670052_INSPECTIONS_20171231

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NURTH CAROLINA
Department of Environmental Qual
II

(Type of Visit: KCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: A Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 1045 County:
Farm Name: V.(aMA �. A_c t-' 1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
q a.
Onsite Representative: f ri
Certified Operator: V
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Region: WIN
Certification Number: 10 2 St)
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
C►urrent
Pop.
Design C►urrent
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , Ploul_ , C+_a aci P,o .
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes b&o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes XNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

vacili umber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes VNo ❑ 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 KNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;XNo ❑ 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 Zo No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
b(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Cg No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

FacilitvNumber: - IDate 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
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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
[:]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments refer to uesnon Ext lain an YES answeis,}and/or. an additional recommendations or. an other comments' `
( qu p_ Y Y -; -,
Use drawings: of facility3to :better explain situations {use -additional pages as.necessary); r %'
- A ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 1 0--7C1 0 1�
Date: C1 5
242015 S

Type of Visit: (jCompliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access,.
Date of Visit: Arrival Time: Departure Time: ® County: Qy S L6 w/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet 10uitry
Layer
Design Current Design Current
Capacity Pop. - Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current I Dry Cow
Ca acit P,o Non -Dairy
Farrow to Feeder
DOWNultrF
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other.
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facifl Number: - Date of Ins ectiou: q
Waste Collection & Treatment
4. ITtorage 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: (Aao_zP
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 310
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
]�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes environment.o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E f 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 V(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fl 4
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E 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
WNo
❑ NA
❑ NE
Required Records & Documents
�No
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
NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Otdyes
her:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectii 2 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [TS o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

h'acili Number: - Date of Ins ec1 jRE
24. Did the facility fail to calibrate waste application equipment as required by thepermit;
❑ Yes No ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Wo ❑ 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 RfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 [Z/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA 0 NE
Comment's {refer=to question ft Explain any. YES answers and/or any -additional recommendations or any other comments.
Use drawings of facility tobetter explain situations (use additional pages as necessary).
SLLJOG-4�"
Sur-06Y 1 -5 E' LTV1s_f Due-1V �1�� ��v �1
k Ave
�r��,
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phon4 910 n — r-
Date:
/4/Z 15

Type of Visit: (Dr Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (rd Routine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: � Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:V-T-- jz=C�� te_ J'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: T� la's,6-
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
C►stile
Dairy Cow
Design C*urrent
Capacity Pop.
Wean to Feeder
Feeder to Finish
Non -La er
I
Dairy Calf
D2ja Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1l . P,oultr,
Layers
Design Current
Ca aei $o
Cow
Nan -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214,12014 Continued

Facilky Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
1Structure Structure 2
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ONE
[:]Yes dNo ❑ NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNog
❑ 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 [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ' ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Zj (''
13. Soil Type(s): AYS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes FNN
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ 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? ❑ YesFNo
❑ 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 fai to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate b
P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 oes record keeping need improvement? If yes, check the appropriate box below. 61"Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? - ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? Ves
es[ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ No ❑ NA ❑ NE
the propnate box(es) below.
ailure 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: °�
4
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 9No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes hd o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [NTo
[:]Yes 040
❑ Yes
❑ Yes u O
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
aa, UeDAfiG W ve fD 9)qy6 5� l� �Gb A�� �xtc �
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0�,�_j dAVC s'00&f.' em
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Reviewer/Inspector Name: U OF�
Reviewer/Inspector Signature:
Page 3 of 3
Phon01b 1 i� �I V 8
Date:
2/4/2 I4

I
Type of Visit: (D CoOpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q�L i�� Departure Time: County: G % Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: U tIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
ean to Finish La er
Design
Cattle Capacity
Da' Cow
Current
Pop.
ean to Feeder
Non -La er
Da' Calf
R
eder to Finish
p
Da' Heifer
rrow to Wean
rrow to Feeder
Design C*urrent
D r P.oultry Ca acity Ro
I Layers
D Cow
Non -Dairy
rrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
I
I Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is anydischargeobserved 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
0 NA
❑ NE
❑ Yes �eNo
[—]Yes
❑ Yes Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

1
Facility Number: Date Date of Ins ection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `,�O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental $hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FZN/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 ❑ 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [,—P<o ❑ 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 101bs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes O N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CjXo ❑ 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 �o ❑ NA ❑ NE
Reauired 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 No
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Zes
21. Does record keeping need improvement? If yes, check the appropriate box below.
To
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections ElMonthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:2,1
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 0 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 2No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /No ❑ NA 0 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 [:aio ❑ 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 O/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
Zo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes '
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or an other comments. .
Use deawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.b SwrDGE SLK- 4 dE KT 3 v .PAO, V1:VS5Kn 7A13
Phone(
Date:
21417011

Type of Visit: Q Zoutine
ance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: 9Dp Departure Time: County: 7�ta�j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: U-z(� �c N Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: Vo 2 O
Certification Number:
Longitude:
Design Current
acity Pop.
Finish
fX 71ceder
"rz11;Mz11jRWjLCUrrent
Wet Poultry Ca
La er
Dai Cow
Design
Current
Feeder
Non -La er
Dai Cao
Finish
Farrow to Wean
Otto
6
Design Current
Dr. P,o_ult . Ca aci P,o
Layers
Dairy Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3/No ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes � ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: (p'7 - 2— Date of Ins ection: ti 1-G
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z3 No ❑ NA 0 NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
lei (Imo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
24--_
Structure 2 Structure 3 Structure 4
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
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [nNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments 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 XNo ❑ 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 21"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. 0 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 YNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [�No
[:]Yes <0
❑ Yes ['/No
❑ Yes ❑-lvo
❑ Other:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q N 0 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - S-z' Date of Inspection: qJ4111
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
.s
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesPNo ❑ 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 FNo
N❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes lJ 'Vo ❑ NA ❑ NE
❑ Yes D<O ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes ❑ NA
❑ Yes qNo ❑ NA
Comments (refer to question ft Explain an YES answers and/or any, additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessa
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
Phone: G13479
Date: 3
2 4 OII

Type of Visit: CK liance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L�Z 1�1.1rJ Arrival Time: ® Departure Time: OpQ County: (�}� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Nb i c_z;i� ; �eo tcx_I+1 S - Integrator:
Phone:
Certified Operator: Certification Number: 1(2&6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C*urrent
Wet Poultry C►►opacity Pap.
Layer
Cattle
Dairy Cow
Design
C**opacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I Ell
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oultr. Ca aci P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 ❑ o ❑ NA ❑ NE
[]Yes [Z yo
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - 57v Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes LEI 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' LAGOStj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZJN�o
❑ 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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures Iack adequate markers as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes dNNo
❑ 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 0 Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
o
❑ YesVNo
❑ 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 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes do
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Z11Vo
❑ NA
❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? if yes, check
[—]Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 mo❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes II No❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facili ,Number: - Date of inspection: 1 7—
ds
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Is tie facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
0 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
UINO ❑ 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
0 ❑ 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
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7No
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
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I�3o NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
' o ❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or, any other comments..,M-.., ~
Use drawings of facility to better explain situations (use additional pages as necessary).-
Reviewer/Inspector Name:
Phone:t � 6. — /3qU
Reviewer/Inspector Signature:
Date:
Page 3 of 3 f 1 21412011

I/I
x. DNj,ion of Water Qaahty W
s FaCtlttvNnmher �Q Dlviston of Soil and Water"Conservatton
:
�.
_.
Other -Agency
W
Type of Visit 0 Co Hance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 IZ) I Arrival Time: ® Departure Time: County: 00SL/61.1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: U —TAIZ -DJJ A 3 GJIt--tiJS Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I =is Longitude: = o = 4
Design Curr
Swine CaOaeity. . P. opula
❑ Wean to Finish _
❑ Wean to Feeder
Feeder to Finish 11g Qb
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
ri
'Vet Poultry �
Layer
]UNon-Layer
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes la No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
[INE
❑ Yes
ElYes
❑ NA
❑ NE
❑ Yes
YN ❑ NA
❑ NE
12128104 Continued

4
Facility Number: (0 — Date of Inspection !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
!d No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-AGct5 ).
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
E�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 notify DWQ
threat,
7. Do any of the structures need maintenance or improvement?
❑ Yes
E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�(No ❑ NA [INE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6
El NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
LG No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,14
E
❑ NA
❑ NE
Comments refer to question # : Ea lain an YES answers and/or any, recomm r ( q ) p y` y endattons or any other comments
Use°drawings of facility to.better explain situations. (use additional pages as necessary):
Reviewer/InspectorName kj4rZJJCL a- Phone:(To 7`�tro - 388
Reviewer/Inspector Signature: Date: p l l
Page 2 of 3

Facility Number: (.�`� — 01 Date of Inspection till
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesgNo
No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain InspectionZNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
No
❑ NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E N
El
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
(� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ 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
o
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

a
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,Compliance
4 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: % E+ Arrival Time: L d Departure Time: County: LIML-60J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: � � �' a NlLI 0S Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f ❑ N Longitude: = ° = d =
As
Design Current
Swine E'papacitVARopulation
Design
Wet Poultry Capacity
Current
Population Cattle
Design Current
Capacity Population
Wean to Finish
Wean to Feeder
LEO
Feeder to Finish
Dry Poultry
❑ Dai Heifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑Non -La ers❑ Pullets
Gilts
POBoars
❑ Turkeys
Other ❑ TurkeyPoults
❑ Other ❑ Other
❑ Layer
❑Dai Cow
❑ Non -Layer
❑Dai Calf
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
❑ o
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

y
Facility Number:( 9') — SZ Date of Inspection g
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 Ievel into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&,Yo Nl
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E� o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑/No ❑ NA Cl 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes 7No
[:1 NA El NE
8: Do any of the stuctures lack adequate markers as required by the permit? El 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 LJ No (__1 NA El NE
maintenance or improvement? El
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
j(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9"/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
[:1 NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
WNo
❑ NA
❑ NE
Comments (refer.to. question #) Explain any YES. answers and/or any, recommendations orany other comments �,
Use.drawings of facility to better ezpIain sitaatio s. (use addttronal pages as necessary) -:_
Reviewer/Ins ector Name
P
U`
N � ��V(c l�\...
Phone t} 3g
� .:r°
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 12128104 Continued

y
Facility Number: Date of Inspection (o q
Required
Records & Documents
/�;
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
El NA
ElNE
20.
Does the facility fait to have all components of the CAWMP readily available? If yes, check
ElYes
No
❑ NA
❑ NE
the appropriate box. ❑ W­UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
/No
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ 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
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�/�
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
�FNo
❑ 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
[3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
dNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UK
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

go
Division of Water Quality
Facility Number � -7 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit ercompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I �1 i G Arrival Time: Departure Time: County: eNSL d Ld _ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rr;Gx 5ENI,NS
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g [= " Longitude: = o = i
Design Current
urrent
DesMcnalyfloci
Design Current
Swine Capacity Population
..
Wet Poultry Cappulation
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I I
❑ Dairy Calf
® Feeder to Finish ti Sa
❑ Dairy Heifer
❑ Farrow to Wean
MET)R BItry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number, of Structures: F
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Wlso
❑ NA
[I NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

r�
4 Facility Number: (p — Date of Inspection 9
Waste Collection & Treatment
WNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: 1..i4C -00
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): a1
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 E�`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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U 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 [2rNo ❑ 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. ❑ 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E!I'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2"NNo/o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LTNo
❑ NA
❑ NE
Comments (refer ta`question'#} 'Explatn any YES1.answers and/or any recommendafions or any othei comments k ,
Use drawmgs of facility to better explainsituations (use,additional pages assnecessary)µ --� ,
�) UPOPrV Sroa.c Av&.A&�6
Reviewer/Inspector Name I (SoH} r-j E I Phone; ` 10 -774 —73 f
ReviewerlInspector Signature: Date: J2190
Page 2 of 3 12128104 Continued

r�
Facility Number: (01 --$ Date of Inspection 1
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes [ /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applic tion El Weekly Freeboard El Waste Analysis El Soil Analysis El 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?
Cl Yes
�o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
20
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesL/I
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El 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
L2 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
YNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[`No
❑ NA
❑ NE
Additional Cotnmenits and/orIlrawings
Page 3 of 3 12128104

Type of Visit o6 rRoutine
pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Complaint O Follow up Q Referral o Emergency 0 Other ❑ Denied Access
Date of Visit: �J Arrival Time: vCl Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: ✓.1. K. C, S ME A J N��l.F Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ l ❑ Longitude: ❑ ° ❑ 1 ❑
Design
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Dai Calf
❑ Wean to Feeder
❑ Non -La er
® Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry ❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Ca
❑ Boars
❑ Turkeys
Other
❑ Turkev Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
""o
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 6 Date of Inspection
Raasst-e- Collection & Treatment ,_ ,�
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? [--]Yes
2 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
dNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
�thrreat,
E2 o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ONo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
/
l l . 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 > l0% or l0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[!(No
[3NA
ElNE
17. Does the facility lack adequate acreage for land application?
El Yes
—
[3/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
ME
Reviewer/Inspector Name E U 'I Phone( 70/7K-
Reviewer/Inspector Signature: Date: G
Pnoo 2 of 3 12128104 nnlinued

Facility Number: 67 — 2, Date of Inspection /7
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C 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 appropirate box. ❑ wup ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekiy Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[a No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U]"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
dNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U1<0
❑ 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
l"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
MNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'io
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
YNo
❑ NA
❑ NE
Additional:Commentsarid%or DrOvki S `" }� R � tea r � x"� '' : " `
ad g ...: .,.t -T.�-r"_.aK d�"-i.�.T"�'m �a^,a��-_...rw.t °p.7aSt4
Page 3 of 3 12128104

(Division of Water Quality
Facility Number �} s?i O Division of Soil and Water Conservation /
- — 0 Other Agency
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
isitReason for V0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'l 0 Arrival Timer Departure Time: County: rWSl A, J _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��'Title:
t�
Onsite Representative: Vs� �.r&k)&,r-K) c
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = « Longitude: = ° = d =
Is
Design Current Design Current Desi Current
Swine Capacity Po Wet Poultry' p ty Population p Capacity Population Cattle Capacity Population,'
j; ❑ Wean to Finish JE1 Layer
ElWean to Feeder �- ❑Non -Layer
® Feeder to Finish 1 1196
❑ Farrow to Wean i Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars - - - - -
Other
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
L1 Dairy Calf
❑ Dairy HeN
Dry Cow
Non -Dairy
Beef Stocker
❑ Beef Brood Co
Number.of Structures 1 If
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El yes
LAN
El NA
❑NE
❑ Yes
to
❑ NA
❑ NE
12128104 Continued

Facility Number: — t' I Date of Inspection
Waste Collection & Treatment
4!/Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ��• S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El NA ❑ NE
dNVNo
(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
t, notify DWQ
environmentaTNc
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
YJ 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
1io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑�o El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 Ll / o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes b No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ��oElYes No
❑NA ❑NE
El NA El 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):.,, . .
u) oBTA-uJ A4VAL, Poe"6E,AL
Reviewer/inspector Name T O - Phone: 3
Reviewer/inspector Signature: Date: 7 6
Page 2 of 3 r12128104 Continued

Facility Number: Ile'] — Date of Inspection Z r a
`Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LI N ElNA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If es check the appropriate box below.
P l P Y�
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I" N'o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
CINo
-��No
[I NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
d o
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
43No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[--]Yes
ko
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
['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
El Yes
,��
!� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128.104

Division of Water• Quality
Facility Number 0 Division of Sol]. and'Water,Conservatiou
Q Other Agency," .. .
Type of Visit (7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit o Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 6 d Arrival Time: ® Departure Time: County: du.C[,a+.+J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: j6;&r_ W_'Q 'j;wg2 S
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
�o
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: = o = ' 0
Design Current. Design� Current'..Design Current
Swine Capacity Population Wet Poultry Capacity �Pophlation Cattle " ^...Capacity Populatton'�`
❑ Wean to Finish
09 Wean to Feeder
Feeder to Finish
G
1 /
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
U[Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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 I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
El No
❑ Yes
o
❑ NA
❑ NE
El Yes
WNo
❑ NA
❑ NE
12128104 Continued

,; Facility Number: Date of Inspection G
r�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (14 6cad
Spillway?:
Designed Freeboard (in): / y • S—
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes hTo ❑ 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 LAN El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I_/J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
El NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or io lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) /3 lib ) 560
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[;/ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question ff): 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):
V & r r,ra o CZ6-c'o V's �' t4. Go o
Reviewer/Inspector Name �o F] r1 j2J3Nj Phone: !. r I'D - 7
Reviewer/lnspector Signature: Date: 5 noLor6
I TIP

F} Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �N El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ Nl:
❑ 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?
ElYes
CJ
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
V Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
EaSNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[I No
ErNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B No
NA
❑lWNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
❑ 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
[f] 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
2o
❑ 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 El ii o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ;& ❑ NA ❑ NE
Additional Comments and/or Drawings:
1z
Page 3 of 3 12128104

Type of Visit 0 C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason #or Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S ii os- Arrival Time: Departure Time: County: �l"� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: !�T�-�- DJT_A ' CJ X-ZN-S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = Q =' = Longitude: 0 0 = ' ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
�T
bib
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ T urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure . ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 LZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
El NE
❑ Yes
El Yes
❑ NA
El NE
El Yes
VN❑ NA
❑ NE
12128104 Continued

Waeility Number: 61 — SL
Date of Inspection EEStPA
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (AGe-0-0 I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Ld No
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes dNo
No ElNA ❑ NE
ElYes ❑ 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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement? /
11.
Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) eca'MUDA
13.
Soil type(s) tl 43
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
(_[/ No ElNA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
B No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
ONo ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�To ❑ NA ❑ NE
vAp rv� A N ip RU "a.®s L00 k­ 0vao-p,
Reviewer/inspector Name A2hIGf - ' `z. Phone: NO 7U. - 7 a6 �
Reviewer/Inspector Signature: 3RAMkIlU Date: S 3 f al
, j
12128104 Continued

)Facility Number: Date of Inspection
Required Records & Documents _
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes N El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ;No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [n 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 Inspectionss Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ No 0 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No Z NNA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VNo
o 2 NA El NE
26. Did.the facility fail to have an actively certified operator in charge? El Yes 7NA
' ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZfNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes U<O ❑ 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 [�Nc ❑ 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 C1 No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes �No ❑ NA ❑ NE
Additional .Comments and/or Drawings:
12128104

Time:
Permitted J(C '' ed [3 Conditionally Ce ed Q Registered Date Last Operated/ r Above Threshold.
Farm Name: ....'' .KG. lr!!' e NS!.! ��il i.._.7.............. .......... County: ....... ,/��LOdl1.................. .....................
OwnerName: K.l...tYG�:!'' ��.. 112 .................................... Phone No: ... ............. -...... ---.....__.................... _............ _.
Mailing Address:
Facility Contact: .............. _ ....— ... _ Title:....... _......_... _...._ Phone No:
Ottsite Representative: Integrator:..L[lu!�fi„� ' SiO uJ�J
Certified Operator:
Location of Farm:
Operator Certification Number:
F�5wine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' & " Longitude • 4 66
I1es,gau� Current De�rgn Cnrreaf ` DestgaCurrernitt
Y t n
5w a Ca a �- , Ca' act Po nlabon
_Po uiation� ''ouItr3' ei P6 ulah7,
ba
,
Wean to Feeder
x .Cattle
e
❑Layer „ ❑Dairy
-El Feeder to Finish
_c
❑ Non -Layer I❑Non-Dairy
Ej Farrow to Wean
_
Farrow to Feeder
;,
g10 OtherSi­
Farrow to FinishDesign
Capac>tty
❑ Gilts
Boars
s Tot81 SSLW n
D%scharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
KNo
❑ Yes
JVNo
❑ Yes RTo
Structure 6
Identifier: ........................... - ....... w_ .._� ............. _....... .. �- ... - _._
Freeboard (inches):
12112103
Continued

Facili.. Number: — Z Date of Inspection I j
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes P No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes QNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ONO
11. Is there evidence of over application? If yes, check the appropriate box below_
,�[ Yes ❑ No
❑ Excessive Ponding ZPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper an or Zinc
12. Crop type !I7l.,(D Z� �,� ri25EE.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 ONO
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes 9No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes A,No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
[]Yes )YNo
Air Quality representative immediately.
_Use drawings of faa,ty tv better exptam Situations. (use additional pages as necessary) � Field COPY ❑Final Notes �
x _ m {
,t .. �.. ". _w�. � v,.. _..., _ _ d_ �� W ,<:"T � -s" -:�` s * _� •• A _1 _� �� ;- -� r � �;��e-'-.`r. ��.--v..;.�.-.•s�-"_'_"-V-""_ _
53 A mac, 1949 &yJ 41mBe�0 41V //F_ /r (5V�C 42, eo
�v�'R5 E � �) -L n! �,E��►/ �4R� Z DD� �i� ��co.5 �%/ � �/ 8
/d!!! 02
(�/� /IioQ� /tea,✓ ,�o aa
54- em /l/ems a 8�
Reviewer/Inspector Name 1
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes jo No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes &No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes O No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J] No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Qj No
28. Does facility require a follow-up visit by same agency? ❑ Yes [2rNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo
31. If 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 farms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
12112103

41
(Type of Visit OComplianoe Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 6Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Bate of Visit:
0 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: w, 0y iRrid—i-eh s F,, ✓►"1
Owner Name: Du I A-& Te't k'-f
Mailing Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Location of Farm:
`Z 2 b D3 Time:
10 Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: 01?51Py
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° u Longitude 0' ° 0 Lf
Design
Swine Ca aci
to Feeder
Cnrrent Design
P,o ulat'on Poultry Ca aci
❑ Layer
Current Design Current
P,o ulation Cattle Ga achy P,o ulation
❑ Dairy
roWean
Feeder to Finish
❑ Non -Layer
❑ Other
❑ Non -Dairy
C7-]Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total Design -apaclty
Total SSLW
Number of Lagoons
Holding Ponds /Solid Traps
� ❑Subsurface Drains Presentj ❑ Lagoon Area ❑ Spray Field Area
.. - - --- --
❑ No Li uid Waste Mana ement 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 observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Freeboard (inches): .7 j
❑ Ye% ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ONo
❑ Yes ONo
Structure 6
05103101
Continued

-)I Facility Number: Z'f —5 Date of Inspection ZD ?
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 XNo
❑ Yes ' No
❑ Yes ENo
❑ Yes ZNo
❑ Yes ?fNo
Waste Avylication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop hype B C '- m 2e .rv--t.at i free ► �-.
/0
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
)21 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records Sc Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
YNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
JZNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
/0
/No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
3NNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:s.� - ttr�' %� >:
�Camments;(refer to question . Eiiplam any YES°:answers and/or-anyWcommendahons orany rather comments: f -
Use drawings af'facihty to tietter eiplalis situations: (use ditional, pag sas necessary) ❑ Field Copv ❑Final Notes
"{
•.s well m � �, a� "kaof Ti, l; �u�, ��. qnd
� �► pp ,�'•�Id
C ra S Are i 5,,°G Ska 1 h B i'qgoGj, qr,/t sLi in P Ll
-f'or L} o � ✓ ��-�dr�.s.
r
ReviewertInspector Name
Reviewer/Inspector Signature: Date: Z 2 D 4 7
O5103101 Continued

• Facility Number: iC % —SZ Date of Inspection 2 z 4
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ONo
❑ Yes ONo
❑ Yes XNo
❑ Yes AM
❑ Yes , No
❑ Yes ❑ No
05103101

Type of Visit O Compliance Inspection .O Operation Review O Lagoon Evaluation
Reason for Visit 0• Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 67 52 Date of Visit: 3/26l2002 Time: 14:OS
Q Not O erational O Below Threshold
® Permitted ® Certified C] Conditionally Certified [3 Registered Date Last Operated or Above Threshold: _ __ __ -- __ _.
Farm Name: Rule Vie kinkinx farm.01....................................................... County: QxshQx¢.................. .---------------- WIRO......
Owner Name: Djilaus-_Je7ukius----------------------.-.__ Phone No: QQ-29=4�23. ----------------------------
Mailing Address: 143. ail.RimckAQ1 d......................................................................... DCulayiAllt..Nc....................................................... 7-8-513 ..............
Facility Contact: ...........................................................Title: .................. Phone No:
...................................................................
Onsite Represcntative: yjrginia.jeukin&._.____-___________________________ Integrator:llluKplLY�;}mi
Certified Operator: X?uAnd..1..............................jCIXkjM ............................................. Operator Certification Number: 1625.1 .............................
Location of Farm:
West of Albert Ellis Airport near Duplin Co. line. On East side of SR 1220 approx. 1.0 mile North of SR 1218. Owner lives in
house at entrance.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 52 ' 25 u Longitude 77 •F 3$ 43 µ
= Design-- Current _. — Design _ Current -= Design Current_
Swine - -
- Ca aci Po iilation: Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
® Feeder to Finish
1196
❑ Furrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
1`161ding Ponds / Solid Traps ` ; ❑ No Liquid Waste Management System
D_ischarses & 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) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1............. ........................... ----------------------------------------------------•---•-----•--------------•--...........................
Freeboard (inches): 35
Af/n7 in if

UNU31vl
Iacility Number: 67-52
Date of Inspection 3/26/2002
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 Iiquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Rye
9.ununuea
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes ❑ No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to question # Explain a`ny YES answers and/or any recommendations or any other comments
(_
_
Use drawtn s.af fae�l�t to bet#er ex lam situations use:addEt�onal a es as necessa " � 'T _
y =P , _ ( k P 1;. Y)❑ Field Copy ❑Final Notes r
1� _ .
11. Not yet able to determine whether overapplication occurred on the 2001 - 2002 small grain cover crop. Need to update small grain
ecords immediately upon having new waste analysis which is currently awaiting return says Ms. Jenkins. Need to send me copies of all
_+
aste analyses and irrigation records for the small grain overseed by April 20, 2002.
15. Need to apply lime according to October 2001 soil test results. Also, rye cover crop needs to be cut and baled.
18. The waste plan needs to be written based on the irrigation design and maintain a deficit for the facility. Be sure that plan is written
based on 2.3 lbs PAN/animal/yr rather than 2.4 as is in the plan I viewed on site. After the inspection, I spoke with the technical
specialist; it seems that there may be a more recent plan than the one I viewed on site; need to be sure to have a copy of the most recent
Ian available for inspection; plan should meet the comments noted above.
Reviewer/Inspector Name .Stonewall Mathis
Reviewer/Inspector Signature: Date: D 2-

05103101 Continued
Facility Number: 67-52 Date of Inspection 3/2612UO2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 hour$? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
t1 ditionai omments an or rawm s
_ g
19. Need to be sure to use a waste analysis dated within 60 days of application events to calculate the nitrogen applied on the
IRR-2's. Need to be sure to use the correct beginning PAN allowance from the waste plan on the IRR-2's.
s

o Division f Water Qualiity mm .
_ Q Division of Soil and Water. Conservation
-. Q,.Pther Agency
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit A.
Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: t l.� Printed on: 7/21/2000
ro_Not Operational 0 Below Threshold
IN(Permitted 0 Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold.
.........................
Farm Name: L��+--�� �'i^5 �.. County: . -
A°U .......I...............
...............................................\...................................................................................................................................
OwnerName: ................................................... ........................................................................ Phone No:........................................................
Facility Contact: ................................... .. Title. Phone No
MailingAddress:................ti....................................................................... ..........................
.................................................................................................................
OnsiteRepresentative: t� �� .. ' t�-3:..................... integrator......1i\�y�+�
... .................."'.'.'.U.......}..........................................
Certified Operator:... .... Operator Certification Number:
...................................................................................................................................................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude
Design Current Design Current DesigA Csorrent'_ .:
5vvine Capacity Po elatioPoultry CRDacitv Population
Cattle C - Pelation
Wean to Feeder ❑ Layer ❑ Dairy
' Feeder to Finish [] Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other -
Farrow to Finish Total Design01 aei , ,
Gilts `_
Boars Total..SSLW­
._ Number of Lag'oonsJ`. ❑Subsurface Drains Present ❑ Lag �n Area ❑ Spray Field Area
H Ponds- . ry
oldeng ! 5olld.Traps ❑ No Liquid Waste Management System
Diseliarees & 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 galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes b'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................................... .......................... -........ .................... ... ............. .................................... ...................................
.
Freeboard (inches):
5100
Continued on back

Facility Number: — a Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes k�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes JRJ'No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �[ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 'X No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop typevy`L��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0:1No -yiolaiigris:oir defieiendje$ -were hbtea- during thi "visit' - Yoe will receive Rio titer :
. • correspondence: abouk this visit
ter to question #):
of facifity.to_bettej
❑ Yes )gNo
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes )4' No
❑ Yes ZNo
❑ Yes XNo
XYes ❑ No
❑ Yes 9No
❑ Yes XNo
❑ Yes X No
any. YES answers and/or any recommendations :or any other comments:
situations: (use additianal:pagesTasnecessary). x
es�— . verse e O s No �e
We
❑ Yes V No
❑ Yes 9No
❑ Yes RNo
❑ Yes XNo
Reviewer/Inspector Name —
Reviewer/Inspector Signature:
Date:
5—
VIX16

w Facitity Number: Date of Inspection 3 rj 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 9Yes ❑ 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
N'N0
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
R-No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�'No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
)S�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�`No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ONo
Additional ommenWaa or rawtn - _
L
J%Z
AJ
(5ve�� -I,- \",e "-�' ,�IL— 5 "'� "t"r"
M1
5/00

Division of Water Quality
Division of Soil and Water Conservation
0 Other Agency
Type of Visit %Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:® Time: 5rG0 Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
*Permitted [3 Certified [0 Conditionally Certified D Registered Date Last Operated or A bone Threshold
Farm Name: ..... 1�"' 3....... C_t'1 `�'`�... 4.1......... County: .,--�ci1..,..................................................
OwnerName:.... ...............................................
Facility Contact: .............................................................................. Title:
MailingAddress: ............................ ..._.......................................
Onsite Representative: „V,�2
Certified Operator: ......................................
Location of Farm:
......... Phone No:
Phone No-
........ .............................. ...................................... I......
Integrator:..... `�,`*^........
........ Operator Certification Number:...
is
t
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I ❑ Dairy
Feeder to Finish ❑ Non -Layer I I JE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I I I ❑ Subsurface Drains Present I ❑ Lagnnn Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [:]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min''
d. Does discharge bypass a lagoon system'! (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier: .....................................................................................
Frechoard (inches): `"i a,
5100
❑ Yes NrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ONo
❑ Yes fvrNo
Vx
Structure 6
Continued on back

`i Baeidity Number: 6,— Date of Inspection Printed on: 7/21/2000
5- Are there any immediate threats to the integrity of any of the structures observed'? (iel trees, severe erosion, ❑ Yes AIo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes &No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
,N�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
RNo
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
XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ZNo
12. Crop type �O 1 Sq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
C'No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
El Yes
0No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc-)
❑ Yes
WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
MNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fgNo
21.
Did the facility fail to have a actively certified operator in charge`?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
XNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
[C'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;9 No
0: Nd •violations oir def deucies -were noted• during �his:visit' • Yoi.� :will - , eceive ti6 ]Further • : •
coriesoorideRce- about: this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
k^.� -5 t \VJQc
e�)3DQO J�J, \ ,�QS 1�✓(((Q� 'i \�' � ��(��,� ^�, Q�~S^ Y � CJ ��ZC�+{.� • ��CY,`+C
VCAA
Reviewer/Inspector Name 11�� �AWQ 3 S [ 60
Reviewer/Inspector Signature: Date: �^'p1-�^-0 0 5100

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

WE U
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number Operation is flagged for a wettable
Farm Name:�acre determination due to failure of
On -Site Representative: Part 11 eligibility items) F1 F2 F3 F4
lnspectorlReviewer's Name: t1��
Date of site visit:
Date of most recent WUP: r)I
Annual farm PAN deficit: 3 pounds
Operation not required to secure WA
determination at this time based on
exemption E1 (J E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler; ..2..center.pivot system; 3. linear=move system;
stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
'`e 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 I 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 Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part H. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational .table in Part 111).
PART H. 75% Rule. Eligibility Checklist and.. Documentation of WA Determination
Requirements. .WA Determination.required.beca use_ operation.fails.one of.the.eligibility
requirements listed --below:
_ F1 Lack :of.acreage=whichTesultedin_over:application-Dfwastewater_(PAN)-on _spray__
field (s):accordingfofarm'sdast-two yearsmf Irrigation-xecorads.
F2 Uncleari.illegible,-:or lack of information/map.-
F3 Obvious -field -limitations InumerousAitches;failure:to:leductTequired_�_:
bufferlsetbackmcreage;=or.25%.of fotal:acreageadentiftediri LCAWMP-=Iricludes _-
small '-irregularly:shaped.fields=.fields less#han75acresfortravelers-ornless-than: :
2 acres-forstationarysprinklers).-
F4 WA determination required because CAWMP=credits field(s)'s acreage -in excess --
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'S
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
4
I
1
f
I
I
FIELD NUMBER' - hydrant, pull, zone, or point numbers -may be used in place of field numbers depending on CAWMP
and type of in igation -system. - If pulls, etc. cross -more -than one field, inspector/reviewer 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.
COMMENTS3 --back-up fields with CAWMP acreage-exceeding15% of its total -acres -and having -received less than 50%
of its annual PAN as -documented in the farm's.previous-two years' (1997 & 1998) of. irrigation -records, cannot'serve-as-the
sole basisforrequiring a WA Determination. ---Back-up fields -must -benoted in.the-commentzection-and must,be accessible
by irrigation system.
Part IV. Pending WA -Determinations _.
P1 Plan -lacks -following-information:
P2 Plan -revision-may_satisfy75% rule based on adequate overall PAN deficit -and by
adjusting -all field -acreage�o-below 75% use rate
P3 Other (ie/in process of installing new irrigation system):

Revised Apri120, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - ��-
Farm Name. 4 e �s
On -Site Representative: 1%Y�„►`��- �e��a-s
Inspector/Reviewer's Name:���
Date of site visit:
Date of most recent WUP: `f is
Annual farm PAN deficit: r o pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) Fl 2f F3 F4
Operation not required to secure WA
determination at this time based on
exemption El E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center:pivot system; 3. linear -.move system;
0tationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system .wlportabie pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part l[, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I 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 Ili. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule -Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required. because. operation fails one of the. eligibility
requirements listed below:
_ F1 Lack of acreagewhichTesultedimoverapplicationmfivastewater__(PAN) on:spray.
fields) accordingtofarm'sdast#woyearsmf:rmga ion-Tecords.-
,/ F2 Unclear, -illegible, -or lack of information/map.
F3 Obvious -field limitations -(numerous Aitches,,7:failLrre-io:deduct.Tequired..
buffer/setbackacreage;-or25% of#otalacreageadentified_in�CAWMP::includes _
small; irregulady-shaped.felds-fiields:lessthan -5acres-for.travelers-or less -than
2 acres -for.-stationary-sprinklers).
F4 WA determination required because CAWMP credits f eld(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'
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
ea
I
FIELD NUMBER' - hydrant, pull, zone, or -point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system.- If pulls, etc. crossmorethan one field, inspectorfreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination"
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage-exceeding`75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's.previoustwo years' (1a97 & 1998) of irrigation Tecords,-cannot serve as -the
sole basis for requiring a WA Determination.-:.Back-upfields-must -be noted inthe,comment-section -and must be accessible
by irrigation system_
Part IV. Pending WA Determinations -
__/_ P1 Plan -.lacks -following
P2 Plan -revision may_satisfy75% rule based on adequate overall PAN deficit -and by
adjusting all feld.acreage_to below 75% use rate
'J +i
P3 O#her ,(ielin process of inqtallinq new irrigation system): C-l"

i
[�-Division, of.Sotl and Water Conscrvation - OperationReview
El Division of Soil and Water Conservation - Como
lhince Inspection
13'Divisi6n.of Water Quality- Compliance'Inspection
El
:Other. Agency'- Operation.Review _ r
1 Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
11ine of Inspection 1330 124 hr. (hh:mm)
Permitted Certified [3 Conditionally Certified © Registered JE3 Not OperationalOperationaij Date Last Operated:
11 Farm Name: \ ...............1 �.....43 ....................................................
Cotmty:......G�•!..........................
Owner Name:... - .......... Phone No:
Facility Contact: .................. Title:............---. Phone No:
...............
MailinnAddress:....................................................................................................................................................................................................
Onsite Representative:.�!..t ✓mil- I ......... J 5 ....................... I .. Integrator:.......�.....I.. ....... `
Certified Operator: _..•...•......•. • ..._ Operator Certification Number:
...........................................................................................
L.......... lti J..'+l.......`Q- ...... IVSk R ....0 ... 4 , . ......5..L.. 1
.... .......
4........t�
1.......................�!. ' ... �. �........
Q....l�i�t.......:....................................................-...
�...� ....�..:..
...........................
Latitude
Longitude
Swine Capacity Population
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 1E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ILI Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estlmmed flow in gal/tnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ...................d�....................................... ............. ................................... ......... ........................... ......... ................
...............
❑ Yes OrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes I'No
❑ Yes kNo
❑ Yes WNo
Structure 6
1/5/99 Continued on back

r
Facility Number: (o — Date of Inspection 0
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 18�No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? 4 ❑ Yes �(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes I�No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes IVfNo
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes I" No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen El Yes XNo
12. Crop type ... .. ............................................................ ............. .................... ......................................................................................................................
13. Do the receiving crops, differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes IXNo
14. Does the facility lack wettable acreage for land application? (footprint) El Yes jNo
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [�5No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes �fNo
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)
El Yes
IV No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CWNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
jrNo
0. No.violations or. deficiencies .were ntit�ed during tfiis:visit:. Ynu �vilfrekeive nar furiiiei- .:.
eorresbiHidenee' about: this visit._ : : :...:. . .:.:.:.:.:.:.:.:.: : : :.:.:.:.:.:.:.:.: .
..... ...... ........... ......... ... ...-....... ...... .... .
Comments (refee to question #): Explain any YES answers arid/or"any:recommendations or anv other. comments
7
Use drawings,of facility to -better explairi situations. (use additional pages as necessary):
__-.._.
{
5 P i t.� �at ►,� ��S q8
A f f I y
II
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
1 /6/99

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Routine 0 Cotn laint 0 Follow-up of DW2 inspection 0 Foil ow -up of DSWC review 0 Other
Date of Inspection/07/7*7
Facility Number
Time of Inspection .30 ' 24 hr. (hh:mm)
© Registered Certified © Applied for Permit [3 Permitted 1E3 Not Operational I Date Last Operated:
Farm Name:....1.1L. �?!'!..!!v'+�?',�.... �.. County:................................................................
-i------ --.. r S ...------
Owner Name:. ]P J..flp.Y�.............. �..Pt..�rr (?. ............................. Phone No:...................................................................... .......
Facility Contact: Mailing L.G.^!..:t�...,G,a.` �1..1s ter `�`r. Title----------------- . Phone No:
Ja� / .......
Mang Address: . ............. €. ....... ll 'k�.�.......... ..tew. . ..........! .4.�I .r.�.� .i.......... I.............................
Onsite Representative:.....;�L �......(�?.Y.. (.7..t�?........ n ws Integrator: ...... 4'... ...................... ..........................
Certified Operator,..----v-- `- `� _? 1.!. ......... .�..t G1 j� ,5...................... Operator Certification Number;... t �.Z$�
Location of Farm:
C
C
Latitude • 4 "
❑ Wean to Feeder
UFeeder to Finish
(�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude
Design Current Design
Poultrys Capacity.. Population' Cattle " 'Capacity
z,❑ Layer ❑ Dairy
a
,: ❑ Non -Layer ;, [] Non -Dairy
❑ Other
r � Total Design Capacity � C
Total SSLW
t
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[WNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
§`No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
0 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
P No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
W No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
,® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
21No
7/25/97

r
t
fiFacility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures La oons oldie Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
❑ Yes P No
❑ Yes jB No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
Freeboard(ft):..........7.]n#...........................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes No
1 I . Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
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 ................ O-A ......................................... . .. . ......................... .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[]: No.viailitions:or deficiencies:we're-noted-during this:visiL- You:twill receive.no-fiirdier ::
correspQndebce iihout this:visit.: :. :: . .:: : . .
❑ Yes ® No
❑ Yes ® No
❑ Yes A No
❑ Yes A No
❑ Yes ® No
❑ Yes No
❑ Yes (AVo
❑ Yes J No
Cl Yes IN No
9 Yes 42 No
❑ Yes ff] No
❑ Yes JANo
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: I Date:

Site Requires Immediate Attention: NQ
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIOIJS SITE VISITATION RECORD
DATE: �' , 1995
Farm Name/Owner: �7Y1 !►( # /
Mailing Address: &-tL' 12LNCK
County: --
Integrator: Phone:
On Site Representative: 6f7vc- Phone: - /
Physical Address/Location: l 2-19 dN �VC 5f
2-W
Type of Operation- Swine V Poultry Cattle
Design Capacity: //q_&_ Number of Animals on Site: I M �INr�i,ll11/�j
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _" !�'?, - ZS " Longitude: -7 q ' ' �" Elevation: Feet
Circle Yes or No
Does the.Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: -1_Ft. Inches
Was any seepage observed from the lagoon s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for s ray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:�L—
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling . Yes No
100 Feet from Wells? es No
Is the animal waste stockpiled within 100 Feet of USGS B1ue.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? Yest&No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: �?L IV/ ! y✓ ��l e_� j � rL7� �
Alt' Zl�e
• M1 U_
Inspector Name
S i mature
cc: Facility Assessment Unit Use Attachments if Needed.