type of Visit JO Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ]Date of Visit;
_12f�
Permitted © Ceerlw"J"I)
ed [3 Conditionally Certified 0 Registered
Farm Name: �rAa
Owner Name:
Mailing Address:
Time.
Date Last Operated r Above Threshold: _
County: G
Phone No:
Facility Contact: Title: /Phone No:
!eIntegrator:/ fx2/1�i�' �✓ Onsite Representative:
Certified Operator:
Location of Farm:
Operator Certification Number:
V1 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' �" Longitude
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Subsurface Drair
No Liiouid Waste
Discharges 8e Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
N
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches):
05103101
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑Yes
VNo
❑ Yes
WrNo
Structure b
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
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 Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?, . F-1 Excessive Poi
12. Crop type '
13. Do the receiving crops differ with those destgaaht,d in the Ceti
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? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JVNo
❑ Yes [(No
❑ Yes No
V
❑ Yes VNo
❑ Yes ONo
❑ Yes ANo
❑ Yes � o
i
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes No
❑ Yes ZNo
❑ Yes td No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
�No
No
No
XNo
No
No
'No
o
�N
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cozninen. ts(referto queshnn #) Expiarn any YES answers "and/or any rei ommendat�ons or anyjather,-,camments
Use drawings of�facilrtyto letter explain situations. (use addrhanal pages as necess"ary) Field Copy ❑ Final Notes
-r:rl'IP���I� ®k/ CMG✓
C�iPo f aT
Reviewer/inspector Name .. '
Reviewer/inspector Signature: Date:
05103101 v1 r— v- f Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
El Yes `UdNo
❑ Yes Ld No
❑ Yes
❑ Yes No
El Yes ❑ No
Ailditional Commeuts-and/oir Drawings:
T
O5103101

f x t
�' r i I?tvision of Water Qual►ty -ON � �
' _ Q Division oP S©il and Water Conservation
._.. ,.`�. j.. _ ...._ - ... mil.-. r - ... c ... ... .- _ e;i� -. v - •. �-_. .. � -.. _ _ :h 1. i� S�i::�.. ..
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: �{ 0 Printed on: 7/21/2000
oZ
Q 'Not Operational Q Below Threshold
Apermitted E3 Certified j] Conditionally Certified © Registered' Date Last Operated o Above Threshold
--
Farm Name: .. �1. L���I, ... Counh :..........................................................................
........................................ _ Gt,l
Owner Name:
Facility Contact: ...............................................................................Title:
;Mailing Address:..........................................................................................
Onsite Representative: 0ist"Q.
..........................:�-.............................. ..................
CertifiedOperator: ................................................... ..................................
Location of Farm:
Phone No:
Phone No:
............................................. .........
Integrator: ..... ......
_....11....-_ Operator Certification Number:
IW
[]Swine ❑ Poultry []Cattle ❑ Horse Latitude Longitude �• �� �66
Design Current
Swine CaD261V POnulatiOR
❑ Wean to Feeder
Feeder to Finish
Cj
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-»n Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid: Waste'Via nagement System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance inan-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 ? Structure 4 Structure 5
Identifier:......................................................................
Freeboard (inches): a
5100
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes V No
❑ Yes 1P0
❑ Yes �RNo
Structure 6
.............................
Continued on back

I
Facifty Number:�
Date of Inspection 1
Waste Collection & Treatment
Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ .............................................
Freeboard (inches) ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
)�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure
[]Yes
ANo
plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XVo
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
No
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
11. Is there evidence of over app ication? Excessive Ponding ❑ PANt Hydraulic Overload
❑ Yes
XNo
[❑
1—❑
12_ Crop type Tin.
CZ 4�•o-�\\ V�-SQ
13. Do the receiving crops differ with those designated in the Certi fed Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
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
9No
16. Is there a lack of adequate waste application equipment?
❑ Yes
X No
17. Are rock outcrops present?
❑ Yes
❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
❑ Yes )Q No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes k�No
❑ Yes gNo
❑ Yes )4No
❑ Yes " No
❑ Yes CZNo
❑ Yes 'NrNo
14
Yes *No
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 0 No
01/01/01 Continued

r
�acility Number. 9 = Date of Iuspection � Painted on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
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?
Additional Comments and/or ravings:,
❑ Yes t4No
❑ Yes V No
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes EfNo
�3e� 1Cd�l .CSi� GAS k.A
5100

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 1,610 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified 0 Registered 0 Not Operational I Date Last Operated:
Farm Name: ti.�' �+.1......................... .......................
.......�Ci`�!..!ESp.�...�.............................._................._............... County........... ......� � .........
OwnerName:_............................._............................................................................................ Phone No:...............................................................-..-. ...............
FacilityContact:..............................................................................Title:................................................................ Phone No:
MailingAddress:......................................................---•----••--...................._.........................:......................................... ................. ..........................
Onsite Representative: --- . ►•`?2'.................•-..................._.............................. Integrator: ......... ..:....................................................... .
Certified Operator:................................................................................---............................. Operator Certification Number:..........................................
Location of Farm:
Latitude ' ' 44 Longitude • ' "
Current
Design Current 7 a Dent Current
_ .- .
.-- wine Ca acity':P6 ulah6fi-.
Poultry Ca 'aci _;P.o`ulation-_---Cattle -'_ �Capact = Po uiation.- �
- Wean to Feeder
❑ Layer W ❑ Dairy -
Feeder to Finish Q -
❑ Non -Layer ' ❑Non -Dairy
❑ Farrow to Wean
;..: , rK }
❑ Farrow to Feeder
❑Other _
Farrow to Finish
sign -
Total DeCapa�tty
❑ Gilts
❑Boars =
. ..: .; . .. :: Total SSLW ' _
Number -of Lagoons L
❑ Subsurface Drains Present 110 Lagoon Area
❑ Spray Field Area
aP
HoldEng.Pondi / Solid°Traps ;
_._. .. .
❑ No Liquid Waste Management System
.s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes , No
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El 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? (II' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes CS(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: N
Freeboard(inches) ............ ...`................................................. ................................... ..........................................------.........................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facili Number: 6q -13L5\ 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 XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 10No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes P(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes - O(No
11. Is there evidence of over appl' tion? [I Excessive Ponding [I PAN ❑ Yes ONo
12. Crop type � t S`1 ,
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
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�' .*tOlatigris:QT ftfidertcies -wire 00fe# Wi#g tbis'visit' • Y:ou %ill•teeeiye do futfte
correspondence: sboutthis visit_
e4rll%k 14 1- �Qt-�
w�.
❑ Yes 5 No
❑ Yes KNo
❑ Yes 0 No
❑ Yes tgNo
❑ Yes t.No
❑ Yes gNo
❑ Yes D(No
❑ Yes ONO
❑ Yes XNo
❑ Yes KNo
❑ Yes O No
❑ Yes KNo
❑ Yes 9No
❑ Yes XNo
❑ Yes 9No
=i

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

Rev is_-d April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 0 - 5`9 = Operation is flagged fora wettable
Farm Name:.- G✓wcw�� ' — acre determination due to failure of,
On -Site Representative: Part If eligibility itern(s) F1 F2 F3 F4
InsI' ectorlReviewer's Name: Operation not required to secure WA
// determination at this time based on
Date of site visit:7y n—(30 exemption E1 E2 E4
Date of most recent WUP: )—gl —c�l
Annual farm PAN deficit:.pounds
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) circle r: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
rZ"ktationary sprinkler system wlperrnanent pipe; 5_ stationary sDrinkler system wlportable pipe;
n. stationary gun system wlpermanent pipe; 7. stationary gun system w{portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part It, overrides Part: I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
T E2 Adequate D, and D21D3 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.
E^ 75% rule exemption as verified in Part 111. (NO T E:75 % exemption cannot be
aDDiied to farms that fail the eligibility checklist in Part 11. Complete eligibility
cneckiist, Part 11- F1 1=2 F3, before completing computational table in Part III).
PART Il. "7:,% Rule -Eligibility Checklist and -Documentation of WA Determination
Requirements. WA Determination .required .because -operation Tails Dee of the eligibiiity
r=quirements listed below:
_F1 .Lack ofzcr ace--which-resultedimovermppii:.ationMfwastewater_(PAN) on:spray_
fieid(s)according-io;arm'slastiwoyearszf rrivatinn7ecorhs.
F2 - Uncl ar,Tlegibie: -or lack of -iniormationimap-
F3 Obvious -field -iimirations-(numerous:ditchesi-:Failureao:deductTequired------
bufrerlsetback-zcraage;-�or25%iofiotal:acreageddentmedj6—:CAWNIP,:rriciudes -
small ;-irregularly-shaped.fields= fieids-less-fhan 5:acres�or-travelers or.lessinan
2 acres -for.-stationary�sprinHers)_
F4 WA determination required because CAWMP credits-�ield(s)'s acreage In excess
of 75 % of the respective field's total acreage as noted in table in Par 111.

Rcviscd April 20, 1999--
Facility Number _-
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER
NUMBER'S
IRRIGATION
ACRES
ACRES
%
SYSTEM
HtL.L7 NUMti�K� - nyarant, pull, zone, orpont numt)ers may be used in Pace Of field numbers oependmg on :;AWMFI
and type of irrication system. If pulls, etc. cross more -than one field, irsbectodreviewer will have to combine fields to
calculate 75% field by field determinauonfor exemption, -otherwise operation will be subject to WA determination.
FELD NUMB=R2 - must be clearly delineated onTriap.
COMMENTS'- back-up fields with CAWMP acFaage�xceeding75% of its total -acres and having received less .than 50%
of its annual PAN as documented iri,+-he-farm-sprevious-.two years' (1997 & 1993) of irrigation -records ,-cannof serve -as -the
sole_ basis-forreouiring a WA Determination:-Back-upneldsTnust-be noted in the -comment zecuon�nd mustbe accessible
by irrigation -system.
Part IV. Penning WA Determinations -
_P1 Plan Aacks.following-information-,
P2 Plan Tevision -may_satis y75% rule based on adequate overall PAN deficit -and by
adjusting -all field acreage -to below 75% use rate _
P3 Other (ielin process of installing new irrigation systern)-

i
© DRv�stan of Soil and=Water'Conservation _ pperation Review
w [ Division of Soil and Water Conservation -;Compliance Inspection' • �"
:Division of Water,Qualit*-- Compliance Inspectroti ;
©hOther Agency Operation Review
L® Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
11 Permitted OtCertified 13 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
Farm Name: .....lvgR !1m0D.......U7wl,,.5.................................... County: ....... QN..��. P.V.............................!
Owner Name: ...... NO�W00%� !/�V/5 Phone No:.... ......
Imo.....9...........................................
Facility Contact: ... /V4! 41 .....y )A.i//,S. .................... Title: ....... ......................................................... Phone No:...................................................
Mailing Address: .... �19-A' . 8679V .....tl/LL// /(!i ......t s1%................ ....... /G�y�- 'NQ. ......N.. ... ?. 5... 7..SL............. .....
............
OnsiteRepresentative: ........ ................................................................................................... Integrator:......................................................................................
Certified Operator:....._ A14�4G oo'b ....._..... �%I, Operator Certification Number :...... ......... ..........
37
Location of Farm:
F.... F..... s.....p.......�.....,...,�..��,���r..... e.............................................................................................................................
.............................................................................................................................................................................................................................................
Latitude' ®� ® Longitude '7�7 • ©°��
- -_
.'Deli n Current
g
Desi - .Ctirreiit"1.;:."
gn
Design Current
Swine :_ -Capacity
Population Poultry ,
_Ca acity Population Cattle
Capacity Population
❑ Wean to Feeder
10 Layer
❑ Dairy
® Feeder to Finish
rp
❑ Non -Layer
EA1E1
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
=
❑ Farrow to Finish
= Total Design. Capacity
a -
❑ Gilts,
:T'otal SSLW
366 5L411
❑ Boars
Discharge- & Stream. Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [:]Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (lf 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 .i
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes No
Structure 6
Identifier:
Freeboard(inches): ....... -- 0...................................................................................................................................... .......... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes t"o
seepage, etc.) 11
3/23/99 Continued on

y
Facility Number: & — a
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 pan 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
❑ Yes kio
❑ Yes NNO
❑ Yes >kNo
❑ Yes A ' 40
10. Are there any buffers that need maintenance/improvement? ❑ Yes W10
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes XNo
12. Crop type _p SCeL.L, 1 12> "4— `
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes t'No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio yiolatidFis :or• &ndendes •were noted• during this.visit; • Y:ou :will •re dW iio further
cOrresporidene . abaut this visit.. .
❑ Yes ❑ No
❑ Yes RNo
❑ Yes ❑ No
❑ Yes [*Vo
❑ Yes ANo
❑ Yes IRNO
❑ Yes Zo
❑ Yes0
❑ Yes _I�'No
❑ Yes 'PNo
❑ Yes �' No
❑ Yes tKNo
❑ Yes *No
❑ Yes �10
3123/99

Facility Number: Date of Inspection Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes X'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 kNo
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JkNo
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 gNo
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 NNo
31- Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Pj/q _ ❑ Yes ❑ No
_Additional-. omments an_ or rawtragsc
3/23/99

.. ,� _ ; a .-- ,..: �..� � v:: �- �'.•a -r;;�; . -- • •�' � - .,..:.,x :;�e�...�� r„�.� - ,;;� ma's zif�' - w ,�. w;�..
[� Division of Soil and Water Conservation 0 Other Agency �'�' y u� ' °,� '
Division of Water Quality �����
Routine O Corn laint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection k
Facility Number Time of Inspection 24 hr. (hh•mm)
0 Registered 0 Certified 0 Applied for Permit APermitted 113 Not Operational I Date Last Operated:
Farm Name:... d.k. <.................... County: ...... ............... .......................
A..J..5 ..........
Owner Name:.......( (....... .. Phone No:.......��..... .................'----......
Facility Contact: ....IJJfLur/�,tf��.✓. �:. Title:__a ... Phone No: .........
Mailing Address: r �2.X t ..... 5 7
!.................. V�..........!!L/ r. 1..44lll t................................ ....... ...............:......`."....` .............................
Onsite Representative:...dX..rUV'D ............................................................................ Integrator%...�)9kh Y..�....---...
Certified Operator:...1)0ai ap.................. '....'$.................................. Operator Certification Number ..........................................
Location of Farm:
Latitude a 0' " Longitude • 4 96
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes,�q No
2. Is any discharge observed from any part of the operation? ❑ Yes O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CMNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Itg No
c. If discharge is observed, what is the estimated flow in-at/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes qNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes EtNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Q�No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes C No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes V No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

e
f Facr 'ty Number: —
S. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes 9INo
Structures (LagoonsMolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard(ft): .........3,..Z .......................... ..............................................
10. is seepage observed from any of the structures?
Structure 4
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 ...........�...l.....�i ... CT..... ................ .��
❑ Yes UNo
Structure 5 Structure 6
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 Onh,
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?
❑ Yes 5fNo
❑ Yes J3No
❑ Yes Ag-No
❑ Yes
O-No
❑ Yes
A2fNo
❑ YesNo
Q Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
&No
❑ Yes
JO No
4N.Yes
WO
❑ Yes
cN No
❑ Yes
& No
❑ Yes
tS[No
0- No.vitilations. 'or' de icierecies were. noted,duhiig this:visit., You :will, re'cei've•nti°furth:ei"
correspondence about this:visit:-: : :..
17 MR. Lhvr ,5 ' s P.rame-5-5
d4,r/03v
2Z, �� 5 rt� -�'� ��r° ' 1� G�G Le.:, �► S 6 � ►ram . n
7125197 H
Reviewer/Inspector Name #U: "
� Reviewer/Inspector Signature:
Date:

v Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection F71 S 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
jo Certified ❑ Permitted or Inspection includes travel andprocessing)
A❑ Not Operational . Date Last Operated:.... _ .. .. .. _..... ....... ........_ ......... _ .._....._ .... ....._ .- . _ .._
Farm Name: 1L ���.� .....v 't!Of� County: ..........
.f}Sctl ...._ ..., �.. _ .
Land Owner Name: � � !1✓' S Phone No: ,�` 6F141 '?x
Facility Contact:. „ ! ...........1 A_ (fi5....... .... Title:. V Phone No:
Mailing Address: .!` D..z ..... ! ..... .,(PIGk'C Itll_ 5 ......... _ ..... ........ OY6 7
Onsite Representative: ,�C !� . ................._............._ Int tar: ..�r.L,.-........+ff'L �.............................---
Certified Operator:-.A/,±�? I�f�✓..., ,,... _.. .... Operator Certification Number: �(�t Z
Location of Farm:
Latitude 0 4 64 Longitude
Type of Operation and Design Capacity
Swine
Des Ciirreat� �:Po°Design ; WE. Cattle Cig unt�
Po ulat on '3''� , Ca' achy}. Po ulation>= a aci Po ulafiI
ElWean to Feeder= ❑ La er ❑ Dairy
Feeder to Finish p �❑ Non -La er k❑ Non -Dairy
Farrow to Wean '� z € .
N HR
Farrow to Feeder Total Desiga CapacityY
Farrow to Finish`' i
Tuta1 ssLW�Ig
❑ Other
Numlifer of Lagapns I Holding Ponds / E ❑Subsurface Drains Present
A x�� x � >. ���. 3 � ❑Lagoon Area ," ❑Spray Field Area ,��
General
1. Are there any buffers that need maintenance/improvement?
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 gal/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 lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ®,No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes ® No
❑ Yes
J" No
❑ Yes
['No
❑ Yes
No
❑ Yes
No
Continued
on back

Facility Number:.. w—....„ . .
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
•r
❑ Yes V 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 (Lag,Qons andjor Holding Pond
9_ Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
� ��pr • .._..... ....... ...._ .... ............,.
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?
❑ Yes RNo
❑ Yes JQ No
❑ Yes R No
Structure 5 Structure 6
❑ Yes WNo
❑ Yes RNo
❑ Yes J4 No
❑ Yes A No
Waste APPlicatio
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �b•�..... ..... _....... .SG i.�,
.,...... _ ....
......
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 Facilities 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 No
❑ Yes No
❑ Yes F$ No
❑ Yes No
❑ Yes No
❑ Yes LINo
❑ Yes A No
❑ Yes U No
❑ Yes QNo
Coniinents (refer to'queshon #} Explain any YES :answers and/or' any ;ecommendationsar any other comments:
Use_ drawings of fac�hty to better explain situations: (use.additional pages necessary)Y .
Nc�, i7.4 Js �.s �4►� 47`�,cJy A►-t,.v�lds2 � ��i J ,. ��t s ,�.�/v �-� ����n 4
Reviewer/Inspector Name • �'� � , °a Y�;: �;� ��;,. ��;,.�, ,�.�-�: �., x ���� �.�` ,
Reviewer/Inspector Signature: Date: — —
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

0
.0
Site Requires Immediate Attention: l (Y
.
Facility No. (o -7-z9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 3 , 1995
Time: 0 IS
Farm Name/Owner: g o i�_W DOD AU l
Mailing Address: 11 2- Ze✓ A WILLIAMS -RD, ' P-tCHLANpS, tl C z S 75j
County: r)N_S Q oil4
Integrator. Phone:
On Site Representative: �16K wyor.:� lip V1 Phone: 34(- q a 3 ?
Physical Address/Location: Y e-4 00-( Sa v 4-k tin
r�v15 2c� t11 S2 Iao�) 1�0 Milo,, 4�rw. ©r
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: Zel>40 Number of Animals on Site: a2 6D 6
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 4-7 Longitude:..._' 35 W-A.r" Elevation:1c7 _Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: -9- Ft. ` Inches
Was any seepage observed from the lagoon(s)? Ye r No Was any erosion observed? Yes or�o
Is adequate land available for spray. e or No Is the cover crop adequate? Ygs�or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback crit a? 200 Feet from Dwellinas? C.-es or No
100 Feet from Wells? D or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orMo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(Vo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or6) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or 1-Vo\
Additional Comments: •t AuA�" A IL4 ,u
/�a ♦�i�',i/��. r-..�, -ice •�,�rr� ..�, � , - ,.-
Dup"ac . —I/ '�� 44W4tt_
Inspector Name Signature
cc: Facility Assessment Unit ti
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone]
Jul 24 ' 95 18 :15 P. O5/ 18 .
Site Requires Immediate Attention' 4,'o
•
•
•
FaCifiLy Number: zc Yr .?r
SITE VISITATION RECORD I
DATE: 7 k ,r_ /1_ , 1995
Owner. 4/0"t-wpod, 04A-ei _ Farm Name:
County: ��14�
Agent Visiting Sitc: IVAO-f Phone:
Operator:. Negi w oo:Z _ Phone: (f/,1i
On Site Representative: gAi.-Ppo /J.ovr-r Phone:
Physical Address: a1 _dui ri s".L. �,� _ r,1ff -Id op A. A-M,
Mailing Address:
Type of Operation
WIFE
Swine ✓ Poultry Cattle
Design Capacity: -f o Number of Animals on Site:
Latitude:° Longitude:
Type of inspection: Ground e Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches) (Zs or No Actual Freeboard: --,?._ Feet .z Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)7 Yes o ]VYas there erosion of the dam%!�r No
Is adequate land available for land application? Yes or(—NOIs the cover crop adequate? r No
Additional Comments: 114-r [•+■ r l+e-r! Zz-
Fax to (9I9) 715-3559
Si,, t ture of A-en,t'