670055_INSPECTIONS_20171231

NORTH CAROLINA
J
Department of Environmental Qua

Type of Visit: QJ Co piianee Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
YIIY 11
Date of Visit: t Arrival Time: Departure Time: County: &110 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: j�Jl�� �14l�YJEd�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator: r 2
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
La er
Wean to Feeder
Nan -La er
Feeder to Finish
Farrow to Wean
Design C►urrent
Drr P.oultr, Ca acit P,o
Layers
Non -Layers
fer
Farrow to Feeder
Farrow to Finish
Non -Dairy
ker
FBcef
er
Gilts
Boars
Pullets
d Cow
©they
Other
Turke s
Turkey Poults
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes WN,
o ❑ NA ❑ NE
❑Yes
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - 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?
Structure 1Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 IZNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7)No
a] 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 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jNo ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[/7 0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ 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
[�Iio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
[] NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Oth
21. Does record keeping need improvement'? If yes, check the appropriate box below.
7es
❑ 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
0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: r171 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6o ❑ NA ❑ NE
Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes XNco ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes u No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2�/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
ZNo
❑ 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
L+lJ 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
[4
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesVNo
❑ NA
D NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question,,#.) Explain any YES'answers,and/.or;any,additional,recommendations or.'any other corhdIents
Use 'drarvinRs`offaality to betterrexplAn.situations'(use�addltional=:pages as necessarY).
11) rz-finq RA-Cla If&/ SUS61�__ �V&A_V'
S&6 wg5 'w & � A�AP�'
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone( 9 10 I J (1
Date: ill
214,12015

a,
Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15 Arrival Time: Departure Time: G $' County: 6.,V5 La;J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: u�—, 1.1wt ,fri 1j azS
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Curreat Design Current
Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pvp.
DairyCow
Wean to Feeder
I lNon-Layer
1
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dairy -Farrow to Finish
,
D.. $oultr. Ca acit P,o
Layers
Non -
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes VjNo
o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Insection: S`
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structur(:e I Structure 2 Structure 3 Structure 4 Structure 5
' 0
LA
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
[3 No ❑NA ❑NE
Structure 6
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes EZ/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F2/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7 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 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 ffXo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E] o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes �o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 6/No ❑ NA ❑ NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Noo ❑ 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 6 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 WNNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA [] NE
Page 2 of 3 21412014 Continued

r..
Facili Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N , ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes I �J No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT') certification? ❑ Yes VNo ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [ vo ❑ NA ❑ NE
❑ Yes P A140 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
21C
❑ NA
❑ NE
ZN3❑NA
❑NE
l_l l"
❑ NA
❑ NE
&N`10"
❑ NA
❑ NE
Comments (refer to question #): Explain any YES'answers end/or any additional recommehdations.or any:other coinments
Use drawings of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
N64/y 1�f�C - L, PhoneenfV
Date: f
2 /2014

(Type of Visit: UYCor�ipliance Inspection U Operation Review O Structure Evaluation U Technical Assistance V
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: Departure Time:® County: 4h)SGV1- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
(4NNY DRVMI
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1619 3 1
Certification Number:
Longitude:
Design Current
Design Current
Design
nt
CuRol,
Swine Capacity Pop.
Wet Poultry C«apacity Pop.
Cattle
Capacity
.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
U p
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder 1000
) 6 o a
Dr, P,oultr, Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
ll Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - — Date of Ins ection:
Waste Collection & Treatment
4. Is stbrage 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
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
�-►ia�
Observed Freeboard (in): 0�-
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 ZNo ❑ 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? ❑yesyo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yeso ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [,] Yes No ❑ NA
❑ NE
maintenance or improvement?
YNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes , ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes YNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 10. ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ZNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ _ _
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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: IDate of Inspection: q"7
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
. ' the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
No❑ NA ❑ NE
No ❑ NA [] NE
❑ Yes i5ZO
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
❑ Yes E2<o ❑ NA ❑ NE
[:]Yes ❑ N
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑NA ❑NE
No ❑ NA ❑ NE
'o ❑ NA ❑ NE
TT 1V0 ❑ NA ❑ NE
Comments (refer to.question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use°drawines of facility to better explain situations (use additional pap -es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ql0 3
Date:
2/ /2011

Type of Visit: (jC liance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z Arrival Time: ® Departure Time: _ a 3s _,_ County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: L�MkJW �&)o Q.s Integrator:
Certified Operator: Certification Number: /ZX.3/
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urgent
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry P,ault ,
Ca aci ry,
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure . ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes 5�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes d ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: Date of inspection:
Waste tollection & Treatment
4. IS storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�`No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1\ Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
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 �NoEj ❑ NE
0 Yes pr<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �] N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1240,
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �10 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D440 ❑ 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
E3/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[51&o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
i No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�-_,,{
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

[Facility Number: -7 7 jDateof Inspection:
24. Did'the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes 2 No ❑ NA ❑ NE
25. '1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F2�/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 21�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6140 ❑ 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 []No ❑ NA ❑ NE
❑ Yes [21/No ❑ NA ❑ NE
[:]Yes O/o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
VN9❑NA ❑NE
No❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pnizes as necessary).- _.
Reviewerhnspector Name:
Reviewerhnspector Signature:
Page 3 of 3
Phone( )a 7w
Date: L/ a 3
2 4/2 b 11

s
(Type of Visit: W pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Co(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencyr0 Other 0 Denied Access
Date of Visit: i ► Arrival Time: ld $' Departure Time: ® County: 00 ✓S j fl)� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: l.j ��� J ���E Integrator:
Phone:
Certified Operator: Certification Number: !D F3 f
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
IIIiIIIIIIIlIlimiMllililimLDesign
Swine
Wean to Finish
Current
Capacity Pop.
Wet Poultry
Layer
Design C►urrent Design Current
Capacity Pop. Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
III
INon-Layer
I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
a0
Drr P.oultr,
Dairy Heifer
Design Current Dry Cow
C•_a aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes Z1,o ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ❑ o ❑ NA ❑ NE
[:]Yes Zo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit Number: jDate of Inspection:
I, -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1_A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):()
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoD
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement? /
Waste Application J/
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 ZNo [D NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N o
❑ 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
EkRio
❑ 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 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail"to install and maintain a rain gauge? [:]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 7 21412011 Continued

Facility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes LA N [3NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes W No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?] Yes Cj No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, Freeboard problems, over -application)
3I . Do subsurface the 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 04o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No NA
No, ❑ NA
�o ❑ NA
No ❑ NA
[] NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.77, .,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 9rCAF
Date: / ✓
21412011

'•- i s'� s :. - ;1 ys ; .. , - s .� - '� �' -' t " ..,:9 I
4 Division of %itee Qiialaty
FaC�iltywNuril<ber Q,Drv�sion ofSmn`l andMatenCoMervatio
�� � •�' � 4 4 ..:`t -� - is-s -c � � s 4 'a '{ ti; '�, �
f�.Otherz-Agency'S,4,�� 4
�
Type of Visit 0 Corupiiance Inspection . Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I $ County: ��5�-� �`� Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: rr Title: Phone No:
OnsiteRepresentative: WN� 5�1.1Oa✓�—S. _ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0. =' = " Longitude: = ° = ` =
F Design
Swine; =Capacity
%' ❑ Wean to Finish
❑ Wean to Feeder
"A [3Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
:Q ❑ Farrow to Finish
❑ Gilts
Other' .
❑ Other
Current
Pnpulahori Wet Poultry tiN i
❑ La er
❑ Non -La er
4
;n� L Current ;y
Zara ��� � ; �� ; � '_ � � ®. •,�
Dry Poultry x;
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 1 of 3
k�
❑ Yes d No ❑ NA ❑ NE
[]Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ltf No • ElNA El NE
El Yes No ❑ NA ❑ NE
12128104 Continued

.t
Facility Number:(Q Date of Inspection
r 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
Identifier: LAG-06oJ_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ol5
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ElNA ElNE
ElYes r /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L?<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes(E(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E lvo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
7N9 ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L7 N ❑ NA
[:3 NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
igy�mi4, 4"..st�F%W B'i4k A:�%a.4="x��:..- �S�V i',Y3'���&: i, WL:., rru. ; 3fy gl �h`. � A ` 'a�. � i b-'f�YS��"�si�,l,.F.,�.#.#�v'• _$�,} Srawid s ofalasituations., essa answers and/orany recommendattons..or any.other LontinentsComments (refer,to,questiom#) Ezpl
� b
ilibai
Reviewer/Inspector Name t :; ,.� ° r'n1Phone:
�4
Reviewer/Inspector Signature: Date: 1
Page 2 of 3 1 12128104 Continuer)

Facility Number: (p' — Date of Inspection l4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
❑ Yes ZNo ❑ NA ElNE
❑ Yes LJ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
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
�No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?ElYes
�<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ILI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I;a/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DN/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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ENo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
0o
`3 / No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: O Arrival Time: A S Departure 'rime: County: QAMLO in) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: CWE OAUa Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ 4 ❑ 11 Longitude: = ° ❑ ' = 1
1
�N A �
Swine �i�,i
Design��'��C•urrent
CapscityF Population
Design Current
Wet Poultry C*ap/acity Population
Design Current
@attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
p
❑Non -La er
❑ Dairy Calf
Feeder to Finish
22 AM
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
❑ Non -Dal
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑
❑Turkey Poults
I ❑ Other
Number of Structures:
Other
Discharges & Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L✓J N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 6 — .�5 Date of Inspection
f'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EZ 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: (aLm ki
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo
❑ NA ❑ NE
through a waste management or closure plan?
cat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment7No
notify DWQ
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 WNo
❑ 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 [Vo
❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or to lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�`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 �r< ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ElYesL❑ NA ❑ NE
nentsa(refer to=quest�on#) �Expla�n any,Yl
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Y
Phone: R G�/3
Date: t d
12128104 Continued

t�
Facility Number: — Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ,'❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes EZ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes PNo ❑ 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 O/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJ o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Do ❑ NA ❑ NE
❑ Yes rN❑ NA ❑ NE
El Yes ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
C' No
❑ NA
❑ NE
❑ Yes
2�`No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
O N ,
❑ NA
❑ NE
❑ Yes
L'J No
❑ NA
❑ NE
12128104

Type of Visit lF C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j Arrival Time: Departure Time: County: oNJLQ1„/ Region:
Farm Name: I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: VAJAH S29N1746KS
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =O = I 0 Longitude: ❑ ° = g ❑
Design C►urrent
Design Current
Design Current
Swine
Capacity Population
Wet Poultry C►►opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I 1
❑ Dairy Calf
® Feeder to Finish
770
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
/ 66 4f
La ers
❑ Non -Dairy
Farrow to Finish
El❑
❑Non -La ers
El Beef Stocker
❑ Gilts
❑ Pullets
❑ Beef Feeder
ElBeef Brood Cow
❑ Boars
❑ Turkeys
Other
❑ Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
ElYes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
V
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
7No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

facility Number: — Date of Inspection a
i
*aste 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 I Structure 2 Structure 3 Structure 4
Identifier: A &�GL)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes MNc ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [N ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes fJ No El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ln No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2rNo ❑ NA
ElNE
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
[ N ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo ❑ NA
❑ NE
COH1It3a{refertoquest ri#" plan any YEn veers a d oryany recommen atioiany other comments. f
Usr, drawmgs oftfact_lity�to beftci�eacplain sltuationS. seaaddttional pages as -necessary):
-
-�&.<L rz' &.'?�%: _ -'v ..�,, i
7
Reviewer/Inspector Name Phone: _ 3
Reviewer/Inspector Signature: Date: 1 too -
Page 2 of 3 12128104 t7onsinued

'Facility Number: — Date of Inspection C
r
Required Records & Documents _,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes EJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z40 [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ld No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ld No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ too
❑ 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
540
❑ 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
L'I N
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Ad"ditional,C'omments4andl- it Drawings ',� `� � � � r � f
Page 3 of 3 12128104

S
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `f +g Arrival Time: / �d Departure Time: County: � �NJL6v�Region:
Farm Name: I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C 1J 1J � Slg rjtX n3
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = Longitude: = ° = d 0 "
Design 1Current
Design Current Design Current
apacity Population
RET
Wet Poultry C•apaclty Population Ca.ttie Capacity Population
❑ l.a er
❑ DairyCow
❑Non -La er
❑ Dai Calf
o Finish
❑ Dai Heifer
EFa
to Wean
o Feeder
Finish
/ / O
try D Cow
❑Non-Daito
La ers ❑ Beef Stocker
Non -La ers
Pullets ❑ Beef Feeder
Beef Brood Cow
❑ Turke s
❑ Turke Poults ❑ Other Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,�,�
L1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VN
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 67 — J"s Date of Inspection
.Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: CA C�'rsN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
[I Yes
,�
C 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
CTNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0,No [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2 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
[ Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0_4 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
�Ko ❑ 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 CJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes lJ 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 /Xo
❑ NA ❑ NE
❑ Yes 9-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name J ;N1j Aqed ELL Phone: ! 1
Reviewer/Inspector Signature: Date: O
r 12128104 1'Continued

Facility Number: — I Date of Inspection 4 71 D
]Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Ch kl' t ❑ D ❑ M ❑ Oth
❑ Yes
3
[I NA
El NE
❑ Yes
No
❑ NA
❑ NE
eV is s esgn aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
[I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LQ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
eNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑'1Vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E-.KO ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
ON' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�,�
31. Did the facility fail to notify the regional office of emergency situations as required by
ElLJ 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
❑'l 1�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
io
❑ NA
❑ NE
Additional Commentsand/or Dre+win
17.. <` k 1A`'C$y6$CIYiR�E§ tii iUYR1ti! F�a'��� 41 i id '4Ai4 bLh4��
A6
Page 3 of 3 12128104

— Division of Water Quality
_ Facility Number (p "7 Division of Soil and Water Conservation
54910j"genc
y
Type of Visit ,Co
0pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: MULO W1 , — Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
OnsiteRepresentative: LWA)e :�Wb614S Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 ` =" Longitude: = ° =' = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C*apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
❑ Dairy Calf
© Feeder to Finish IZZY /
❑ Dairy Heifer
® Farrow to Wean 1 0 a o ID 3
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
[INon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
ElBeef Feeder
❑ Boars
Pullets.
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[� o
I--]NAEl
NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
�o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page I of
12128104
Continued

Facility Number: 67—�� Date of Inspection
.�" Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Oyes
NoEl
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.A60o)J
Spillway?:
Designed Freeboard (in): Zo
Observed Freeboard (in): 1-j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q&
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[,2<o
❑ 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
El"No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Q Ko
❑ 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 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El1J Yes
�/
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�, NNo
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/
E2 NN
❑ NA
11
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L_'] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[?fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ;
Reviewe rlInspector Name - —_ lo� - - _-- Phone:
ReviewerlInspector Signature: Date:
Page 2 of 112128104 Continued

Facility Number: —LEI
Date of Inspection
• 3 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP [] Checklists ❑ Design El Maps [3 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�kNo
❑ 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
t No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑'1Go
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
` 141
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2'�4o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Eg 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
D<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E?q'o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�o
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[3' o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

to 1 H .t S
Type of Visit C pliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine o Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 4 a1s Oti Arrival Time: S Departure Time: County: 6A)S L01,) .. Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ l_FNQ f
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = u = 6 Longitude: = °
Swine
ElWean to Finish
❑ Wean to Feeder
Design Current
C+apacity Population
1
Design Current
Wet Poultry Capacity Population
❑ Layer
10 Non -Layer I I
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
® Feeder to Finish
/2 Z a
❑ Dairy Heifer
ElFarrow to Wean
Dry Poultry
El Dry Cow
m Farrow to Feeder
/000 MI/0
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El❑Beef Stocker
Gilts
on -La ers
Beef Feeder
PE]Boars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures: 1
DischarsEes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
040
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
"o
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
YNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Fadllity Number: 6 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LW "a l'J
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 2b
Observed Freeboard (in): Z D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EA/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 2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [!I/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require El Yes LEI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [I/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN [:IPAN > 10% or ] 0 ]bs ❑ 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) a CO)Mu S b o
13.
Soil type(s) P4RGST'VX1 Tjjtt.Ay< ,)r/h
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?
ElLrJ Yes
,2"No
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
LJ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[NIo
ElNA
[INE
18.
Is there a lack of properly operating waste application equipment?
[IYes
[90 o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or.any other;eomments.
Use drawings of facility to better explainsituations. (use additional pages as necessary)::
%Up ,,has UeDn7to,
1~AT 0a#4 L
66YToo s W EE n (a OJT Vt..*k.. Do ►JC .
to 6LVV� 40D 9 C Cop ,D S Lnu tL Craob 4
Reviewer/Inspector Name job L� rjq��,��Phone:
Reviewer/Inspector Signature: Date: 2,1" 06
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
• I Required Records & Documents 1
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes iNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ W-UP D Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E14o
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2"NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
E NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EINo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
�,�,��
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
El Yes
�(
C: No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,❑'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

SS
Type of Visit 46 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: [ Title:
Onsite Representative:
►��� SANS
Certified Operator: _I LAW SA 10 P
Back-up Operator: 7 �3
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = & Longitude: 0 o = = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
ION n-La et
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
/,I Yo
❑ Farrow to Wean
Farrow to Feeder
OU/000
❑ Farrow to Finish
❑ Gilts
❑ Soars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El
El NE
❑Yes
El Yes
❑ NA
❑ NE
❑ Yes
VNo ❑ NA
❑ NE
12128104 Continued

Facility Number: k Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to ha�WUP
e a components of the CAWMP readily available? If yes, check
the appropirate box. ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes
26No
❑ NA
❑ NE
R<yes
❑ No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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
U(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[2"T'
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
L.,�'1VA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ 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
�
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
F 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
N
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
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/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
ltlonfll Comment5'and/nr �Cdd'DCflWltigs,'�y;r .L;;',it i;Y�«w K' ;� vJw.aa�„f_+`
12128104

Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
for Visit g(Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time.
O Not Operational Below Threshold
Permitted [3 Certified © Conditionally Ce 10 ed 0 Re ' tered Date Last Operate4#0 Above Threshold:
FarmName: ...,.....�(....... .....5 County:....... ...........................................
OwnerName: ., �..r�.!!�. ..�' ........( .... Ri ................ Phone No: ............................................................. .........................
a�
MailingAddress; ..................................................................................................................... ..................................................................................... ..........................
FacilityContact: .................................................. iy . ........-,,, TTiitle:.............................................................. Phone No:
Onsite Representative. .lrlrr�...T!,;2................................. Integrator:„,,�,�..........
. ....................
Certified Operator: ................................................... .. . ................ . .... . ............................ . ... Operator Certification Number:
Location of Farm:
J] Swine ❑ Poultry 0 Cattle ❑ Horse Latitude • 4 44 Longitude • 6 46
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal rain'?
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 O'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 PNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: .............. I................. ................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Facility Number•
Date of Inspection IO rf I
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Waste Management Plan (CAWMP)?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ONO
❑ Yes Pfgo
❑ Yes ONO
❑ Yes _L31Vo
❑ Yes ONO
❑ Yes j2 No
❑ Yes 2r&o
❑ Yes P No
❑ Yes ONO
❑ Yes ONO
❑ Yes ErNo
❑ Yes W40
❑ Yes Z No
❑ Yes ONO
❑ Yes eNo
❑ Yes ;2'No
❑ Yes PNo
Comments fec to'q'u"`estionY#1"$�7C'Eic"'kui'ari{,`pYES?:answ ,ii3und/di aiiy:rrecomm�endidous oianyiotl eLcommen�'yt��t��t,1
q p,y,i i{4 .... ! y_.+-..:A:ik LXaAl:1.iYwsi:.il.f,:...�1.11."..'Y.v'iliR4i4'i:�Af:Eivat:r313:.i
f'S d'. .. '.b v - 'tl 3 E .�" jEF.�. Yi.
Use drawings of facthty, to better explain situations (use additional as necessary? �
pages �i ❑ Field Copy Final Notes ,
Yl ❑ i$. t'
��Z� k r' s, }3 8 >}'. ! q� f tF. �3i + y:� fed f� Y 3 . �,"f zfa; { "na3r
� 'N"F¢.;t �,'
M •t. �o + 9 +
"'..'e'�..�... ". r� .. .,.�4�h3,:. 1..r7•',: .'i.r"- ?:.9,. •A .�: +�1. .�++k.g, a.y� `�..,. 7...:.�irF..:�.&},�i '� €. .'�F+�:a E.M+�;,�.tra'm:. m•.ti.r d 3,1,
So 'r I S r �r►, e G� shcw�c� !'I Pic,% �o /. rorr
5
Sail ,sa n' need i;r
ieS G C/e
CiAld, w1111
�QyI�ar,
t ,y , + s„�- i ;r-•;s�
Reviewer/Inspector Name: '. ... . k� ' it%�'i•m .cam/. ? ..,mot €, ' M�;. "?:r"
Reviewer/Inspector Signature: Date: ll
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 00
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 Frio
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7No
❑ 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
ZNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
C'No
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
RfNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
PTNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Y No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ONo
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 forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
[:]Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number Dalc of visit: I Time:
Not O erntional 0 Below Threshold
O Permitted 0 Certified [3 conditionally Certified 13Registered Date Last Operated or Ab ve Threshold:
Farm Name: _yal. `f- �^%\ S av County: 10
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude r_�a ° 11 Longitude e 1
Design Current
Design Current Design Current
..Swine
Capacitv Pa elation
Poultry Capacitv Po ulation Cattle Capacity Po ulation
El to Feeder
❑ Layer ❑Dai
❑ Feeder to Finish
JEI Non -Layer JEI Non-Dai-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other I-
❑ Farrow to Finish
❑ Gilts
''Total Design Capacity
❑ Boars
Total SSLW
Number of Lagoons
Holdmg. Ponds°I�Solid,Traps
.'"" ❑ Subsurface Drains Present ❑ Lagoon Area
, ❑ No Tiquid Waste Management System
n.
Spray Field Area
Discharges & Stream Imgacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & TEcatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (inches): o
05103101 Continued

... . • 'd% i
Facility Number: —f7 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maittenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Pond ing ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
33. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a gettable 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
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ A1UP, checklists, design, maps. etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DI Q of emergency situations as required by General Permit?
(ie/ discharge. freeboard problems. over application) ❑ Yes ❑ No
23. Did ReviewerrInspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
LNo violations or deficiencies were noted during this visit. You will receive no further correspondence, about this visit.
i w.y�.o ti•°i. ".1.,1 w$i ;{•f.f.��.��.- .,—..� � ..i.:�.`1�..v�i'�:_S3i:i�n':�f iiR�',���f'��.q��ini,Yi9✓!�$�Y�/�w'�.o f:�i °�i'�Ci)MG'r:Fes.-C:`.li'w N °:krt `HO�!"�i3 �':✓.l" al.. `,..�"`f�}M?I::x rfi»..: i+!
better
Field Conv ❑ Final Notes
1�y "A" 4- ,dam � r,, .� Vim,A_�f -e- , �' 'q 4'r 4, , "_ a
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number Date of Visit: 3 1 07 'Time: 1 Z 5
N -to verational 0 Below Threshold
Permitted [3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: S�t *d a f f v , ,r Fit y hC County: Q n - acy
Owner Name: , �g rI�C✓l M,V,�� Phone No:
Mailing Address:
Facility Contact:
Onsite Representative. Len .Sq vq Q �S
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: d -Srrwel
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 « Longitude ' �GG
Design
rrent 'Design Current
Design Current
Swine .Ca aci
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
P,o ulatiou P,ouItr. @ate aci P,o elation Cattle
: ❑ La er ❑ Dairy
10 Non -Layer I Non -Dairy
Ca aci 1'.o elation
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons0[���Q
0 ❑ Subsur€ace brains Present ❑ La goon Area
❑ S ra Field Area
13oltling Ponds 1 Solid TraNo Liquid Waste Management S stem
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 8& 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): 7-0
05103101
❑ Yes J2�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 4!fNo
❑ Yes ONO
❑ YesXeNo
Structure b
Continued

Facility Number: — 55' I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Pounding
12. Crap type Be V +•. V of a
❑ Yes ZNo
❑ Yes No
❑ Yes"ONo
❑ Yes RNo
❑ Yes /KNo
❑ Yes 6No
❑ PAN ❑ Hydraulic Overload —❑ Yes J!fNo
FeSGve 4g,y
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plah (CAWMP)?
❑ Yes E!fNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ON O
b) Does the facility need a wettable acre determination?
/
El Yes o
c) This facility is pended for a wettable acre determination?
❑ Yes o
15.
Does the receiving crop need improvement?
❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes INO
Required
17.
Records & Documents
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?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
,�TNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes J;YNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes �NO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
El Yes No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes No
24.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
adlxlaian YEaser,ns ora,
Comments. (refer to comat
ny°hnmmrn
dditional p=
Usewi°oa' tteex1am sttuationsi"e Field Copy s ; Final Notes
v"r-A-,
►'S h,-Aell ke f4 r1l e ee ) ,20d ar�der
q no[ *A-c eeee+'v1,j Cr'ef S' qre well �s ���11'f�� ,� " k:'
C0rtvee_rg4+'0r►, ij .seems -{--A+ 4t e 14,)w areas hold,',
//r.,�a�✓�,�.�.
on-�l�esQ ��Ils�• �1 ease -�a�e ac-�>i oj-, �o �,�ev�n-� ��nd;� �'
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: 3 -7
05103101 Continued

Facility Number: & 7 —5,
Date of Inspection 3 1 03
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 _,❑/ NNo
❑ Yes _,2No
❑ Yes -,ZNo
❑ Yes ZNo
❑ Yes �No
❑ Yes ❑ No
Additionaf.Comments,und/or, W`raw_ ngs ..� :"�
for s4e ,
Y �
-7-4 -1 n k y O t.. �o ''' � � k r ���Q r �'.5 4.n' m eo", et ,' L, 44 e fa r
05103101

Type of Vlslt .0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit grRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit:
0 Permitted O Certified O Conditionally Certified © Registered
Farm Name: _— �e n ofe r J � Dn v : S'
Owner Name: (,-e- V, A ndQ�j i
Mailing Address:
Facility Contact: Title:
Onsite Representative: Ce n it ]? TO) -Az es 4 C-_he -f 1)a ✓ f f
Certified Operator:
Location of Farm:
Z? OL. Time: 46
rO Not O erational Q Below Threshold
Date Last Operated or Above Threshold:
County: On SldG✓
Phone No:
Phone No:
Integrator: 4241✓e011,5,,,,,,,,,,,,,,_,_
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0& GG Longitude • i LL
Design Current
Swine Cnnaeitv Pnnnintian
❑ Wean to Feeder
Feeder to Finish
f 2
❑ Farrow to Wean
geto
Farrow to Feeder
10 D 0
' V
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -La y er. ❑ Non-Dai
❑ Other
Total Design Capacity {..
Total SSLW
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 84 Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: fr7
Freeboard (inches): 3
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
Structure 6
05103101
Continued

Facility Number: -- j Date of Inspection 2
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding JJPAN ❑ Hydraulic Overload
12. Crop type Fegove Mete , 15er.tie uiTev Bett, 1srlt4I / &:,ro4•n
❑ Yes RTNo
le—
❑ Yes I E2'No
❑ Yes XNo
Yes ❑ No
❑ Yes efNo
❑ Yes ❑ No
2rYes ❑ No
13. Do the receiving crops differ with tdose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
7No
b) Does the facility need a wettable acre determination?
❑ Yes
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
ZNo
15.
Does the receiving crop need improvement?
zYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Reouired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
2f 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.)
I 0-—yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
10,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
B'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes ZNo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
,Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ctiminents (refer to questiori'�#} explain any YES=answers;apolarkat y recomme>?dation's�or any', other'co'mments :h,
Use drawingswof facility tombetter explain situations .{use additiana>I'pages as necessary} Notes Field Copy El Final N s
... .... ..- „ .
is. A c'C-,^e n►1 1.3 r*a.1 r,,e /'esjveaJ; c
Nyd,-a-t 3 a,.,6( zone 15.
1B. Need -rho gel q copy 51P41ee 1ageaij des;9z­, a✓1o( tjqve Jh qvai/�61e
40,- ;-rJR¢C4 -'On
0. Tie sure 1,0 use e� WaJj e Ainetlysix L,,;�Lj ays 011
of jfC4-;V, evenis}}4,0 ca/evle14e 4he /,M 4kte �
16—
Reviewer/Inspector Name,;)oYLlW i; ,e, a. f r, qx "•� -° " ' mM_.
Reviewer/Inspector Signature: 40 Date: Zrl 42-
05103101 Continued

Facility Number: —Sr Date of Inspection 2 7 OZ
Odor 11=
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?
29. 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 'ONO
❑ Yes ,EJ No
❑ Yes 23"No
❑ Yes XNo
❑ Yes /❑�No
❑ Yes ONo
❑ Yes ❑ No
Additional Comments�andlor Drawings:
• Ga'+1 4 d) �' i.,vCs 1C12'`� S. nowc� �l
More - Pwi 60 dat7.r-F'ro,..,► -itie dai4e
e' Tyne A cyyc G," Skot,J`l I n -�Lt F
-� J waste p1 aJ'i .Fo, 41'e
4r" ,re l �o u 11 sd e n e y v �� wlA4 C L, -t h e " 1r,e
del vl . a11/e r- �1)e &-t rev; sad �p lvl* 4 74Q -Ic�a jc
11b�S. ✓ �NlatrP
62 ►'A'� q 11 • (.,, s 5 o 16 s o F a r -a -� a,re rsee of Sep. 15
1 •� / / �• ,�/acs�
�iirdtn�L, �Glpbe� 3p 77 Q e4h& J0 Afs v Ivt {`lG�Vve,"`l1.4 M(�fGL,,
1 1J a ' re we j ^19pl rd ro Sr,\ai1 �t
f b0u1 56 bs PH % 0/01 s �0 6e SvrF �o
0r,4o6a- ,411-o��► A)Overtibe,y'! (7rawP� need
�'o1(0L,/ O n;���eh A1JPLVrA 1CeJ 0,"10f �� 1:c��;on pr/v.�eS q Y.
n 4�e t,-'A:54e F(A-%.
i5• Z abser,red 11.04 a.F' 9fa.sses be.s;4es reccue m of pulls 2-d3.
Mom. Sated erg' +naf, CA4ed 11,,J )Ie, ;S rued fescue U'?W he
j,J4,�s �-I ra+r,d q�f¢,�w��d ��eSe °ahe" �rass�s ►'�-�11 � s�a�-if Go�^'t ��.
%je �ed �a hP CUSS -11,e ,Ccs��e end 1eac�¢� �l6vzt� -I�✓a o
6e 400 GCdse
a rid 3� -1*aId l,t.rt 4e) -Iry r, 14 a4,a6v44 640 8 � �►�-,a.�.,,;,�
8. Me. Sn,1de►^2f ;nd;eAl ed AQ4 Sawte eP 4Ae sold se) rr'se*-f ke'?k
broom 4�p S75'4'rn 94r. 7h,'! f,'461or►, i-PS r^evc>ie4 m ,
Sa�df'✓} �rp,� V.S;qq ZdyJQ `'ar?d 4 eI reoyns k be i rr& e" OFV
AI ICAsi owe I",'SC�r m Zorle 5 adj4(Cen4 -k► 4�e P'Sl*
aLJt? 1v1�4on, � itir. -la c�S PeGll �v i»t�ixjJ ;,I `1C;heU liAiVef �'x-\
- 4cz ieca4;ans .sucii 4mi When the S r)cr-x iS 7v�neG�rJ��, -ft P
vAI W.5 Ca)i be closed 40 freVev14 (eZ�k;► g
05103101
2z. per► 4; Hoe ,ieedl 46 r9241,'Fy oe9,'o4w 1 o4r, ce ►'ii evert
0,(' 41VerGipp),'c44;"'1

lrype of Visit 36,compliance Inspection O Operation Review O Lagoon Evaluation
Reason far VisitRoutine O Complaint. O Follow up O Emergency Notification O Qther ❑ Denied Access
Facility Number Date of Visit: Time: �U
NNot Operational Q Below Threshold
Permitted [3 Certified 0 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
- c '............................................................... ......................
Farm Name: ....... ?Q�f.....G.li...................................................... County. d�Vl
OwnerName .................................................... ....................................................................... Phone No:.................................................................
Facility Contact:...............................................................................Title:.................... Phone No:
........................................... ..............................
MailingAddress:.....................................................................................................................................................................................................
Onsite Representative:........ ... YT ........................................... Integrator:\5....................................................
Certified Operator:................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design
Current Design
Current Design Current
Swine
Capacity
Po
oCattle?
--capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
112.
• ❑ Non -Layer I
JE1 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
Other
❑ Farrow to Finish
'
Total Design Capacity.
❑ Gilts
❑Boars
��, �.<< 1
TotaUSSLW
y Number of Lagoons �; : 3 r, 5 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid=Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes k'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? (IfyCS, notify DWQ) ❑ Yes ❑ No
c. II' discharge is observed,. what is the estimated now in gallmin'?
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 kNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
01/01/01 Continued

Facility Number: 1] —
Date of Inspection Q j
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 4No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................................................................................................. ....
Freeboard(inches):...........�V..............................................................................................................................
..................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
KNo
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
❑Yes
�No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�9(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
IgNo
11. Is there evidenc of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crop type
13. Do the receiving crops differ with t ose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
b�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ YesfNoc)This
facility is pended for a wettable acre determination?
ElYeso
15. Does the receiving crop need improvement?
❑ Yes
eNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
b`No
17. Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Rewired Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
kNo
20.
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
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
V`Yes
❑ No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
tWNo
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
" No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P�No
(ie/ discharge, freeboard problems, over application)
25.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
RNo
26.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
V No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
A?No
liquid level of lagoon or storage pond with no agitation?
}}
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,M No
01/01/01
Continued

Facility Number:
Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
❑ Yes �No
❑ Yes 'No
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes rxO
o
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes NNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this -visit. 71
vaa�sns�caawila a.ca. � yu � �.p ..J - 4 v. - d a. � . . �, .tag- .n y.t.-;,•.
�} ' zI 4 b a U1
Isetdrawng istof facilitj iib be�ttcr explain situations , (use additionalipages as nec3essary} i,E tx �
❑d Copy Field C Final Notes
a I ❑
� 5� Cam►-` �-e, � - .P,s�� � �-� ►-��,.., - �►-�-�'.�. -�..� ` ��
Sew, O"y F)\-(VA
..
eD, �,ec-lk ���
6-11LO
\- 5; t- -\-
01/01/01

rr , ^< Division of Water Quality
ivision of Soil and Water Conservation
Q Other Agency
Type of Visit i� Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit/ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: L�.��'-rJThile: = Printed ow 7/21/2000
Q Not O erational Q Below Threshold
*Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Ab ve Threshold:
Farm Numc``Y....rv�.J County:........ fl ........... ...........................
...............................................
OwnerName: ................................................... .............................................. . ........................ Phone No:.......................................................................................
FacilityContact:..............................................................................'I'itle:...,.............................. .......... Phone No
Mailing Address: ............... ...................... ..........................
OnsiteRepresentative:.........................�........................................................ Integrator:....��4<4.�..................................................
Certified Operator:................................................................................................................ Operator Certification Number:........................
Location o1' Farm:
..
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 Longitude • 1 «
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer
JE1 Dairy
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
arrow to Feeder
(G6
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JFD Lagoon Area 10Spray Field Area
Holding Ponds / Solid Traps JEI 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 Arian -made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If diseharLo is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identirier:...............................................................................................................................
Freeboard (inches): �Lq
5100
❑ Yes x No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )�No
❑ Yes WNo
❑ Yes X No
Structure 5 Structure 6
...........................................................................
Continued on back

Facility Number:b l — Date of Inspection II Printed an: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[�(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
,YNo
(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
t<No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
&o
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
ONO
11. Is there evidenceofov application? []Excessive Ponding ❑ PAN []Hydraulic Overload
El Yes
VNo
12. Crop type V E S�
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
gfNo
b) Does the facility need a wettable acre determination?
❑ Yes
kNo
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement'?
XYes
,❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
P5No
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
D�No
19. Does record keeping need improvement? (ie/ irrigation, freehoard, 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
.j No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
KNo
22. Fail to notify regional DWQ of etnergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes .9No
23. Did Reviewcr/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 9No
24. Does facility require a follow-up visit by same agency? ❑ Yes gNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
Rio violatiQns.or• f Gcienc�es mere not;ea iluritig �his;v�sit: Moir ;will receive ftio. #'uTther
corresporidence: a'bouh 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):
A.
�
eL-,`�
cYt-
EL-
Reviewer/Inspector Name ` h+c� �� (]�� � [ (C) - S QC)
Reviewer/Inspector Signature: _ -1 C�� Date: 9r`13 � 5/00

. . .
.
c_
.
.
o
'
'^
.'
�
..
`
�
�
.'
`

/ Facility Number: — Date of Inspection
Odor Issues
26. 'Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
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 O(Ro
❑ Yes '($1�1 No
❑ Yes �No
❑ Yes NINo
❑ Yes 4 No
❑ Yes PNo
ksk6Iz- 6"td
rA5 c4c,�L-\
A6f

[3 Division of Soil and. Water; Con
#Division of Soil and Water Con
Drvisinn of Water Quality Coi
Other Agency_'>Operation'R�evi
ervation operation Review "f J
� - r
el 1+atlgn COmppance Ins
peet1on,
.J
0 Routine O Complaint Q Follow-up of DW ins ection Q Follow-up of DSWC review Other.
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified 0 Registered 113 Not O erational Date Last Operated:
Farm Name: l^ r� -...S Count, . �5..`.?..................................................
.................................. y .....
OwnerName:................................................................................................................... Phone No:.......................................................................................
Facility Contact: ........................................................................ . Title:................ Phone No:
MailingAddress. ........ F...... I.......................................................................................'......................................................... I.—.... ..........................
Onsite Representative :...t"-��....�...................................... Integr itor:.V....................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............................................................................................. .................................................................................................................................................1
Latitude Longitude
r" Design Current Design "Current "`'' " Design Current
Swine Capacity Population. POUltCy J Ca acit 1'0 "ulation Cattle Capacity Population ',.
r:a
-V
❑ Layer ❑ Dairy
,} ❑ Non -Layer ❑ Non -Dairy
❑ Other
L t >Total Design Capacity Y
Total SSL W
Number of Lagoons. ❑ ent Subsurface Drains Pres❑ Lagoon Area 10 Spray Field Area
Holding.Ponds /Solid Traps ❑ No Liquid Waste Management System '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance inan-made.? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Dues 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 i16Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Identifier:
Freeboard(inches): ............ 1............................................................................................................................................................. ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
Continued on back

Facility Number: — S Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need'maintenancehmprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
0
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
❑ No
18..
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
O VIOIa FQC1S;Or [IPItICiencie5 1Vgre Oofje(l,O(rifi this'visit; Y;oit w;RI—tee0*4e dd futt�t ;
COrreS Orideike. about. MIS VislL
ruse drawings of facility t'o better explain situations (useiadditiaal n� pages asinecessary) 1, s. 8t, 1�fa �� r F,e, r i 1 � ' ' 1t , '3
lE-��5 I,v �J� 1��•e. S�-�.-�L..�� c�e,�� �C��•-�� , �� ��- •� t I� -�'
ei4. V-1-1PI P(✓flA-r KS .1-, -09,w alc i6Fi 1 Ia i
Reviewer/Inspector Name7`� `'`'
Reviewer/Inspector Signature:
Date:
3/23/99

? ' 0 Division at Soil and WatersConserVahDxt ODmp1 ante InspecttDn M
ire sr
' n a11Ce II1SpeCtiOn r , 4 }r !a+
Other Agencywat er ty �� ,j °r' t r n+
all C6ni li
atton Revtew
I I ° ? 11 Ik oar
J �
Routine 0 Complaint 0 Follow-up of DW ins ection 0 Follow-u of DSWC review 0 Other
Facility Number Date of inspection
Time of Inspection 24 hr. (hh:mm)
permitted [3 Certified ❑ Conditionally Certified © Registered Not Operational Date1Last Operated:
G� } (��G � JCi� Gaunt lU�+f ..........................
Farm Name: ... � �L .:.11... .... ......I ................
......... ......... ..................................................I.........I.... Y ....................F...... .............................
OwnerName:........................................................................................................ Phone No:.......................................................................................
FacilityContact: .. Title.. .......................... .......................... phone No: .....,.............................................
MailingAddress:. .........................,.................. ..........,.............,............--..................................................... ..........................
Onsite Representative:..}1.........A......................................... Ittttrator:....1!1......,........ `�/..................................
Certified Operator . ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
i
............................................. .............. ........... .......... .
Latitude �'
Longitude • �' �°
Design Current
Design
Current Design Current
Capacity Population,
Poultry,, Xa acit-;;Po'ulatiou'
Cattle Capacity Population
"
❑ Wean to Feeder
Layer
FE]Non-L
❑ Dairy
Feeder to Finish
ayer
❑Non -Dairy
❑ Farrow to Wean
kJ
❑ Other
°
Farrow to Feeder
00 6
❑ Farrow to Finish
'
Total Design Capacity:
❑ Gilts
M
[3 Boars
�Total'3SLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated aC ❑ 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 ycs, noti fy DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P�rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus.storm storage) less than adequate? ❑ Spillway D(Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure h
Identifier:
Freeboard(inches): .................................................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
❑ Yes A No
Continued on'back
3/23/99

OT_
Facility Number: — Date nl' Inspection I�
- 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? -
❑ Yes
D�No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
& Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
X No
Waste Application
10. Are there any buffers that need main tenancelimprovement?
❑ Yes
bgNo
11. Is there evidencf ovLrpplicatio? ❑ Excessive Ponding ❑ PAN
❑ Yes
RNo
12. CroptypelYl
13. Do the receiving crops differ with t ose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
M Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
A No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[NI -No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NINO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
j&No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) &Yes ❑ No
23. Did ReviewerlInspector fail to discuss review/inspection with on -site representative? ❑ Yes �!J No
24. Does facility require a follow-up visit by same agency? ❑ Yes 4No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
o yioiatiQtis;o� deficiencies were ;ed dpririg Ois;vlsit: • ;Y;oO will rt ee$iye Rio; fu>j th r .
corresaorideilce: a�au this visit: ..::..::::::.:...:::::::: . : . ::.....: . : . .
;.•i_. �l [, ,. ;xrt ... >�.Fa,- 3t l;:i �f4 •. .. FRi t,i.E§F f: .�.I��ii f
Comments�(refer to'quesbon #). 'Explain any YES answers and/or any�1recommendatrons orianylother�comments� °;rir , ,� „,,`r'�; °'
Use drawing's of facility to�better;explairi situations (i setaddet. nai pages as necessary
.i, , .,
�-� `-� a�Q'r �•S Ire-`�,� �s �aSS�l�IS2 Q'�►— ►-�
N Dwc�' '41N�
pA.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: --°f
3/23199

I
Facility Number:�WT--?��
Odor Issues
Date of Inspection
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below C] Yes tg(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of'properly within 24 hours? El Yes 11kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 Yes JJWNo
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 4�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or '�SfNo
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes A
31. Do the animals feed storage bins fail to have appropriate cover? 0 Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? eS *No
Additional Comments an "A. I
��61)
(9`I�.�1�.e 'ih re��. ��l� S(�e �re„� k
93-3—��3 Eel. Sad -�� ne..� c�z tt ewe lei
low',
91 R-9 y
Lk5z hQ1-J CY� Q KO-L-"
3123199

Revised Apn120, 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 item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: ' Operation not required -to secure WA
determination at this time based on
Date of site visit: -� `f'—k c7 l exemption E1 E2 E3 E4
Data of most recent WUP: Operation tended for wettable acre
determination based on P1 P2 (3 .
Annual farm PAN deficit: pounds
Irrigation System(i) - circle # 10hard-hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7.'stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility -failure, Part 11, overrides Part 1 exemption.)
'k.
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�Dy 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 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
checklist, Part II - 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 listedbelow:
F1 Lack.ofmcreage:whirhTesultedinnver-mpplication:of.wastewater(PAN) on:spray.
fields) according#ofarm'sdasttwo years:ofJmgation3-e_--ords.-.
F2 UnclearjIlegible, or lack of information/map.
F3 Obvious -field -limitation s-(numerous itches;failirreio:deductTequired :-.._,
buffer/setbackmcreaae;-or25%:oftotal acreageddentifiedanmAWMP.::includes
small,-irregulariy-shaped-fields = fields-lessihan-5-acresforlravelers-or..less-than
2 acres forstationaryaprinklers).
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 III.

Revised April 20, 1999
Facility Number
Part Ill. Field by Field Determination of 75%Exemption Rule for WA Determination
TRACT FIELD TYPEOF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER',2 IRRIGATION ACRES ACRES %
SYSTEM
I I I
• I I I ,_{ I I •
1 I i I I I
== n KI"PAM==1 _ i,..A f n„11 iN ". A in ni�re ,.;;; 1 i ., ... F..a.......,.::rl AIAYK An
. .. ". ..........�,. - -'JT ..." t-u. t n.�, ....�...•................, .....J ... ...,..... 11 ... 4. . w ...a.,+i.c.,� u�trc„�s�i�u 6,.1 vrzrvwir
and type of inication system. • If pulls, etc. cross -more -than one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBERZ -must be clearly delineated nn Trsap.
COMMENTS' - back-up fields with CAWMP acFeaae-exceeding75% of its total.acres Und having received less than 50%
of its annual PAN as documented in the farm'sprevious-two years' (1997 & 1998) of irrigationTecords, cannot serve -as -the
,.sole basis for requiring a WADeterminston:_Back-upfields- nust-be-noted in the -comment se--bon.and must he accessible
by irrigation -system.
Part 1V. Pending WA Determinations -
.1
P 1 Plan lacks.foliowing information:
P2 Plan Tevision -may:sabsfy75% rule based on adequate overall PAN deficit and by
adjusting all field:acreagedo below 75% use rate
4
P3 Other (ielin process of installing new irrigation system): w Gl IL-,

Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, xH:1V
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Llpy Sanders (Sander &Davis Farms) 67 - 55
91 72 /99 Names of Inspectors 2ahid Khan
Vincent Lewis
9 - 12 Freeboard, Feet 1.0 - 1.1
100.000 Top Width, Feet 5-`
1 5Ao 1 Downstream Slope, xH:Iv 4 to 1
Yes 2j_ No
Wave action .n the
Upstream. • +
Yes .X_ No
Follow -Up Inspection Needed? Yes X_ No
Engineering Study Needed?
Yes X_ No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
If Yes, Depth of
Overtopping, Feet
Yes X No
Tther Comments Talked with LenU Sandgra. -Lagoon Lowered -by

Division of Soil and Water Conservation 0 Other Agency
GLDivision of Water Quality
K
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other'
Dale of Inspection 1'
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit KPermitted 0 Not Operational Date Last Operated:
Farm Name: !N %� .. ....L. t'� 'i'-CCounty.........�1 ?................... ........ I ..............
....................I�11`... .... ... z
Owner Name: .... Zv►v�sS-�...s y0...............h f.Y..tX .....,�%�.V.cS Phone No: ........... J. . ..........G t. j................................
Facility Contact: Ll.L.n.w� f.e ............... Title:..... �<.x..4`Z-::.............................. Phone No:...34.6..... .7. ..........
n. /
MailingAddress: ..... 12...A.. .......J:...! .4... f<�.......................................... ....On- (.f....... e.P./. .............. ............... ........�..1.."..L
L � I 2
Onsite Represe.ntative:...........f ✓..`Z.k........�R' Integrator: ....... e�!`�Q.420.-(L�..............................................
Certified Operator;..... ........,5 ... ..... .............................................. Operator Certification Number_..&..ff./,...............
Location of Farm: [
C
Latitude =0=1 =« Longitude • ' "
s " Deli n Current
g
Design Current ��t Design
Y.;
CtrrtenE
wine:Capacity; <Population
�# �.
Poultry Capacity Population N CatEle rapacity Population
❑ Wean to Feeder
ILI Layer I❑
Dairy
❑Feeder to Finish
❑Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
El to FeederIss
❑ Other
��
k
Farrow to Finish
Total Des>Egn Capacity; '
❑Gilts
.€
❑Boars.
Total SSLW
Nttnaber of Lagogn5l Holding Ponds
❑ Spray Feld Area <:
❑ Subsurface Drains Present
❑Lagoon Area
,, x rsNcM.
�f
❑ No Liquid Waste Management System
§"
General
1. Are there any buffers that need maintenance/improvement? ® Yes ❑ No
2. Is any discharge observed from any part of the operation? Yes -allo
Discharge originated at: ❑ Lagoon Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [;] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [ffNo
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 WNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? KYes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 5,Yes ❑ No
mai ntenanceli repro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 13 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

i
+Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons olding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes 5LNo
❑ Yes allo
Structure 5 Structure 6
Identifier:
Freeboard(ft):........................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes E4No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes j!�No
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wastg 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 ..... e—P..r..................................................�...9.................... ............. ..I........ .... ...........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
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?
❑ Yes 4 No
❑ Yes ® No
XYes ❑ No
................................................
❑ Yes [5(No
0• No.violations•'or. deficiencies.werenotedduring this:visit , Yodw'ill ikei i.ve-ni &furflf&
: correspondence fiWit-this.visit.
❑ Yes K No
A.Yes ❑ No
❑ Yes Q No
Yes [] No
t
❑ Yes No
❑ Yes rW No
❑ Yes V] No
❑ Yes JR No
❑ Yes QNo
Cot
,awlelop
�n} 1
7/25/97
I Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

0 Routine O Complaint O Follow-up of DWQ inspection �O Follow-up of DSWC review O Other
Facility Number
Farm Status:.... R E & { 5'�I� _ _ ........_._.._ ......._.....
Date of Inspection Z�
Time of Inspection : r17 Use 24 hr. time
Total Time (in hours) Spent onRe%iew r
or Inspection (includes travel and processing)
Farm Name: .!? �. _ ..� _7Ar��5...._ ..............Y._.. _ County:...! .iiS�G�L�............... ..._....................
Owner Name:Phone No:.�
Mailing Address:. W!PA_1�r....— 9.6
Onsite Representative: �L =� w_� .� '�' .....
Certified Operator: _ Z /> _RAJ _ _.� _. _ ,_ .. _ .. Operator Certification Number:
Location of Farm:
Latitude a 4 0- Longitude ` 1 99
❑ Not Operational Date Last Operated: _.^ .._._..__ _..... _-------- .__._.__.................... .._....__--
T)-pe of Operation and Design Capacity
"$k .i?':i�.•.fi"� �Sh-3 F '.:". 3
i '��
kk - -
�C^C,
Swine
.i S'H.
n
Poultry Cattle
Number
.. , 7 3 tiambeC r 'I�'umber;;
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Finish Farrow to Feeder
r y 7-" .
Number of Lagoons /a°Haldus Ponds ❑ Subsurface Drains Present
0 Lagoon Area �q ' ❑ Spray Field Area ¢F FF
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
. Y. Is there evidence of past discharge from any part of the operation?
_ 4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system {other than lagoons/holding ponds} require
maintenance,'improverient?
❑ Yes ['�10
❑ Yes B<0
❑ Yes D-No
❑ Yes �o
❑ Yes
Number of Lagoons /a°Haldus Ponds ❑ Subsurface Drains Present
0 Lagoon Area �q ' ❑ Spray Field Area ¢F FF
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
. Y. Is there evidence of past discharge from any part of the operation?
_ 4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system {other than lagoons/holding ponds} require
maintenance,'improverient?
❑ Yes ['�10
❑ Yes B<0
❑ Yes D-No
❑ Yes �o
❑ Yes
C.�,
[I Yes
,'%o
Lf'No
❑ Yes
2<o
© Yes
❑ No

6. Is facilityinot in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
8. Are there Iagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Hoidina 2ndsl
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon I Lagoon 2 Lagoon 3
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-1.2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate' markers to identify start and stop pumping levels?
Waste A plication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the active crops differwith those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Onlv- .
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does Cc facility fail to,comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
�'1�• 1,� ,� ,.� f1W5!5 ,4-4 G ti+s�i?l� �i 5 Ce �
>* pry 414
❑ Yes
,'o
❑ Yes
l_`INo ' -
❑ Yes
El eo
❑ Yes
3-50
Lagoon 4
❑ Yes ❑oo
❑ Yes QXo
❑ Yes
&es ❑ No
❑ Yes [moo
❑ Yes E No
❑ Yes ©'No
❑ Yes [?'Co
❑ Yes Of Ko
❑ Yes ❑ No
❑ Yes ❑ NTo
Dies ❑ No
❑ Yes &?Ro
❑ Yes , To
Reviewer/Inspector Name
Reviwer/InspectorSignature: Date: LA
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit
11/1-4/96

i PCs•
Site Requires Immediate Attention:
Facility No. _(0 7 - s_s
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD 1
DATE: ' 3 , 1995
Time:
Farm Name/Owner:
GE
5.,(A- ep'S
5
Mailing Address:
166 ! -
PPr3>667_ PD._
MAPt,E H)LL,
N C _7-RY 4
County: 2
Integrator:
Lj
Phone:
On Site Representative: /) mow Phone: —3-V 7-6 543
Physical Addres � u a� e ° S /Lo Tr t
s/Locaaon: NAw iynJ,,�D I,&t ,54-i�. r✓ FYI �,J4-7
7�AUl5,l1af'r.tl�'..!'-[fU1fA_..OL:h.�Y Tu_.,Y_sT'UA., 1.01�t- .5, ./1.04 1,f-!IE//
Type of Operation: Swine i!
Design Capacity: 1000
Poultry Cattle
Number of Animals on Site:
On
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 N 39 to " Longitude: -77 Elevation: 5 Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)�or No Actual Freeboard: -2 Ft. �! Inches
• Was any seepage observed from the Iagoon(s)? Yes a Was any erosion observed? Ye or No
Is adequate land available f6rApray?<ne or No Is the cover crop adequate? es or No
Crop(s) being.utilized:
Does the facility meet SCS minimum setback criteria? .200 Feet from Dwellings? YesSor No
100 Feet from Wells? for No
Is'the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Line? Yes ofZN��
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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: _�✓ >< 4.. _, _ _ ,-� _�
Inspector Name
Signature
'cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. o 7 -- S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S',) -3 _, 1995
Time: S� .' 2 a
Farm Name/Owner: '4Y ARMS
Mailing Address: _309_ 5 fc_A a-► cC R j�? J A CK5 on1yi PLC NC Z85 Sib
County: 0/4 ScOw
Integrator: ro Phone:
On Site Representative: nona, Phone: 3? i — / Y.2 Y
Physical Address/Location: L2oxt ff ���eN oou7v r-/ryY_So
60 a.S M►Ccs Tu2ti3 L 4E5r- t9 076 //'y(o ~ A-t-
Type of Operation: S wine v Poultry Cattle
Design Capacity: 750 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ' 31 ' V63S" Longitude: '�7 ' 35' -1Y,_ ' Elevation: Zb Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (5) or No Actual Freeboard: 3 Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes og2 � as any erosion observed?�9or No
Is adequate land available for spray?C�50r No Is the cover crop adequate?/?A or No
Crop(s) being utilized: l_oA57-09-C___--
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinus? ( or No
100 Feet from Wells?-- or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue.Line? Yes or NCO)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o
Additional Comments: 64OSi07-- ' OOJ 6&A?M /mvsr .BE /l�i'`'341aec;'6 ,Al 134c-lL
G £ �✓ f� v/L 1�(.Ld GAO 7" �ALt)
4. a�7JL�lIi�-TILT
/J!L���7/JL:,��1['J._T% ��YL�•��r��f�1S�/1t.��!' �i�C�..Il!''i�lL!
A / a
• -Du fZ2
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERRTI01�10 BRANCH - WQ Fax:[phone]
Ju 1 25 ' 95 7 : 30 , P. 14/ 17
Site Requires Immediate Attention A'¢
..Facility Number: G 7s"yam
SITE VISITATION RECORD
DATE: ,y-ccc� �A , 1995
Owner: ! M y� SA�Ti,4.fxr _ Farm Name: _ S A•w�r�= .{1 �- .Q.avu
COUnty:
Agent Visiting Site: luxe Phone: Mol 5%•r Vy7:
Operator, .� -r ;k _r-.41v4r4:W-r ... Phone:
On Site Representative: 4dx2ev.v Phone:
Physical Address: lle-R .r * „C. 2-ire4,v .C.v't ft
Mailing Address,
Type of Operation: Swine Poultry Cattle
Design Capacity: /wao Number of Animals on Site: lope.__ _
Latitude: Q ' " Longitude: °
Type of Inspection: Ground ` I Acriul
• Circle 'Yes or No
Does the Animal Waste Lagoon have sufficient frceboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches)C?e-s. or No Actual Freeboard: —L Feet B Inches
For facilities with more than one lagoon, please address the other lagoons' frceboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oRo Was there erosion of the dam?: Yes ot�
Is adequate land available for land application? der No Is the cover crop adequate? eOr No
Additional Comments: -,Y4,r /�s,r»*f.� sr .•� ,r /�Fr�-►.��r*-c . .�._� r
A�,ytrr�•►.�! ,�.�.E.�.s�.4� ate.. .D'rs-,�.,.,_ d- �: vrrr:e.y _ ,yPrc�s f" 6
•
Fax to [phone]
Si,enature of Akent

OPERATIONS BRANCH - WQ Fax:[phone]. :u1 25 '95 7:29 P. 13t17
Site Requires Immediate Attention 4 o
Facility Number: 0_ - s-ir
SITE VISITATION RECORD ; zi
DATE: 1995
Owner: _ _ Yr �•,� •iy t� ,�,�? rc Finn Name:
County:
Agent Visiting Site: mitt r Phone: (V/oa „ 's-a�- !✓*o:;r 1.
Operator: phone: i41.r
On Site Representative: _ e arNy �r�.�:=� _ phone:
Physical Address: F i,7 +ea ol- P-JWO plev
Mailing Address: Joe ,,sr�Ac•:" _ _ ,.,.
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: T�'�.Q�.s•�� r� u..rr,.
Latitude: a' �" Longitude: Q
Type of Inspection; Ground Aerial
• Circle Yes or No
Does the: Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches) Ye or, No Actual Freeboard: _,J Feet -Inches
For facilities with more than one lagoon, please address•the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o R Was there erosion of the dam?: es r No
Is adequate land available for land application? r No Is the cover crop adequate? Zgbr No
Additional Comments:
Fax to [phone] Sign Lure of Agent,