670046_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual
§X)

Type of Visit: aCom nce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit:l Arrival Time: 00 p 1 DepartureTime: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �(' F It ^ C11-1, S Integrator:
Certified Operator: Certification Number: 6 (r
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
I
Dai Calf
Dairy Heifer
F er to Finish
arrow to Wean
Farrow to Feeder
Farrow to Finish
41< 00
Y,x 7
n Current
Dr, P,©ultr. Ca aci P.o ,
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q�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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 o ❑ NA ❑ NE
❑ Yes 0710 ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: {r7 YE Ds ection:
;r -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):- Z
G-Iqlo QNA ❑NE
❑ No ❑ NA ❑ NE
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 D<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesFj"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 ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N 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;�N
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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes eNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E.34No
❑ 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 rNoo
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 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes i Io ❑ 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 o �N�AO
NNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No 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.
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?
0 Yes NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—].Yes No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No A ❑ NE
[:]Yes o ❑ NA ❑ NE
Comrnchts (refef to question #) Explain any,,YES answers. and/or anyj'additional recomtnendatipns or': any other;comments h ,r
Use drawings ©frfacili Ito better,ex lain situations, „ ; ' _
,i.,�
g ty p (use additioaal'" a es asncessa
�-- L4 o �.-c it s 9 J 6 S G G V C--wq >L
Fm/-- 2a/6/1,017' (0D )� sCr --:,. -r-�CC-4.sr,,r;G1•s-/-
Y
Reviewer/]nspector Name: Q�"&JA�� ] 'i"'�� one: 7 73g1f
Reviewer/Inspector Signature: Date: o l s I
Page 3 of 3 2141615

(Type of Visit: m C pliance Inspection O Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit Routine O Complaint O Follow-up O Referral C) Emergency C) Other O Denied Access
Date of Visit: Ji],p/ j(/ Arrival Time: ® Departure Time: Q i3 Z County: j jV Y_, } W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J C �E �CN1N cJ
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: "
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design C+urrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
-
Feeder to Finish
Farrow to Wean
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Dr, P,ault , C_a acity Pio
Non -Dairy_
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
DischaMes and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ZNo, ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes .❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA 0 NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: J
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: LAGdw i LA &XW 71-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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?
M/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
tf any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentifl 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 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 El Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste _Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MAo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
[ ] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,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?
es
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
❑ No
❑ NA
❑ NE
the appropriate be/.
LJP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
r:
❑YYesoNo
21. Does record keeping need improvement? If yes, check a appropriate box below.
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Inspections
❑ 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
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - V1, 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
VNo ❑ 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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA ❑ NE
Other Issues
7Nog
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
YNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ 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)
Z-No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
jv�o ❑NA ❑NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to questionrv#):,Explain any YES answers and/or any additional recommendations or. any other comments.
Use drawings"of facility" to better explain situations (use additional pages is necessary)._�
C1119A)(rC — t,A sr 19CW&C- 1 �As lvei weep
a� 11T
C-ve F-T -3 Phan
Reviewer/Inspector Name:
Reviewer/Inspector Signat
Page 3 of 3
Q FLA �6tLl Pho e: -) qj _15y�
ure: Date:
2/4/2 1 S

(Type of Visit: O rRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up O Referral 0 Emergency Q Other Q Denied Access
Date of Visit: 12A [11 Arrival Time: Departure Time: County: jA s b jj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V r J&N -r S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: I b 9 2,6
Certification Number:
Longitude:
yC
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Wet Poultry
Layer
Non -La er
D P,ouI
Design
Capacity
I
Ca a
Current
Pap.
P,o ,
Design C•arrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Farrow to Finish
JLavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other JS
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [:]No
[—]Yes (—]No
[—]Yes
V
o
❑ Yes
o
[:]Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑NE
Page I of 3 21412014 Continued

Fac�Ji Number: - Date of Inspection:
Waste Collection & Treatment
r4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UAG06N I LA6%0J I, -
Spillway?:
Designed Freeboard (in): 4�
c5 6-
Observed Freeboard (in): e�;
5. Are there any immediate threats to the integriof any of the structures observed? ❑ Yes EfNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:)Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 0No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility it to have all components of the CAWMP readily available? If yes, check
the appropriate ox.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ No
[—]Yes E3�qo
❑ Yes E(No
❑ Yes
❑ Yes
Yes
Yes
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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 d 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 21412014 Continued
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE

Facility Number: - Date of inspection: I
;4.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 El
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [� 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[/No
❑ NA
0 NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O/No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FNo 0 NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.any.other comments.
Use drawings of facility to better explain situations fuse additional pages as necessary). .
Sf" �(
N 6 x T TO
"sC-S ,
,CIE t,/
W v P ocep t rJ
ro
sNa W cluo v G-E .
Da UIST
Pu M f v /-/
rMC- L-D
odu-t-- -P-Xxe9 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
1_504IJ FAg,(e C L/ Phone: �� D
Date: 7 O
/is
214 011

(Type of Visit: aC pliance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1t Arrival Time: Departure Time: / D County: _dN3(Ab Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: l 1 t1�1 {C. w Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 4bC8?A
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I El
:Dairy Calf
Feeder to Finish
I
Design Current
Dr. P,o_uitt. Ca aci P,o D.
ILayers
Dairy Heifer
Cow
Non -Dairy
I Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
l f7d
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turke s
Turkey Poults
Other
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 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 a/wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: t�
Waste Collection & Treatment
4. Is.storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (,AGooN I Lx-�.C� Z/
Spi I Tway?:
Designed Freeboard (in):
Observed Freeboard (in): Tj 3g
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 FNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes [�lo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes En 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
ZjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F11INYNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
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

Facility Number: Date of Inspection: al It i
24. Did the facility fail to calibrate waste application equipment as required by the permit? E�`Yes ❑ ❑ NA ❑ NE
25. 1's the facility out of compliance with permit conditions related to sludge? If yes, check. ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? (—]Yes �io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes To ❑ 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 Ea'<�o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ]Yes LJ '� ❑ NA [3NE
34. Does the facility require a follow-up visit by the same agency? El Yes No ❑ NA ❑ NE
Comments (referrto question #): Explain any YES answers and/or any additional recommendations or any other comments.
Vie drawing's of facility to better explain situations (use additional pages as necessary).
LOC.AT(--
PASS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Tf7 CA Nbr (7mi0 Do a aa�j W,7_tHj.nj 3a
Z-, Phone: UID (o
Date: 9-1 11
21412011

Type of Visit: OrCo fiance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit:
Arrival Time: ® Departure Time: j i County: OIVJLOr� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
11
'
Onsite Representative: ( ) E-K J . N 1r r45
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean(
ION
Farrow to Feeder
Farrow to Finish
Boars
Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
Longitude:
Y Cow
Cy alf
y Heifer
Cow
Stocker
Feeder
Brood Cow
❑ Yes ©No ❑ NA ❑ NE
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)
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 �§N
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
Page I of 2/4/2011 Continued

7
Facilify Number: - Date of Inspection: i 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (,601J I L&OW—Z/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N ❑ 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 environmZ/0
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 [70 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Yes
❑ �] NA
❑ NE
❑ Yes
� ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
i 0 ❑ NA
❑ NE
❑ Yes Q N ' ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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 'rNo
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

Facili Number: - Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the perm? Yes [] o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ 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 N ' ❑ 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 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office
ffice of emergency situations as required by the ❑ Yes YN
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below, ❑ Yes ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �Nfo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [6 No ❑ NA ❑ NE
se ara%
a y).
(refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.?
us of facility to better explain situations (use additional pages' as necessary). .
,445 L-UE ear ftr
S1_01)G6 smey.
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Rccf'-A ate,
0 1h-EP-9 QR GF r6
Phone: ( ? 3UP
6
Date:
41011

jType of Visit: (D CCoiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
(Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: 3b Departure Time: County: OA6C. &b .J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J W L} (WKS-0,)� Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine C►►opacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dai Cow
Design C►urrent
C►►opacity Pop.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
x' Farrow to Wean
9 Design Current
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P,oultr. C*_a aci P,v ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rIBe,f
Brood Co-,
Other
Other
Turke s
Turkej 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes FZ/o ❑ NA ❑ NE
❑ Yes �'No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Faclli Number: (n - Date of Inspection: .7 4 t 1Z
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes Q'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: g,j I LAGcnd Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ef7No ❑ 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 E 110 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C2 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Eg-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 Lam' o ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ET o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes n 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
[El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E'<io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate Coverage & Permit
Yes
NA
NE
of readily available?
❑
E2 1�
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
90
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check t appropriate box below.
❑ No
❑ NA
❑ NE
aste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�fo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: tc - of —Ins Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? Dyes ❑ No
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P!rNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
E3'*No
❑ NA
❑ NE
[JYes
l]Wu
❑ NA
❑ NE
[:]Yes
No ❑ NA ❑ NE
[—]Yes L.DIN/o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes 0140 ❑ NA ❑ NE
❑ Yes
�N
❑ Yes
V2zo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any,additional recommendations or any»other comments" ! g
Use drawings of facility to better explain situations (use additional pages as necessary).
a #) �jASTc APPLXCA T tct,� DA►C OUrSZ C GO C)A'� waJVDOrJ • OW-06K Q>UC3ucb
l.AST hlR 5tC 14NAc.'?S>'%$ A#jo bxb PoT PQn� dL �af� ELT �Qrlq
'L'- ) (7t._,ow MC-M� WAS CA L TS(t,AjE AG-AXX3Sr e.(_- rLTr f_,LT_-'9 M(TO,
N°�q WJL-M rLOW M C:TUL 'J6ti 175 TO "C-rBrZ-Ate (tAQ 1 TaAzrrA�
EQU-Tp , OT
M0,0 wAS D00(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `�v �-
Date:`'
214120 1

Division of Water Quality
FaC1fity Number �'� �y 0 Division of.Soil and Water Conservation' �k
O'_gther Agency ,
Type of Visit Co liance Inspection O Operation Review O Structure Evaluation 3 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: t} 5 Departure Time: County: �1JSL.Q+� Region:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �fl��t`%-r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: c =' =" Longitude:
..
Design'.', Current DesignCurrent
Swine Capacity Population; Wet Poultry Capacity Population Cattle
❑Wean to Finish ❑ La er [] Dai Caw
❑ Wean to Feeder JEI Non -Layer I Dairy Calf
❑ Feeder to Finish `< ❑ Dairy Heifer
Farrow to Wean 1960 12r30 D bry Poultry " ❑ Cow
❑Farrow to Feeder ' �" ❑ N D
❑ Farrow to Finish
g: ❑ Gilts
❑ Boars
Al
;Y LLJ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
on- ai
❑ Beef Stocker
`{❑ Beef Feeder I I I _�
4 ❑ Beef Brood Cowl I
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
�/Nq, ❑ NA
[INE
❑ Yes
I o ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: - Date of Inspection 1
Waste Collection & Treatment
4As storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 , Structure � Structure 3 Structure 4 Structure 5 Structure 6
W identifier: kw (
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ NA El NE
dYNo
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
❑ 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 environmenta7th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EIo ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
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 Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
Zcco
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yesFN0o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
q
El
ElNA
❑'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to questiion'#): 'Explain" any YES answers and/or any recommendations or any other comments . -"
Use drawings of facility to better explain situarions. (use-additiiinal`pages'as necessary):
cEr "e
w
Reviewer/Inspector Name �6%,�� L�t� � ° Phone: d
Reviewer/Inspector Signature: Date:
Rap 7 „f q 1 12128104

LFacility Number: L — �(p Date of Inspection Z.
Required Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L.l'No ❑ NA ❑ NE
the appropriate box.
. ❑ WUP El Checklists El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KTo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
G
I o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
QNo
❑ 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?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
Ta
❑ 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
ElL�l
,�,
4o
❑ NA
❑ NE
10
33. Does facility require a follow-up visit by same agency?
❑ Yes
0
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

G` ] M. qla
Type of Visit Co pliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: $ Departure Time: County: OA)S(A +J Region:
Owner Email:
Facility Contact: Title:
i
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = A = Longitude: = o = 6 = 4{
Design Current
Design Current
Design
C*urrent
Swine Capacity Ptapul�ation
Wet Poultry , Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Daily Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
IN Farrow to Wean / 9
Dray Poultry
❑ Dry Cow
❑ Non -Dairy
® Farrow to Feeder
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
21 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[!
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 6,7 —q(0 Date of Inspection
s
,',Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? �es ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes LI No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LaCsysqv L ,acsaar_4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rz� Zb
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No. ❑ 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? El Yes E No ❑ 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 EQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes G No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes E�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
L'J o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
L`J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑'f4o
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
0"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
�E w kx)P 06IJC wa-m Psu6rr Do^ht '
SL d VC4 6 Uf VE le rJc E bd -TO65C r0 kINlE � XTP t J✓ 30 4Q15 srNo f9P y To
c f,) 3 21$L�U �zS l ro NLo AAADJ , CC T 3a DAY Pa 4 Oar-4 '
�o;L iG-ST JAU PILL, 1,�E0 To DO AjL&#'1iC0_
Reviewer/Inspector Name 9hJ Phone: 910 7% "73T f
Reviewer/inspector Signature: Date: Z, 7 l6
Page 2 of 3 12128104 Continued

i Facility Number: Date of Inspection 1 112:97
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�
ElNA
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
(dyes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[INA
[INE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[IYes
�ffZN
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CR'54
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Zo
❑ 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
U�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
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[/No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L 40
❑ NA
❑ NE
12128104

Type of Visit t4Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: u Arrival Time: ® Departure Time: County: dN AL/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: FF� f NX�S
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = I =46 Longitude: = ° = 6 = «
Design Current
Caacity Population Wet Poultry
Design Gurrent
Capacity Population
rUi-e—sig!nWifturrenine
Cattle y
Population
❑ Wean to Finish ❑ Layer
❑ DairyCow
❑ Wean to Feeder ❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean ACI d Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Turke s
Other ❑ TurkeyPoults
❑ Other ❑Other
❑ Beef Brood Co
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?
Page l of 3
❑ Yes [/No ❑ NA ❑ NE
❑Yes
[I No El NA
El NE
❑Yes
❑No El NA
El NE
El NA
❑ NE
❑ Yes
El Yes
VNo El NA
El NE
El yes
o ❑ NA
❑ NE
12128104 Continued

Facility Number: 6 Date of Inspection L 0
V�aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA6-mj✓ 1_ _ A e c od—,-
Spillway?:
Designed Freeboard (in): 1-10 �
Observed Freeboard (in): VL r�0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No
El 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 ❑ 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"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�}'N0
NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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
Ir N
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
u o
❑ 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
El NA
❑ NE
18. is there a lack of properly operating waste application equipment?
El Yes
YNo
❑ NA
❑ NE

Facility Number: — Date of Inspection 6 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes r No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L'1 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2(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
N
[I NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[TNo
❑ 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
CNo
❑ 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
Ld 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
ld No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:;::
a
Page 3 of 3 12128104

Type of Visit e) Coptpliance Inspection Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i Og Arrival Time: Departure Time: County: aNJ"10) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: JE� f Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = ` = 1. Longitude: 0 ° 0 i = "
Design
Current
Design C►urrent Design
Current
Swine
Capacity
Population
Wet Poultry Capacity Population Cattle Capacity
Population
❑ an to Finish
❑ Layer
I
❑ Dairy Cow
❑ an to Feeder
❑ Non -Layer
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
Farrow to Feeder
002
/ f 1i
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number• 7 — Date of Inspection
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: LA %" %( L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 Nc ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ZNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N ElNA ElNE
(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 E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. RrYes ❑ 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 21 o
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYesWN
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes VNN
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings off facility to better !explain situations. (use additional pages as necessary): r
"A,Alt' LAJ I _jk c,rAIAl� 11 l�G �i�G�L} gwr
p r At-0- A4 A-ac 4110 We i„ ►may rlo
m4rJ- �h. 3y6 41
Reviewer/Inspector Name �!%i✓ �,�,/{G(L Phone: 4
Reviewer/Inspector Signature: Date: 000
r2i2RM4 rantinned

Facility Number: Date of Inspection u d
Reg uired 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 ❑ Design ❑ Ma s ❑Other
❑ Yes �o ❑ NA ❑ NE
El YesWNo ❑ NA El NE
P
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 Ef No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WN
[I NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? VYes
s El NA [I NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes I_/J No 7NA
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes fNNoo El NA ❑ NE
Er
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
,�/
L7 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
L"J 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
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional-Camrnents and/or Drawings
i
Page 3 of 3 12128104

Type of Visit 0 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: + ,r Departure Time: County: 4WAAa Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = g = Longitude: = ° = 1 = u
Design C*urrent Design
Swine Capacity Population Wet Poultry Capacity
Current
Popula#ion
Cattle
Design C*urrent
Capacity Population
❑ Wean to Finish ❑ Layer
❑ Da' Cow
❑ Wean to Feeder
10 Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
Farrow to Wean
Dry Poultry
❑ Dairy Heifer
❑ D Cow
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
El Non -Layers
El
El Beef Feeder
El
❑ Beef Brood Cowl
❑ Turke s
Other ❑ Turke Poults
❑ Other ❑ Other
Number of Structures:
❑ Farrow to Feeder
❑ Gilts
❑ Boars
integrator:
Discharges &Stream impacts
,,��,,//
1. is any discharge observed from any part of the operation?
El Yes
LdNo
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
VNo
❑ NA
❑ NF.
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Ib No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
e 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: /.&r'`_J _ to
Spillway?:
Designed Freeboard (in): 7-0
Observed Freeboard (in): ZL IZ_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ETNo ❑ 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
_f
rJ 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
fj No ❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑. o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
-�o
El NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�/
[Z No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ 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
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
L" I No
❑ NA
❑ NE
2'�o
❑ NA
❑ NE
E2"No ❑ NA
❑ NE
2�o
❑ NA
❑ NE
aNIo
❑NA
El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any.other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
.
ZI� NAr owiz CnAn43 -XAwffn�' -6wv St�GfC lf'l o�C QJ2 ��MrO A
Rm c1
Reviewer/Inspector Name �A Phone: -4T : — 73
Reviewer/Inspector Signature: Date: Z (p D
Page 2 of 3 it 12178104 Continued

Facility Number: 61 -- G Date of Inspection OZ
r
'Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes e�:No
o ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
L'! Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Q's"'tocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El.,( Yes
�'J NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El❑
VN
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes El,<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Etgo ❑ 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
,,//
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
LI7Vo ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
BNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L11No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i"
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Facility Number 7 yb
DiAsion of Water Quality
O Division of Soil and Water Conservation
Q Other Agency .
Type of Visit QfZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tP zs1 df► Arrival Time: Departure Time: County: of cboiN Region:
Farm Name: Owner Email: Phone: 91d 3V 0 - a 93 ! 1
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' = Longitude: = ° =' =
Design Current` Design Current Design �Currerl
r, Swtne; Capacity Population Wet Poultry Capacity Population Cattle xcCapacity' Population
z�s.. .... ,�.. ,. .
❑ Wean to Finish ji. 10 Layer �-
❑ Wean to Feeder ❑ Non -Layer
❑ F eder to Finish
Farrow to Wean 1
4 Dry Poultry..
❑ Farrow to Feeder
❑ Farrow to Finish i
❑ Gilts
❑ Boars
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures ' ,
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 - Date of Inspection o
G
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
Identifier:
I- A kvN I
LAG °,FAI 7-
Spillway?:
Designed Freeboard (in):
ZO
2/0
Observed Freeboard (in):
-SLl
3(
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 42 /No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? [IYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EJ/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 [:I/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. ElYes LaNo'❑ 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
[3No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dN 0❑ NA
El 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
El� ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
� No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
9.l,) U PiD A rC- AAiA/vxl L, AV 6" 61E
ti-fr7- SNi64fkAT60_
Reviewer/Inspector Name r szrcoq ,/ jam, Phone: /0 it —11 0_
Reviewer/Inspector Signature: Date: y

f
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes YNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. 2(Yes ❑ No ❑ NA ❑ NE
❑ Waste Applic ion El Weekly Freeboard El Waste Analysis ❑ Soil Analysis [I Waste Transfers El 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 d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:]No
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No rNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[? o
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[I No 7NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZrNq
❑ 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
2 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
2rNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
l�f N
NA
El NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

FaciIitv'�iumlier�
7
�;�,
d
in of
Q10ther. Agci
Type of Visit 65ptripliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: j j.S Departure Time: County: 0�L" — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��{ E'J jC&J j
Certified Operator: �tff J f JW_ZAZ
Back-up Operator: LA 0 R Lh __ IV J+ i'135
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ ' ❑ « Longitude: ❑ ° = ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[:]Layer
❑ Non -Layer I-- I-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures: EJ
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 9K ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[--]Yes
❑ No
❑ Yes 2No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — ID Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (ZNo ❑ 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: 09 (fiat/ 1 LA Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No ❑ 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 ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EI'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C,&) SGro
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
o El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes
WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
In o ElNA ❑ NE
17. Does the facility lack adequate acreage for land application? ElYesVNo
❑ NA Cl NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA ❑ NE
refer to question , �-Egplatn�any YESaanswers andlor:E
r
F A G7Z-+v� L4 a KS U�
01> . 1
IReviewer/inspector Name Phone: 3q.S
Reviewer/Inspector Signature: Date: 3 3
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E N ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'] No ❑ NA ❑'NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other ,�,�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes l/ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain InspectionVXo
Weather Code
22, Did the facility fail to install and maintain a rain gauge? El Yes
El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ No
A
2NA
El NE
❑ Yes
❑ No
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
❑ Yes
❑ NofNA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,E NNo ❑ NA ❑ NE
❑Yes L'JNo El NA El NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes LAN NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Ad`dltional-Comments and/or Drawings: t ° ; a. tr .,f,. _ N. `..
12128104

IType of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
O Not O erational � Below Threshold
jd Permitted 13 Certifii�ed) [3 Conditio!�Py Certified 13 Registered Date Last Operatedd�r Above Threshold: ..... ......_.......
Farm Name:�rl. '5.....'...� !..� ......__ ..._ County:.. sY.......w
...._ / -
Owner Name: ...... ......rPhone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative:.. F .... .�kZ�.?s ....._.— __ , Integrator•. .,�V—,f � , J�O[�/J
Certified Operator:
Location of Farm:
Operator Certification Number:
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �� �46 Longitude • 4 94
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Vlo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ff No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... #. .................... .........' . ..,............ ..... ........................ ..._.......
Freeboard (inches): �•
12112103 Continued

Facility Number: — Date of Inspection !!
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes RrNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 1XNo
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes &No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes )9No
❑ Excessive Ponding ❑ PAN ❑j3Hydraulic O%v�erllo /❑ ❑ Frozen Ground Copper and/or Zinc
12. Crop type A�D.4 (/ Cj/li406 /i1�/1 _ �/hfh'� (t��Zi+l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Pf No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ As
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
f RfNo
I6. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below [:]Yes eNo
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 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes XNo
Air Quality representative immediately.
) Commeats (refer to quesdon- Explaan any ,,YES ataswers amrl/or ariy:i ommendatioas or a� other comments. =
-
-Use drnwsngs of faefty to better explaia situations. (use additional pages as necessary): Field COPY ❑ Final Notes
e
?. "- � .r, re k .c�..�.�.. .��^; 'F"". ...�. �. HW..w _�° -w ""-- �.-:::"�,....,-T',' 1.e-� _']I�� -•-.d ... ^.'�",��v^3
AL
41 / /� 4;P-e l D4 �.E enr��e 5 E p f11,4.6
7/)459�2
'70 AV �04/�1ac �i9s ��� �D 7 Q�,�,esEEO ,✓ �.
1-2 6/6
71
ReviewerAnspector Name
Reviewer/Inspector Signature: Date:
P
12112103 e.� - T Continued

If Faciltty Number: 67— Date of Inspection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ;3No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes No
(ie/ WUP, checklists, design, maps, etc.)
❑ ,6
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ONO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ SoiI 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?
Q�No
(ie/ discharge, freeboard problems, over application)
❑Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes IVNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes XNo
31. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddiuonal Catximants.andhnr Drawtnig§V7
&1PX,05 A,647' 4'vo
12112103

Type of Visit 1C co/mpliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit X� Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number '] Date of Visit: I 03 Time: 0
rO Not Operational 0 Below Threshold
Permitted [3 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: *s c..) ett k *�-s To-1 County: vti SI at✓
Owner Name: . _ �- ��'' `'`�G G Ma k i✓11 Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: 2e 1 e 1, k in -f
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: M V��• i - t5fow.
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 u Longitude = 0 6 u
gn
Current Design Current Design Current
Swine Ca achy
1'o ulation Pioultry Ca aci P,o tapacew P,o ulation
❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
TOtai Design C►apacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons L___ �___J
❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
❑ No Liquid Waste Manage ent System
Holding Ponds 1 Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
i Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 2-
Freeboard (inches): z �.[3
05103101
❑ Yes 'p"No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes AO
❑ Yes )dNO
❑ Yes 'ONO
Structure 6
Continued

Facility Number: / 7: Date of Inspection 2 b3
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?
❑ Yes ONO
❑ Yes ,ONO
[:]Yes No
❑ Yes No
❑ Yes ONO
Waste Annlication
10.
Are there any buffers that need maintenance/improvement?
[:]Yes
XNo
11,
is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONO
12.
Crop type J? e y lv. I of n G 8"I a -ze -) S _11 1 Q tAS ✓ 54 e d
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
'ONO
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
J;ifiio
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15.
Does the receiving crop need improvement?
❑ Yes
ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,[�'NO
Renuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes .CJ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,
❑
(ic/ WUP, checklists, design, maps, etc.)
Yes No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes j!fNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 'z No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes 10 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 2rNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JZ"No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a ES answers,and/or an recoiarmendadons'or an ether cntnments. , '' (Comments referto queshoq'r#) Explain any Y� yI a
EUse drawuzgs of facrlity to better explain stfuattons ,(use addthonal pages asrnecessary) AAA
>. ❑Field Cap
❑Final Notes
paL
e we
lTfq c1n; Zed
j J1e [rc�s oL 61 I % jooY,s qre k1Eli Mc,-��a,•-,Fd . 1 ti�+t
�reJc,� �o�
f
Reviewer/Inspector Name X n ► iew <;.
Reviewer/Inspector Signature: &aEnsai2y�^ Date:
Z
05103101 Continued

f
Facility Dumber: 7 Date of Inspection + f�
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 Zr 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 ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Z No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional"Comments andlorDrawings:
O510310I

IType of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Z D z Time:
rO to "
Not Operational Q Below Threshold
0 Permitted © C-er�tifiedL 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: J F ` "T '� ' �) �a `L County: a h s/ZL
Owner Name: Lo` w re k Ge /J • J—e#7k i H 5 Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Jed �e.rt k;V%S
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 Du Longitude 0 °
Design
Swine Ca aci
Current
P., ulation Poultry
'Design 'Current " - Design Current
Ca acity P.o utadon Cattle Ca aci P,o ulation
❑ Wean to Feeder
❑ Layer
Non -Laver
Other
iry
❑ Non-Dairy
Total Design Capacity
Total SSLW
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
❑Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1$olid Traps
❑ No Liquid Waste Management S stem
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ! rr Z
Freeboard (inches): 14 [9 3:2
05103101
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZfNo
❑ Yes ❑ No
❑ Yes .-No
Structure 6
Continued

r Facility Number: 4 7 — q&
Date of Inspection S 2 OZ
S. 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?
❑ Yes ANo
❑ Yes ,KNo
❑ Yes E!rNo
'Efyes ❑ No
❑ Yes 01No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload 101yes ❑ No
12. Crop type V,4et _(;Na,ze, S;nA I oyerScGd YCIze .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Mo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? A5 Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
EFryes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
,rNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JTNo
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ZrNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[:]No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
'zYes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:zTf _. y... 3 �� b'F°'!�4``<YtiA s`�a, i '�.{'.+ - _ --. S - �'4
Comments (refer to queshon;#r7 Exp in any YES answers and/or any recommendadpps or any other comments. x ,s _ �, i ysf .F',r�s, - „ic •�_ .. -- .-tee S�° ,
Llse drawrngs faciiity better (use
of to eaplainituat,onsT addrhonal pages :as necessary) ❑Field Copy ❑ Fina) Notes
..
1
!8, Need 4D knue r,icjool, ofzs;9ll 1`iT/O'�'�`1�lo�n 4p�.-rile' Q�/'y''1/C�jji OR13
✓✓fO/
1A�00VL G]1/�2�'rgI7�G lYls/�e[�i01'1• �IISOJ St,et414 Inzwe 4�e tal/►t
"lei
CE✓� ►{r t[i� i��t Avn lle -60- iv►s�G{;cr�? .
!41. Neeed 4a use 1"'sae gn�l�s;s �eraed L✓�'��,��, �� days
0-F 417C Afj0 )ieA4;o� even4f 4o cede Utn-fie 4Zte �rara�eYl �jP1l:cd off
L,A-4c anglysi1 Ag4edd r-ebYve,y7z6)Z00z_
Reviewer/Inspector Name _ �m� N.
Reviewer/Inspector Signature: Date: S Z Q Z-
05103101 Continued

��45 e 3
j r
Facility Number:
Odor Issues
Date of Inspection
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 'O'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FzrNo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes -,❑/ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [:]No
Additional Comments and/6i=Drawings: ,'
�9• rah}ice✓e'�) %,).f bee" V.Ser1 P,*, nLI4)01;Ce,-IiahCl/Gn)S WI14�
OGGt/✓r�si a'1 h'tat� `Leo 2 . m✓ . zJ--C �'7 :� �Q S .Scvl-� 0;;r
aid �s ex�oct�; -111e- ys,'s Gat �);
Need!Iwo 1Gv1c,-�c 41-c-TAi(—Z'f w; }l,-7L,E ►1al�.s v-rave wh; eL,
Also, Me. cTe�k:�s is c41c,11f0i'j-9 4 e n;4eoy+, q�pl;ed Lv1�-'f11C
h;sAeO aovtl.�sir �'�nw. -}l,,e 4wo 1q.9Qahr -e, q '%le&1
'G�,. ]�,� oai, '�L1 �' aPi' 1 i G�.,-� l o�-•
rS- 6 e;►•5 y" Ade Q &nd tlSe -/he corres�and;.� w�sAC 01►1701ys� f
4a Cm1cAr?-fe -411,' r1;4Ye e" q lied .
5 �P
Ake, neco! +'P be, sure qa 1le ve a wa13e gklal .s iy ad4oeot
O day 3// d,r - 1n e 1i �OP l i cc4,`o1n e. veq-1I )' 41'C ee is .114 an�x l y-; 5
�e,led l,,r���,"►1 C�� days 11di �v�vs� 8 a-xd c7,, Z�
aO� dielic4�;ohs "
[ �vrsar�n�/;ny q+uttl�sel �a� �L,PSe even1s4rPe4ated �vncl,2lao]
N o vp,vt (,� r �j Z DD I
Of17e� 41, , 4i7ese 14ev,,s n oleef Above; -f he neevr-ds qfe ivell
a�9��;Zed and nQg4ly kefl-
Ig,Ccen-l�-tivec�� 1+?r.r5erik,.�s did FfGsC-n.� la5aax,des,'c�h ;��'o�nLc�-};on
Hof-It,e o';�;-qj IQ�aoh wh;ck was f'our,ddu,�� ✓ -fhe �ns�ec�;oh;
�cwe�P✓, -1 he elev­asa� rYtr/a✓NI�L�i �"1 tacs Gv� oPf' w�,en Ae 419t,c,s
we,& ,Haute; e,,44cLc � 1), s+r, t-1 �6r a beN�r God 54PLA. ,'/�� -4lie
*11A vndey9�aur,vl 5y34G,"'N 1La3 rccen�l beep-, trts�u�ied • 7�,�✓e is
some Fu of el l ecl t..,,t s-1 a a-l- Ae ed eW 'o- '"; 6 f d Soil -Ae l ew side 0-1
4Ae f;eld 4hd �fs6 .Sow+e sougo )o�ddles r►'1 �,'1�101 �,-Be sure�a nod
1?Aye )aomd;r� c✓ Pu laf'O wAs4A I S.� need 4,5 T,V4 4vt
iy, d i v. of uo j G u-� er--t en 4ke e; ise'r i41, e low 41ea -%►id use "� It, 1.11
IP ►-eveyl-1 leq kot4e i„iL. A, oG LvY wh evi st,, s4a,m is
05/03/01 Vp p✓ SZ['/��"� dew'i A1sa }need -Fa r'Q/'s q✓t 'qit /''eli0-1*' I►'1
�o �rer�l-t� �eax;�� - �IS6 / /'rrGo•'trn�r►d �vu.�;Y,A a cen-l-u�n►�n-� be,.� �j
.��,e )mow �r�a i� �',•�ld S.

P-m,9e q
Facility Number: 6 7 — Ittm
Odor Issues
Date of Inspection Zit
26. Does the discharge pipe fro the confinement building to the storage pond or lagoon fail t 'scharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage d with no agitation?
27. Are there any dead animals not dispose f properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during Ian lication? (i.e. res' on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not Iota nea a liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems wi a ventilation fan( oted? (i.e. broken fan belts, missing or
or broken fan btade(s), inoperable shu , etc.) ❑ Yes ❑ No
31. Do the animals feed stora s fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush to ack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Comments and/or
�S. t��id ? iS ���;n9 heg�y Gd,M��;�,•�i',, 6y a-tl�.ey �rasse5 ��r�k.
des, �vtm f ed berwtUde,, tvo Jo ells+o 4tie se o4ke
A�a1.Ts�S c) d prom-o4e bev-vvvdq. AI56) 5 qnd 6 k'tVe
beep W;- "11 -1bte fAJ1 GaK1111e
a�wee s� eh4U1,e c- 900d Iaand o-f ber'I'L"ell1 e-i Aese 4;ti 3,
�5 z� q pP e a , s -1 4 ,t4 on e Q 1`,e � v 11 s > � >r; e i of 4 --7— � 5
desy�,,ed 4P ;51 a/ 2-eG9 -Fee-i -0.,c a dwC11 vty ntr�
-f1c h . med i .F ; c et4 ar11 Ytnqy leave 4e b& 'made -a Ae s y s4 ,
05103101

i r`
Dtvisign of Water Quality
- H
ateonQDivision ofSailandWaterConse
21
_ Q°f)ther Agency
Type of Visit x Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )� Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ,`3 —� Time: �s Printed on: 10/26/2000
F— Q Not operational Q Below Threshold
10 Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold
�� >~� rJ t—'G 1.r
Farm Name: ............�............5.............................................................................. Countv:.............................................................. . ......................
OwnerName: ................................................... ........................................................................ Phone No:......................................................................................
FacilityContact:.............................................................................. Title:..................................... . Phone No:
MailingAddress:.......................................................................................................................................................................................................... .........................
Onsite Representative:. t..�t.e—................ ....................... Integrator:...... F.................................................
...................... ..... ...............
Certified Operator: ................................................... ............................................................. Operator Certification Number:.........................................
Location of Farm:
[]Swine ❑ Poultry []Cattle ❑ Horse Latitude Longitude �• �0«
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
t
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I 11E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons a ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsmed, did it reach Water of the State? (if yes, notify DWQ)
c. ll' discharge is observed, what is [lie 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
Identif icr:...............................................................................................................................................
Freeboard (inches): 3 ,
5100
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
)ErNo
❑ Yes
1� No
❑ Yes VNo
Structure 5 Structure 6
.............................................................
Continued on back

Facility Number: — t j Date of Inspection Printer on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes bfNo
(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
WNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
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
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
❑ Yes
VNo
12. Crop typeir�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
gNo
b) Does the facility need a wettable acre determination?
❑ Yes
[VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ff No
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
kfNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
EgNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
tNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
0 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
L 'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
NrNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1�rNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
014o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Jallo
: yiolafigris:oi� d ficien�{es ry re ngted ding tlus•v�s�ti Yoh witl-r 000 0o futt�ter'
•
correspondence: a�auti this :visit: ................ ::............... .
Comineuts (refer to question.#): Explain any YES answers andforrnei any recomdationor s any_other eommeaA
Use drawings of facility to better explaiti;srtttations (nse:additional pages gkneeessary)
`_..
AGL_� Q
�l��r�2i �`�tr-�"o��3 ���Q � Uo.�7, � `� t�rG.•vT ��� lGCt2 G.'1 SG
9 '� ( r p1, � � -�c 4-�.�. � ►tee
JT3
(%sue �e�� ►^-�.5��2 j� ��c�s �v- .7 �. ``<7V�01_ V-e%� qL' t,N5 ,
( ✓r, �.2r- �pv.� �yr rn-ZQ SQ-e d s Ci r_ G 3 G�QSC vQ ,
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: —3 --G SIIJo

!� 1
r,
I -Facility Number:, Date of Inspection �-� Printed on: 10/26/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes )�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 P<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 R No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 14No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes M[No
Additional omments an or. Drawings:. .
C�) (-r" C7, V-el r�'� Ak'
6� C7��+�5e �c GVQi U O V� — 1 iC�►� G h. V,1V
t
v�—Y �CQ-
V--
5100

�d; W&e- r.Conse&iition
-Conce Inspect<on mp1ia
s
JQLRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up ofDSWC review Q Other J
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified © Registered Not O erational Date Last Operated:
Farm Name: �� ��.�'' ...c�c�.t^-i riti County: .....G.�,_jQW.p.......................................
OwnerName: ...................................................
Facility Contact: ... :............
Title: ..........................
Phone No:........
Phone No:
MailingAddress: ........................................................................................................._............ ..........B
........................ ..
Onsite Representative :: .................. .\......................................... Integrator:... 1'.1.........................................................
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
............................................................................................................................................................................................... _
Latitude Longitude • �� �«
.. = Design Current Design ,Current . = t_ ,; Design:. nniCtiftent
:Swine Capacity' Population Poultry Capacity Pb lation Cattle
_-= u Ca actty"Po ulation
T ❑Wean to Feeder ❑ Layer FI:
Dairy
ElFeeder to Finish ❑Non -Layer Non -Dairy
Farrow to Wean I;}Q
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Desigm Capacify
❑ Gilts
❑Boars Total SSLW
_ Number of Lagoons ❑Subsurface Drains Present ID Lagoon Area 10 Spray Field Area -
'Holding Ponds'!So Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Dischar-c originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes Dj�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches) . ............J 1......................... 3 o................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes KNo
Continued on back

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DW Q)
7. Do any of the structures need maintenance/improvement?'
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste. Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
•viulati#ris.or• deficiencies •were n6fed. diWing this:visit; - Yoi wiil•r. eeeiye lio further • . •
rorrespondeinee. about: this :visit: :
❑ Yes gNo
❑ Yes XNo
❑ Yes KNo
❑ Yes P(No
❑ Yes D'No
❑ Yes 5Y�No
❑ Yes KNo
❑ Yes 1KNo
❑ Yes ❑ No
P(Yes ❑ No
❑ Yes kNo
❑ Yes W40
❑ Yes gNo
}Yes JWNo
❑ Yes j(No
❑ Yes gNo
❑ Yes [) 'No
❑ Yes To
❑ Yes L�?No
❑ Yes WNo
❑ Yes XNo
Comm toF4ti.estion'#):; Explain'any'YES answers an`dJor any recommeniiations or -any utlier comments
Ilse drawings of facil�ty_.tto`.better explain sthtations {use,addrti0ii -_ ages as",necessary) r
g
iK 1 r�q L w tt-cam IR�4
RZ41 ,
Reviewer/Inspector Name
Reviewer/Inspector Signature: �Q Date:

FaciI0%Number: — Bate 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 Klo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ElYes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNO
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 IkNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J�(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes kNo
'Additional Comments; an or rawings - ,
sAL
14,
-
R4�-Pep
�4��`--� yo cue
v 3-- sa$ lac
3/23/99

` [3 Division of Soil and Water Conservation Operation Review
Q:Division of Soil and Water Conservation =:Compliance Iirispectioa
� Dii�ision of Water Quality Compliance Inspection
_ Other Agency Operation Revrew
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 1p Date of Inspection 2- `1
Time of Inspection U5=24 hr. (hh:mm)
1f Permitted 21 Certified [3 Conditionally Certified © Registered JE3 Not Opera Date Last Operated:
Farm Name: ...J..EN/%�J1/......�RQM.......ttlC.............................................. County: _...Q..1 - d..W.......----.._.................. VJID....
Owner Name .. ...W.. L�NlCE..............Phone No:
Facility Contact: ... a.rpr..... �N��I..15.... Title: ........................................ .................. Phone No:.......................... ....................._
Mailing Address: ...... 7...... 3a.2/1,J....... ../..!4..«r.......................................... l.Cf/G!¢+Viu........ N C ...................
OnsiteRepresentative::...-.�.......................:..........`....................................................................... Integrator:......................................................................................
Certified Operator —/ F Sy...../Y ��w/ //�15 ..... Operator Certification Number•.. 1.61--an.............
Location of Farm:
Latitude �• ©� �•' Longitude ©• ®` ®«
Design Current - Design-,-
-_.. :_. � Current ..
Swine - - Capacity Population' Pouttry'-Capacity' Population Cattle
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
d0
f7a(o
Farrow to Feeder
647
❑ Farrow to Finish
❑ Gilts,
❑ Boars
[I Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total ,SSLW
-Current,
7C�0
MA
Number of Lagoons - ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
�=
HoldirigPonds l Solid Traps E.. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 11ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: 2
Freeboard(inches): ......... J. ......................... 4.......................................................................................................................... I..............................
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

I

Faciiiity Number: 7— 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 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
IMMAJI
❑ Yes LkNo
❑ Yes XNo
❑ Yes �No
❑ Yes 4No
❑ Yes allo
❑ Yes XNo
12. Crop type kArt',,,,,.,-- " Btu`'' S..j `'(s _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes allo*
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
❑ Yes ❑ No
❑ Yes [X No
❑ Yes [RNo
❑ Yes L�KNo
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes WNo
❑ Yes E�No
❑ Yes [,No
❑ Yes KNo"K-
..
LF.�'�Tti vhAptfidtis:or• &flcieeni ies •mere noted luting phis visit; - Yoit will •ceeeiye tto further
......
- . corresporic#etrce. abut: this visit.: - - - - - - •
Commenis (refer,to;question #) .Eacplain any YES answers and/or any-recommendaiions oe any other continents .-
Use -drawings of facility to:better explain situai>ois use adclttional pages as'necessay) _ v
. _ w r.
Reviewer/Inspector Name��`
Reviewer/Inspector Signature: Date: / Z�` q rj
3/23/99

"e lity Number: ? - Date of Inspection Z
� 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [-]Yes qNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gNo
28. is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes )KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 4No
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 ItzNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IV
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
_ition = ornments'an or aw!ngs _ , _
3/23/99

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number � - - Operation is flagged fora wettable
Farm Name: �7. acre determination due to failure of
On -Site Representative: 2 Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: [�
Date of site visit:
Date of most recent WUP: 7
Annual farm PAN deficit: q96 pounds
Operation not required to secure WA
determination at this time based on
exemption E7 E2 E3 E4
Operation pended for wettable acre
determination based on (Zl)' P2 P3
Irrigation System(s) - circle #:0)iard-close traveler, 2. center -pivot -system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system .w/portable pipe;.
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part i exemption_)
E1 Adequate irrigation design, including map'depicting wettable acres, is complete
and signed by an 1 or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE-75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational .table in Part ill).
PART I1.75% Rule -Eligibility Checklist and .Documentation of WA Determination
Requirements. WA Determination.required because. operation fails one of. the.eligibility
requirementslisted below:
_ F1 Lack .ofmcreage=which-resintedin:over.mpplicationmf_wastewater,(PAN) onepray_-
field s)according-fofarm'sdasttwoyears:of irrigabon3-ecords.7:
- F2 Unclear,rillegible; ar lack of-information/map:
F3 Obviousfield-limitabons-(numerous_ditches;failure:-to:deductTequired_ _--
buffer/setbackmcreage;-or25°/a.of.total:acreageddentified:in-CAWNIP.::iridudes_-_ =
small,- irregularly -shaped fields z.- ields Jessthan-5Mcres for-travelers`or.less-ihan -
2 acres for.-stationarysprinklers).
F4 WA determination required because CAWMP 'creditsfeld(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised April 20, 1999
Facility Number. _
Part III. Field by Field Determination of
75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER',2
. TYPE of
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
-
I
I
I
I
I
.
I
I
-
I
I
I
I
I
I-
I-
I
!
I
I
I
FIELD NUMBER' - hvdrant. oull.zone. or:ooint numbers may be used in place of field numbers
deoendina an CAWMP
and type of irrigation -system.- If pulls, etc. cross more -than one field, inspectodreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER - must be clearly delineated on -map.
COMMENTS'- back-up fields with CAWMP acfeageiexceeding75% of its total -acres -and having -received less than 50%
of its annual PAN as documented in the farm's.previousfwo years'. (1997 & 1998) of irriga#ionTecords,-cannot serve -as -the
sole basisfor-requiringa WA Determination.-_Back-upfrelds-must -be -noted in the -comment section -and must be accessible
by irrigation -system.
Part IV. Pending -WA'Determinations -
/Pi Plan -lacks _followinginformation:
� w � ��- qc►-e�2.r
P2 Plan --revision-may_satisfy-75% rule based on adequate overall PAN deficit -and by
adjusting -all field.acreage:to-below 75% use rate
P3 Other (ie/in process of installing new irrigation system):

Lagoon Dike Inspection Report
Name of Farm / Facility Jenkins (Murphy) 2277 A
Location of Farm / Facility Robin Trail Road
Owner's Naive, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:IV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition' of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
9 / 29/ 9Q_ Names of Inspectors Patrick Grogan
Janet Paith
8' Freeboard, Feet 19"
1.0 Top Width, Feet 10
22 to? Downstream Slope, %H:1v 3 to I
Yes X No
Yes X No
Yes X No
Excellent - atass
T Yes -X— No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes �X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes x No
Other Comments

Lagoon Dike Inspection Report
Name of Farm / Facility _Jenkins (Murphy) 2277 B
Location of Farm / Facility Min TrO Road
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, r,H:l V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
{ Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes)
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors 1
an Jet Pail
12' Freeboard, Feet 26"
2.0 Top Width, Feet 12
,2 to 1 Downstream Slope, xH:ly 3 to 1
Yes X No
Yes X No
Yes X No
Excellent - Vass
Did Dike Overtop? Yes No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Y X N
Enguteertng Study Needed. es o _ F
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Farm / Facility _ Jenkins (MuEphy) 2277 _ A
Location of Farm I Facility Robin Traii Road
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream SIope, xH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors —Pa-trick Grogan
Janet Paid
8' Freeboard, Feet 19„
1 A Top Width, Feet 10
2 to 1 Downstream SIope, xH:1v _ 3 to 1
Yes X No
Yes X No
Yes X No
Excellerrt_ - gr sus
Did Dike Overtop? Yes X_ No
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
f
Yes X No

Lagoon Dike Inspection Report
0-
Name of Farm / Facility Jenkins _(Murphy) 2277 _ B
Location of Farm / Facility Robin Trail Raai
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
9 l 29J 99 Names of Inspectors Pat&kSsra=
Janet Paith
- 1-2' Freeboard, Feet 26"
2.a Top Width, Feet 12
2 to 1 Downstream Slope, xH:ly _ 3 ro 1
Yes X No
Yes X No
Yes X No
Excellent -,grass _
Did Dike Overtop? Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection Y
Facility Number
Time of Inspection ' ' 24 hr. (hh:nnn)
Megistered 0 Certified D Applied for Permit A —Permitted JE3Not Operational Date Last Operated:
Farm Name: ` n . rr3 fl��!?!{.. ��— County:...... `S r^.....................................
Owner Name: L. ?! t .fr:� 4. ............ ... K k.t/r- .............................. Phone No:.:.� �....Z..1�......................................
Facility Contact:.. .f!WJL.r7{?G.. ........ �t� tL%.< Titte:..e.... .................................... Phone No:
Mailing Address:...... 3.................................................l`�Y.,.✓r5...................................... Fl: .
Onsite Representative:...,.. r?- ............. +✓.
'''t5........................... [ . Integrator•...... IMM-11! a ..............................................
'
Certified Operator;...... `: 7............. �---ZlvI�1< ...�.................. Operator Certification N her:...................
Location of Farm: J
Latitude • ' " Longitude • 4 "
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
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes E[No
❑ Yes 0 No
❑ Yes Q No
❑ Yes ® No
❑ Yes ® No
❑ Yes @ No
❑ Yes ® No
❑ Yes 53 No
❑ Yes UNo
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ®-No

Facility Number:-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes WLN0
Structures (Laaoop5.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 14 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): V
.......... .............. ........................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
to No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RI No
12.
Do any of the structures need maintenance/improvement?
Zyes
q No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Wo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
WNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type h.
.................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
,_] No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
g) No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
j] No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
MNo
22.
Does record keeping need improvement?
{Yes
❑ No
For
Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Rio
0, No.violationsor deficiencies:were'hated-dtiring this" visit.• you;wi11 i-ecei"Ve,66•further-
corresp0QdeJh0 dliouE
1+ ceJ -tc, 5 �� �t'-� s Carr ram,
7/25/97

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review ' O Other
Facility Number
Date of Inspection 7 7
`i Time of Inspection (O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _...._._..... _.... _........._.....__............... _..... .._. .._....... ....... �.....
Farm Name: _....... _ iul� A.If [lQ_{..ixa[........ _...._ _.... _ County:.__...Qsd oar.)_ ....... ..... .............. .........__..........
Land Owner Name: _..-..._..'tip... ......_.... tw...... ...... Phone No:
Phone • � q
FacilityConctact: No Title: �.C..�...._ � S.._._......_............._..... ..if}lpt'l�eY.............\ .. � ..irO� �_.k_.�33W....__.....
Mailing Address: —.2122 _....... .._...._._...... _...... ..... .._....... _ .... __.... 11V� .....
Onsite Representative: ..... Integrator: LviLl .. ....
Certified Operator �.i; ... ..:k�1�,1�.L ............ �._ ..... _._. _ .. Operator Certification Number:1AX .
Location of Farm:
..... ....... .........._...............__..... _....._..................---._..._................ ....... ......
__....
Latitude 3y • �` -�R _u Longitude ~I •i ®"
Type of Operation and Design Capacity
3,Design C�rreut Design Current k©esign Current
Swine y . Poui .Cattle
Ca aci . >Po ulation* Ca achy Po ulatton = s__,: , a.. t<.- , . Ca aci _ Po ulanon
❑ Wean to Feeder ❑ La er ❑ Dairy J
s ❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean zootax . Nv
a
Farrow to Feeder TotalDstgn Capacity i Z0( r
Farrow to Finish
❑Other
W �Totai SSLW f'd
�m
sm,a111,77 '
�' Numlier of°Lagoons ! Holding Poiids L ❑Subsurface Drains Present
��` � � ��' �`� 1 n .. '; �� ���''� � �� � [] Lagoon Area ; ❑Spray Field Area � �'�-� �
General
I. 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?
❑ Yes 59 No
❑ Yes tA No
❑ Yes P No
❑ Yes No
❑ Yes No
❑ Yes W No
❑ Yes 10 No
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/9 7 maintenance/improvement?
❑ Yes ;&No
Continued on back

Facility Number:... �e..... —.... 6
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
,Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 DO Structure 2,,x+o Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type --.... 5.. ... ( f Lt S...,...................................
❑ Yes ,� No
❑ Yes No
❑ Yes ONO
❑ Yes ® No
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?
For Cerh'tied 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 CDNo
❑ Yes No
ER Yes ❑ No
❑ Yes IN No
❑ Yes ® No
❑ Yes
MNo
❑ Yes
ONO
❑ Yes
1)&No _
❑ Yes
[;$No
❑ Yes
CjNo
❑ Yes
%No
❑ Yes No
❑ Yes No
PZYes ❑ No
Comments'(refer to question {t Explain any YES answers and/or any recommendations or any other comments k
Use drawings of facility to better explain situations: (use additional pages as necessary) :.
�� s18n &) r 5 esv` 4 z,nyar off' In oovk PJaAIS of la6cor, Svdh
be �ifler� 0z4 G W� rcscAed. �c S� Should be fineded, A- berm 'Ju d be
& � j + o.rot yY R 'uer^ ova (&5M1\ * z'
2-4. 5 X%C(o rdT 56) d be V A f by nUVK6-r &W �MJ numbq- am� A W
nt}m -s s,6,4 eovyes�c W 14km &�+ .
a
cc: urvrsron of warer Vuaury, warer Muaury section, tacurry tissessmenr Unrr 413U/V I

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Lawrence Jenkins
Jenkins Farm Inc
207 Robin Trial
Richlands NC 28574
SUBJECT: Operator In Charge Designation
Facility: Jenkins Farm Inc
Facility ID#: 67-46
Onslow County
Dear Mr. Jenkins:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sincerely,
Preston Howard, Jr., . ctor
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 276$7, N���
Raleigh, North Carolina 27611 7687 An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 = 50% recycled/10°/. post -consumer paper

Site Requires Immediate Attention:
Facility No. 7=�
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 11995
Time: i..12: ->0 L4,A)�-����
Farm Name/Owner: f Aj ekk _ � k: - s _ --
Mailing Address:
County:
Integrator. jmL�L Phone:
On Site Representative: ^� Phone ` 31
Physical Address/Location:�
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 4&qD .5 cw5 tr = Number of Animals on Site: �� �,51 cw�.� 4- &Sr`'
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 `( `f r' Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm even
(approximately 1 Foot +3 inches) (!Pwr No Actual Freeboard: Ft. _ Inches v
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observes or No L74711.
es Is adequate land available for spray? or No Is the cover crop adequate?�9 or No
Crop(s) being utilized: Cwn+—x( : , jjm 5Z&=d _j _ 1. Jai- .n " J& L.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? -Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& 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)?J�s or No
'S y r
Inspector Name
-L cl�
Si a e
cc: Facility Assessment Unit - Use Attachments if Needed.

OFERATION BRANCH - WO Fax:[phone] Jul 24 '95 18:20 P.17i18
Site Requires Immediate Attention A10
Facility Number: G 75/f
SITE VISITATION RECORD
DATE: Tk cy /3 .1995
Owner: 1 A4v1c.f"~e E T.�.Wr_ �-.r.. Farm Name:
County: -
Agent Visiting Site: Phone:fd/ _�'rf� - f'7
Operator: A .ca�,+� c.! S ,vx ivl _ Phone: ,3 y -.t�y�? r
On Site Representative: Phone:
Physical Address: Z z _tom o l d i--
Mailing Address:
Type of Operation: Swine t. -- Poultry Cattle
Design Capacity: Zzva Number of Animals on Site: vo
Latitude: ° Longitude:
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
,(approximately 1 Foot +9 inches) ioe or No Actual Freeboard: � ? Feet 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)? Yes or 0 1 as there erosion of the dam?: Yes o915-4)
Is adequate land available for land application? Or No Is the cover crop adequate? d�r No
Additional Comments:
Fax to [phone] Sitnature of