710031_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

AV Division of Water Quality
Facility Number 3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ffl Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Q<outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: O Arrival Time: % dd Depa/ �rture Time: Q County: �f-7" 0 Region:
C'ov
Farm Name:Y_&/ /Pi Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:.�6"a)".)')
Certified Operator: ���i9L%� r Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = d Longitude: = 0 0 I=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T.❑ Layer
I_ I ❑ Nan-Layet
Dry Poultry
N
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ DairKCalf
❑ Dairy Ileifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
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 gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection I
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?
❑ NA ❑ NE
❑ NA ❑ NE
Strucjurg 1 Strut re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: c 4,� }
Spillway?: / A)O ! v o
Designed Freeboard (in): / l
.Observed Freeboard (in):
5
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 �] No ❑ NA ❑ NE
through a waste management or closure plan? /
❑ Yes�No
El Yes ❑ No
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? ElYes 0,
J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Q�J No ElNA El NE
maintenance/improvement?
(p,(
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.)
❑ FAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑�Evidence of/W� Wind Drift Application Outside of Area
12. Crop type(s) -r2l� % '� • v`% L/!/f� �� �/' , �-
1/7
13. Soil type(s) Ur
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
)�fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? VfYes
❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
l 6 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
eNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ZNo ❑ 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
Reviewer/Inspector Signature:
1149ar.1,9 Cy�T S ��� zoo✓ .
ADS
Phonek9
Date:
12128104
Continued

Facility Number: i — Date of Inspection �S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ElyvqJp El Checklists El Design ❑Maps El Other C/1�
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o [INA ❑ NE
/10
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Rrsoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
['No
❑ NA
❑ NF
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes;jZfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�INo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
y
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7' /`—c�2
1212&04

Division of Water Quality
Facility Number., Q Division of Soil and Water Conservation
:Other Agency
Type of Visit JO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 22 Arrival Time: 0 'O Departure Time: County: Region:
If
Farm Name: GG Owner Email•
Owner Name: �a,a/AC l? Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
�, /Phone No:
Integrator: IY-16
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = s 0 « Longitude: = ° 0 ` = "
Design .: ' Current
:Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
;DEy-Poultry -
❑ Layers
Boars f LJ Pullets
u
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
i
❑ Yes 0 No ❑ NA ❑ NE
El Yes El No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑No
El NA ❑NE
❑ Yes )XNo
❑ NA ❑ NE
❑ Yes�o
❑ NA ❑ NE
12128104
Continued

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
St ture k Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: A10 AL
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
9Yes ❑ No
XYes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
,ryes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
Yes ❑ No ❑ NA fflWE
❑ Yes ❑ No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA )�j NE
❑ NA gNE
❑ No
❑ NA 2fNE
❑ No
❑ NA ;IrNE
❑ No
❑ NA I, NE
[]No
❑ NA /TNE
❑ No
❑ NA E3 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}:
f>�j >r../<�P��'7"D
�4 /7i.'R Plftl— �G�ot.�JN� �i✓C',E.P.Jz.-�� 4 `5s Z�5Ti4IIJcC
I Reviewer/Inspector Name f '�� Phone: (_qzV 232
T,-
Reviewer/Inspector Signature: _ %1J0�. Date: l//2Z //?/.
Page 2 of 3 12/23 04 ' Continued

Facility Number: — Date of Inspection ?)
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ❑ No ❑ NA NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA NE
the appropriate box. ❑ VAT ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
Ld NE
/9NE
23.
If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
❑ Yes
❑ No
❑ NA
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
❑ NA
7NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
XNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
�NE
27.
Did the,facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑ No
El NA
)If
J.'
29.'Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
'ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
IQ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
General Permit? (ie/ discharge, freeboard problems, over application)
'P3NE
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?
P(Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
oyP��F— �✓G/f1'/�5 G vF�FGau)z�C� y .��-,E
�fLLI��Qd .� �/ J�F_�M 5 !O ,B,e= J i`/�SG,E �i2 rl"
�o��F al /�
x�a.e,JF.e
�f 7 �ACf,
Sf4LJo 150GS' /qT Z4c1F 5 T
�V_-7rJe_- �clir'TP� �O .�sv ra/fFz.C9 Cft �/� C�
V�/� �� LzF7 Jai T2�. ��'%F2 ��ccJJ�_L�i✓�� ��
1��T
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r�o�"f j!!�CF
'/lf�'�✓� (j-Cum
w
Page 3 of 3 12128104

31
Type of Visit 0 Compliance Inspection 0 Operation Review trStruc7Emergency
Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Other ❑ Denied Access
Date of Visit: i 1 O'1 Arrival Time: L--7lj Departure Time: �,'D M County: _ PE/yi�fiL Region:
Farm Name: Owner Email:
Owner Name: S C AARP a Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = 6 Longitude:
u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultty
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
ElN Layers
El Beef Stocker
❑ Gilts
❑on -La Non -Layers
❑Beef Feeder
❑ Boars
ElPullets
❑ Beef Brood Co
❑ Turke s
Qther
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
❑No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes D'hlo ❑ NA ❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection II a� OG
Waste Collection & Treatment
_,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
lL�/�J(Yes
El No El NA El NE
a. If yes, is waste level into the structural freeboard?
E Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: CA 6a t-J I M.,,O L A 6 Ztdl c�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f3 g
5. Are there any immediate threats to the integrity of any of the structures observed?
8Yes
❑ 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
9dNo ❑ 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
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RfNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
,.,/
I!Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0�'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
94o ❑ 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 ❑ No ❑ NA ® E
15. Does the receiving crop and/or land application site need improvement? El Yes El No ❑ NA 7NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ❑ No ❑ NA L►J NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA VNE
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):
LI) �sAS6b) TJrWfN of R64DEfL SnL,4 WAT64L 06T.54� ZC-D vd-Ew 3urr-4l. -t ToCac. GC frtov, WZ.A r+ucrq lAk
,z,-r W'%-rc fL (4- )4z(„µ Fa�EGOA0_9 ON 111o4o/oto, 000 Noi4=F-rCD SArv%C DAJ P K&D tjC)-r-qreAT
6 FcnOiI• 44,0 IN" ONO 000L-0 ac- ,s0jr6CT:rr1G -TUC fifX*fi W vrA PNo1j(_. i)WQ
L,7,1jd AedC_l-L) AND 5� w "cam 1909-kC j _614M �v ��) i✓VAi�Ar-69 i-A Craoy 0�l! 1��o7ro(o
AT , �:3U Awl , -.AGoM 1 (rao„1T) WAS* rroL,wD Ar 13" w 4,n- LA&x)o LLBAGWAS
Reviewer/Inspector Name �j 0 ja V Phone: n0�q i? --'� 3V
_y
ReviewerlInspector Signature: Date:

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes +[No ❑ NA [INE
❑ 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 ❑ No ❑ NA [NNE
❑ Yes ❑ No ❑ NA E I NE
❑ Yes ❑ No [DNA dNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA [N
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ No
El NA
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA Vt
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
ElNA
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ /(No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
[Yes
❑
❑ 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?
MYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4.) zmsPccrr&o D.zKc wKu. RgzcD cakicc, s <3� -Mc- So�T Ast Gap-N�2
Jar r SrAIx6►.r aF Tk4F r NT,(__G9_rT� , D 1W 6y\ ns o F "mR '>
NAS GW-rAct(V 00 45Pr-- 'ED H 10 7/b�, AF-MUL.6oN . ;ZA.W Feam I%/6-7/vb
RA469 LAGoox) LvCl,& rro 11"' zd "a, s ) AA)g Ty rk) LA Goof 2 ,
Page 3 of 3 12128104

Division of Water Quality
a' ility Number Q Division of So, il and Water Conservation
0.Other Agency Lolo� 1
Type of Visit 0compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint eFollow up 0 Referral 0 Emergency 0 Other ❑ Denied AcceJssl
Date of Visit: /% Z° �� Arrival Time: Departure Time: County: �Y�D Region: �Q
Farm Name: GL Owner Email:
.Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator• _ `6a)
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = « Longitude: = ° = d = «
Design Current
Swine .- Capacity :' Populatioi
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Design Current Design Current I
Wet•Poultry Capacity PiSpulation Cattle :Capacity, Population
❑ Layer I Ij
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ZfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ZYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 9Yes ❑ No ❑ NA ❑ NE
St ru e l Struc e 2 Structure 3 Structure 4 Structure 5 Structure 6
rune I Structige 2 Stru
Identifier:
Spillway?:
Designed Freeboard (in): /Uo
Observed Freeboard (in): g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes oNo ❑ 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 ❑ No ❑ NA ANE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA JKNE
(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 Vr�NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA PNE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 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 ❑ No ❑ NA &NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA �NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA 9 NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA XNE
18. Is there a lack of properly operating waste application equipment?
[]Yes ❑ No ❑ NA ,[NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
L TF 1 5 - �Or -x 6 6� 6 r�f�2- D88 ('�Ll ) �n�0 p}OtI/� COGGF_GF
(Astdc)'
Sr�F �ST -�o�� �Gft
i
Reviewer/Inspector Name I c4a-- 2 [�O �� CiOCL Phone: q1 7'F& - -7,3;? 7
Reviewer/Inspector Signature: Date:
Page 2 of 3 /l 7y o 12128104 Continued

Facility Number: —3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA PrNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ;Z(NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA E NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El No
❑ l� NA NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA PNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA / NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA �NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA gNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
and report the mortality rates that were higher than normal?
_�NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA PNE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P3"No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
PYes
❑ No
❑ NA ❑ NE
Additional Comments and/or Drawings:
06 v x f�, - j s
3 Z (1117 VV
Po�
Page 3 of 3 12128104

Division of Water Quality
FF�cihty Number Q Division of Soil and Water Conservation
— -- Q:Other Agency
Type of Visit /11 Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit 0 Routine 0 Complaint 146Follow up 0 Referral 0 Emergency
Date of Visit: !l S Arrival Time: Departure Time: County.
Farm Name: #� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
0 Technical Assistance
0 Other ❑ Denied Access
Facility Contact: Title: Phone No:
CG
Onsite Representative: Integrator: ZV--&
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: 20
Latitude: = 0 , = „ Longitude: = ° =' =
Design Current Design Current
Swine
Capacity Population Wet.Poultry Capacity Population
10 Wean to Finish
10 Layer
❑ Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
I
...
ter.
Other
❑ La ers
ElNon-Layers
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3 '
❑ Yes,ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
o
ElYeI',
❑ NA
[I NE
ElYeNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection / o
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Xyes ElNo ElNA ElNE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: /29d 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
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.)
10
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J�`No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? $Yes [:]No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? yes ❑ No ElNA [INE
(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 O'NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑E
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ No ❑ NA 9f NE
❑ No ❑ NA gNE
❑ No ❑ NA 2"NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. .
Use drawin s.2f fa
cftto better explain situations. (use additional pages as necessary):
f �9�vanl v5.� f/vf�FGowZ.► liv/IZAGa eel C
Reviewer/Inspector Name 7 Phone D
Reviewer/Inspector Signature: Date: / O
Page 2 of 3 12/2 /04 Continued

Facility Number: 22— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
❑ No
❑ NA
�NE
❑ Yes
❑ No
❑ NA
PINE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ElWaste Transfers
❑ Annual Ce ification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA X6 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA yj NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA P111E
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA "ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA,/6NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA A NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
❑ No
❑ NA NE
and report the mortality rates that were higher than normal?
/
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA [�NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA VNE
General Permit? (ic/ 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
A�d/dittiio/n�al Comments and/or Drawings:
G C bow ri
G�
—C �ex, �z r
-SLOT
/0
Page 3 of 3 --' QjU 7� wzy*�w 6 vGL��L= (05z.,t—
Y2128104

Type of Visit 6 C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason #or Visit Routine O Complaint 0 Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: i S J'S Arrival Time: Departure Time: County: PDI J1)6-fZ- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: -` Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: °
Design
Swine „Cap ty
Current
Population
Dessi Current
We Poalti y "° -Capacity'"Po ulatioon
Desiga Current
Cattle Capaeity Population
❑ Wean to Finish
A
Layer
❑Dai Cow
❑ Wean to Feeder
Non -Layer
❑Dai Calf
© Feeder to Finish
_I
I L4 M
❑ Dai Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Stocker
❑ Gilts
El Non-Layers
ElBeef Feeder
El
❑ Boars
El Pullets
❑ Beef Brood Co uA
❑ Turkeys
--
Other
❑Turkey Poults
❑ Other
Number of Structures:
F
❑ 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
❑
❑ NA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYesVN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

.1
Facility Number:
Date of Inspection S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGIQC#-� i LAC-sc.%ax� Z
Spillway?:
Designed Freeboard (in): jG _ 10,
Observed Freeboard (in): a1rc, D4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNNo ❑ NA ❑NE
El Yes Lf 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 [2rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �(o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12<0 ❑ NA ❑ NE
maintenance/improvement? ./
1) . Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes Cj' . ❑ 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) Cos 3 ,, J (�y O A (. G 4- A) rEs cd Cr C
13. Soil type(s) a C (y) E Jy d
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 l,Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes [� No El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �1 El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ No ❑ NA ❑ NE
lasc-WCr otj wc1TE9 AC(LE-C fcia1, 5 + W W 8C't-f QoN (- 9-EusrE LJOP To
94UCT AGR-EA&D AW3 C"P.
A) UPGH-t& CP-OP V.z,_E.OS Ats O TOsP,�GT LAG00)J A4�TEa__ i" 1ZA�iJ�At_l",
Reviewer/inspector Name V.'. "Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to haponents of the CAWMP readily available? If yes, check
;ClpryE]
the appropirate box. Checklists ❑ Design
g ❑Maps El Other
❑ Yes No ❑ NA ❑ NE
Lei Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee Freeboard ❑ Waste Analysis ❑ Soil A sis ❑ 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
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3VNo No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LIJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
TA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q N"o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[j-io
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,--,,``
[7 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�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
❑-Ko
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M- o
❑ NA
❑ NE
Addtttonal`Comm, ts-:and/ r Drawin s
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9f Routine O Complaint O Follow up 0 Emergency Notification O Other © Denied Access
Facility Number Date of Visit:
Aj Permitted Q Ce ed 13 Conditionally Certified 13 Registered
Farm Name: _
Owner Name:
Mailing Address:
Facility Contact: .._-___ _ _ Tiitle:..
Onsite Representative- _,, -4 Q,.(_'� r Q ... 41*4�-
Certified Operator.
Location of Farm:
Tune:
Date -Last Operated or Above Threshold:
County:
Phone No:
. Phone No: ...
Integrator., Atevu!�
—,„,,,.. Operator Certification Number:
j2TSwine © Poultry ❑ Cattle ❑ Horse Latitude • 1 " Longitude • 44
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;dNo
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 XNo
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 JZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
W f ?/
Identifier. __�_........
Freeboard (inches):
12112103 Cowed

]Facility Number: 71= Date of inspection I /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes ONO
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes P1 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes PfNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanc r- improvement?
❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes O No
ydrauli Overload ❑ Frozen Ground ❑ opper and/or Zinc
❑ Excessive Ponding ❑ PAN ❑ Hmlqq
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal WasAfitnagemew Plan (CAWW)?
'WYes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
01fes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes IffNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ yes JZNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes FINo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes �No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ yes ONO
Air Quality representative immediately.
�-.� � ...�,'":'fs-
.cts te<AQr��YBs��aaara�.�m �. w
i3se draiarngs o �iac ty better glam mati©as. {ase addition�d pages as aecas y} Copy ❑ Snal Notes
_
-f 0:5 o �F R. �Tf/`� r�5�0 � T�iQBG�
.
C./lf S Ado
Z-, Fox�G��OS id • �5 �iz,� ��
���
7
. F/J 71191-t;§ f- �oa
D��y 2 r cJ�sT� 54m s
23)
r
Reviewer/��,�,.,�,,�,.r Name ;y ." /InSpe'Cto i,.. ` � _ � _�, ��2.:.a.:a.;.:a rT
Reviewer/Inspector Signature: Date: U
12112103 Continued

`• Facility Number: Date of Inspection
`Reauired Records & Document...
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes RrNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
9No
23. Does record keeping need improvement? If yes, check the appropriate box below.
XYes
❑ No
❑ Waste Application ❑ Freeboard PfWaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
(YNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
'! „ti
(ie/ discharge, Freeboard problems, over application)
es
❑ No
27. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative?�❑
Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
9Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment?
❑ Yes
PrNo
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
9No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
RfNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate
box below. Yes
❑ No
❑ Stocking Form JgCrop Yield Form ❑ Rainfall 0 Inspection After 1" Rain
120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You wM receive no further correspondence about this visit;
AP g
21�N - ! 1����iDRf�O ✓F G5 �G T � AceoAd,.O 6R // D"� / YZ �O
WA S 01; ' & //
Qn� � f t l lex-1 Pevo
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W ?5 ©� 6
1
Ido T z FZ6 p
4•tr o� �o�a f �� 2 : was BF s
Pxx AM,005
Ns�,ec rz o� �� Fc��z7y A17 1 '2
,#,) 60,7& /�EyPDi� ] f
12112103 3fj� `74Ll0Q-FL �t112✓�Ey �fJr� � �T �J 'V
s 1410 �p�

Type of Visit Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine O Complaint 0 Follow up O Emergency Notification ther ❑ Denied Access
Facility Number Date of Visit: `Q7 Time:rO 1
Not Operational 0 Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: (O�� r� County:.- c
Owner Name: J�rnn a�Y Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
ZI-Wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` Du Longitude ' 6
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acity Population Cattle Capacity Po ulation
❑ Wean to Feeder 10 Layer I ❑ Dairy
❑ Feeder to Finish ILI Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity.
❑ Gilts
❑ Boars Total SSLW
Number ofLagoons " ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holding Ponds"/ S❑ No Liquid Waste Ma
olid Traps --
Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify 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
1 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 es ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued
1

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Apnlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
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?
(iel 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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
&A"j 4\ A-�
Reviewer/Inspector Name f
Reviewer/Inspector Signature:
Field Copy ❑ Final Notes
Date: -7--
05103101 Continued

- - ,
o
Othern
-- W -
Type of Visit eCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Numb
er r 3 r Date of Visit: EMiKl Time: �5
... ...�. - Not O erational Q Below Threshold
©Permitted ❑ Certified O Conditionally Certified ©Registered Date Last Operated or Above Threshold:
ff� rA' j-�County-pe►r
Farm Name: �q.L, , r 2 ..,
Owner Name: __ 1/ 8 h CI � � I�tat�� Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: o Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' C�• 0 " Longitude + F__]• 0"
_._.Design.; : ;
--
`; .Current ;Design Curren# - Desiga' . Curreitt
-
'Swine-- _-C,avacitr
Population p6iiltry ; Ga ariri -Po ulation Cattle,::. , . Capacity -Po ulition .-
❑ Wean to Feeder
; ❑ La er _ ❑ Dairy
❑ Feeder to Finish
Non -Layer � - ❑Non -Dui �-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other -
❑ Farrow to Finish
�.
- TotalDesign Capacity` I
❑ Gilts
❑ Boars
:Total SSLW -
Number of Lagoons.
Subsurface Drains Present ❑ L oon Area 10 Spray Field airea -`
HoldtigPonds/Sohd
❑ No Liquid Waste Management System jk
s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes FzrNo
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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 2—
Freeboard (inches): 2.10
05103101
Continued

Facility- Number: 171 —,3
Date of Inspection 2
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 ADnliCatiOn
❑ Yes 0 No
❑ Yes ZNo
❑ Yes J!j No
❑ Yes ZNo
❑ Yes ZNo
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
jZfNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN oHydraulic Overload
zrYes
❑ No
12.
Crop type Co4S+qI &--" +yd c1 resave �Corvt r Wikect 11 Sod 6ecthj —
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
El No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Yes
[INo
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
0Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
2fNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ,O Yes 0 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Ef No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes JZNo
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 ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes Z No
25. Were any additional problems noted which cause noncompliance of the Certified AR'MP? ❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
`Cocnments'(refer to questioq #)t Explain any YESlanswei^ssandlar aav re�ommendstiots or any'othe_r-'ctirnments
_
-Use drawings of facility to -better explain situations. (use additional pages a"s necessary) ]Field Con, ❑Final Notes ~
�� Sw ;n e h d L4Se Qe'Cz4LS atvv( �lygO or, r r vre Lve f ►'►'l a✓1 ; G Vr^ezi .
-rye /'eGo,,p{s ot,re he9-fiy or�9�y�`�Zeal b� ->F�.Pre is heed( -Pop'
5-6eAe r'►^lprrot e"ne✓f -T ; bl 44C ,wa A keeke, rn . -7 k e,-e need-1 4o 6e
ll�t+�ct�Ys�'s even4-r
4 VVa"14C W;-il..;�, (o detys a nff °'i°pf'��;or� or%o�
411e/e 1 J P10 � okle ' V [0✓ef so-­,e lq to j—uv►e gvid TUly ZOpZ
ed)
Reviewer/Inspector Name mm �` C_cw%'s r ` _" to r_ _y _
Reviewer/Inspector Signature: Date: Z QZ
05103101 Continued

Facility Number: III - 3 Date of Inspection �f 2
Odor /sues
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 IoNo
❑ Yes ONO
❑ Yes ZNo
❑ Yes )ErNo
❑ Yes No
❑ Yes ❑ No
Additional Corriarents and/or Drawings: <. )
4ka,^a ►'3eeefs 4p be a soil re�4 aoGf1 `j�eal, W,r'. r7��� �lAJ JOU+ �
lI•✓hQ OL44 r✓tei )Ot)tS 4 OUf eVC--f ti�Ic�.f tie SOL 5 _ 1
�oeol Cray o.F 6e 4► ')da 'on abotAl af 44e
�' eloj i�% 4•o-x4 c-P mall 1 a+,Na( (here r1 a .,eeof Tor ;.�.►lvl^a1�"le+'i-{
•Ovp-, 001 4k,- N n ll -spt;of Pl A►-.t A'Ce rn rl rice - a
The j'a►c, 1i4`I needs 4c, lla,ve a 1„re46161.e Aeres c�(e-[ .•, i-�a o•-t
I ct C C D rd t 'n � 4('
y+earo-dS S�ou(d 6e k� p C{ LGord:r q I1.r . Cu✓+ e'�" �y 5a�e aF -�� -
�,-� r e ldJ kav�e a d,,,rrere,,- ere)e � ;s
�h ~�'I-�e L.fc.s-�� ���t� ��le Ca✓/eG� Gra)05 Skouid 6e fnCl vdG�
4t e i,-as.ter col-tL1 e xd r1crv14ed GIecord -,, !y rr1 ate r e l4
Me. uA ll Cal #ed �✓I qnd r-e�o��ed 1'T:� '� Gnu �� .� of
--r,leebvard e YJow has 20,r 1k1 ee,LtA . We 'S-4t')sK%'
_ffee6OCr4 rvLa "5er+Aev1400IS l;kC 5wi'Z� 'eL tVc)lew'erS) frcfsvre
re3v k440-s J 'P1''`d USinJ et ✓ot;l4le 01,\ CrePS
TL,er� W^S some rtJnaf( Or wa14e ;In4o weDO(S
6 e-StA e or1 e '',' e l of -#-A -i wG.s /'[� C e �' -� [ R / .,CA
-41\e Areq Of Ot 1Ow (once 101 44e .\; elo�. e wa's4e ✓'urtid'Ff
wo,s -) 4ke wood-5 o% -,-d Uc�oPear�dl 4o be lc)
►1ry.'�3� of CX+^,w(,{h�.' M, i4ck qj't� vrseo(-fI^`+� n0 rir),t P
.54e'4.fC( OC6Ur nor, rtQI( flames TQ GI-,tSei 441`.3 -rie.IdA-e If box ai
hArd 19Otrl . G%e aISo G�rSCl/SSe' -f I►'1C/OCS,'-x5-�ve�f' Sy�eLO�Oh �r��UG1.
M Y' . Hai) h A s h a A 41,e q no[ -� �` *,.1 � r��J a,� � v •�►�s
reGo,i-r,, vre4 -l-e l Jf s+a4mA sU 211 act Ae -two tim4ser
vv; Il rl �Pv►^1 of Ae c4use ah ov�r�[aw Yn�r
a Ve a Arlen uk d .
`t k X1.
W fi0 Ll D �T W O!� S 0 t T ►'t e 4a05103101 `ctsk- yt7lq✓ 66,4;,i ved G00ta--,-44 4,, ad i ess 44c
1-6v- 3 above vt.Ad look 0t-t.

i-
D><v of water Qom' s
Q`DivisiEai� of purl Water'ConserVahoa.;,
s
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit -4 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Axess
Facility Number Date of Visit: Time:
O Not O erational Q Below Threshold
#Permitted 13 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........_
FarmName: ...... * ` ►............................................................................ County: ...... 11R- ........................ ..... _
Owner Name:
Phone No:
FacilityContact: ............................................................................... Title:................................................................ Phone No:
MailingAddress: ................ .................................................................................................... ..................................................................................... ..........................
Onsite ..... Representative:.0 ....... Integrator:
........................................................................................................................................................................
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:.............
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 66 Longitude • 4 I�u
De_srgq _.Current Design ' 'Current Desrga _ Cerreat
.Swore Ca act -Po ei<ilafroto-. Poeil4y Ca act .. Po ulatioA Cattle Ca act -=Po elation
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish Iff1jC❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
Farrow to Finish
❑Gilts Total Design:Capacity :
❑ Boars Total
Ainmbei• of Lagoons :: [� Subsurface Drains Present 0 Lagoon Area ❑ Spray Field Area
Holdii g Ponds / Solid -Traps.;. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure t Structure 2 Structure 3 Structure 4
Identifier: ....................
Freeboard (inches):
5100
3-�
❑ Yes IgNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JZ No
❑ Yes W-No
[:]Yes $fNo
Structure 5 Structure 6
Continued on hack

31
Facility Number. - Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes krNo
(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 gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? E(Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 3�No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
11. Is there evidence of over application?} ❑ Excessive Ponding„❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type _ CI jUA5v� 1 b�N Sci
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 KNo
b) Does the facility need a wettable acre determination? ',Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes KNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ;Oo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(icl discharge, freeboard, problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
*0
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)d No
P. iIQ-*i01�ti0rjs.el• dtficj neies v► re hoof dirri6g thjs:vjislt;- yoj� will->�-ec lye iio r irtltgr
correspondence. Motif this visit
ons. Luse aawtionat-pages as
F
viewer/Impector Name
viewer/Inspector Signature:
Date:
KI.TJ

A �
Facility Number: 1 — 3 � Date of I nspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
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 Iagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional omments an or rawuigs:.
❑ Yes N0
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ONO
Z�'5�p& U 4v'�& A'Pj� 'A L-,V"-- �- r
{t� +-b ��s 1 � � c
W�1, �c.)�� 4� ���f K1 IDES �tr'
v
V-4
5100

�f
Facility Number 3) Date of Visit: Time: �S Printed on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
e er
Farm Name: 01 ��'r.." i. .......... County:..........��...................................................................
OwnerName:.......... ,il.A. Y�c} e �......� q............................................................... Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress:....................._......................._.._......................................................
Onsite Representative: Ja.",A , 1
..................................._.....................................................
Certified Operator:
Location of Farm:
Integrator: U..''r...........
Operator Certification Number:........ ..................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 46 Longitude • 4 04t
Design Current Design Current Desrgrt Curreat'-
- tan PoutCattCapacityle Po ulattion
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
` ❑ Other
Farrow to Finish Total DesignC8
Gilts , pid.
Boars TOW SSLwl-. -
r Namber of Lagoons Z ❑ Subsurface Drains Present ❑ L.agnoa Area I0 Spray Field Area
Holding Ponds /Solid Traps. ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? %Yes ❑ No
Discharge originated at: (3 Lagoon [I Spray Field [I 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 XNo
Waste Collection &'Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I ................... ......... ....-............ ........................................ .................................... .................................... ....................................
Freeboard (inches): Z Z Z 3
5100 Continued on back

C%
Facility Number: 1 -3. Date of Inspection x 5 G'A Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N 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 16 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
$ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
X No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jo No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over. application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
OYes
❑ No
12. Crop type Ce+^h, wke, ' ,,�6�j6�h+� I res-cV461 caws4a i
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?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
jRNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
M No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
P9 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
,) Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Pd No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
J9 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
' Iio •viOlatiO6s:or• dgf cien-.. mere mated during this' visit' • Y;oit will 4,&01ye ii6 further
cor3resporidence. aboitt this visit:
C6mtnents (refer to question #): Explaiin any YES answers and/or any recommendations or any other comments --_ ,
Use diiawini of facility to better explain situations -.'(use additional_pages aspecessary) „
1. 1..��.5-�� 1 s 1eG k; �� -{�cw. �t�.•��r'•� s3a-� k� A� 2-�0 ��tr Gon neG-��'�z•, ott, ia�ooh . �
-2 ale-mver rleect s 4a e_ iv.-e 1"4 wa s4e, L4,
�. �I-acre I's ev;dGv►c� �' 6 1ea�o,�Q ai pvr"P'��
G o" n e el ii a ah Oi•+ f a5 d0►-t I ; n eeA 40 041 S V/r, KO ,,,,�5l e, lea k� 4e m rev e
IT s��.-Se wal-fie; �uddleel b �a�ses ct� "Nq h4:V co.",v r�om
� crac+ ram. A4 knu'.se. pear- Gr'gcks On hO&CSes o,t^ol�f'1
S, -r1►e3­e ',s aH:101-A1 powdinj pi,► geld B.,
t�
Reviewer/Inspector NameOpieLJe iy• I S. `
Reviewer/Inspector Signature: Date: 4 ,500 5/00

Facility Number: /7 — 1 Date of luspection rj d Printed on: 7/21/2000
Oder Lssue
•26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or balow
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 [TNo-
❑ Yes ONo
❑ Yes A No
❑ Yes WNo
❑ Yes ff No
❑ Yes JzNo
OrYes ❑ No
Additional omments an or rawings:
f3: 7,e t s 14 S rvrc her, -,ude,, Jil 'Plate LO A,-e mt..J crc�f -l';elctr t'N
-ptokcAi ce Ftc ld, 6 ' J -Ea sG V e i P 1 a �,, ;'s row cvo i.�. fPv a; re.
Plan v d c 1A ' G4 p` t',�J � r7bt (Oi wct re, e,
f �t t.Al
114 vlccd - A W e�q bl &c.res ple-�
Y-
Ao,4 41i s 1 S GVrfCs'►� � bei Yi9 work e� d�
E5G vG be S
7
ol of rem-I�esGve .;4,1 10 h . t'►'tA�'�a�'w
18. Need ihstrG� �Qdc�� a ► or A j, f � ►►�avt s?nta� � C�teG� �� .c.
A 1...as4ewe,
c et- A w 4 h t'� (D Ae s #YC /,' - t's� �(o,r cadLv I0 t'��' 3 d t�
-TX e- ZlS• VP vtq use a" ^vervt C t:.wogSk nv)ei ��ti J to rIW7 94I 401-t4
Othq�yS; �• (J38 beiGj:r,y�re... _7�� �iVp'l41C Ivy-�.'r/!;�'"' RI�aWL�,h(,C
'VIA), o� -� e �-Ei�- Z's • s ntrle �'"°jam'' Gr'p� �n
,; 1,,,�,.s� �la�, �Et.•r'� �e z� � wt�e�
acres Pef{o r 4�A Lle� sq y s - lVeeDt A esls v re tkq 4 c tro p r
in -; C'l4 1..' ; 11 MAq Gl► w"\ qe P �4h �h�i P)ee-A -fa Aellow w4-4e,
P[a`,. . .
5/00

ad Water OoRew� iDi-orsoil
xs
:Division of Soil'and Water Conservation - Compliance Inspection
Division of Water Quality Compliance Inspection
ti Other Agency'- Operation, Review t
Routine Q Complaint
Q Follow-up of DWQ inspection
O Follow-u of DSWC review Q Other
Facility Number
Date of Inspection
Time of inspection
`3
24 hr. (hh:mm)
*ermitted © Certified © Conditionally Certified
—1 `t-
..............................................................................
Farm Name: � \ &...,...k.�...,.....
Owner Name: -. - t
❑ Registered Q Not O erational Date Last Operated:
County:.......e.....................................................
Phone No:.............
FacilityContact : ..... ................... .............---......... Title:•--............................................................. Phone No:...................................................
MailingAddress: ......................................... -, .....................................................................................
Onsite Representative:_Wl"� �r2� 11.................. Integrator: ......t-,v .......................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of.F arm: , % .. c f, n h n
P•-- _. .X .. ,... t.......y....................................... ..................... ....... ............. ....................... ............................... ............ ...............................................................................
E
Latitude � � �� �'c Longitude
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
$
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer T= 1(:] Dairy
❑ Non -Layer I I JE] Non -Dairy
❑ Other I I I
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes 9N0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. if discharge is observed. what is the estimate([ flow in gallmin?
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes EgNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [XNo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 (structure 6
Identifier: i
.....
Freeboard (inches) : ............� ............. 3 I ................... .
.......................................................... .............
1 /6/99 Continued on hack

Facdity Number: -I — 3 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 pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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? ❑ Ponding ❑ Nitrogen
12. Crop type .......� 1. t15 T -
W=`01
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
F. No.vio:lations.or. deficiencies .were noted during ttiis.visit.. Y.ou will.re-c ive no ftirtlier .: .
.... s.... .� ..abbot. this iris ........ •...............:.:.......................
.
❑ Yes [XNo
❑ Yes WN
NrYes ❑ No
❑ Yes %No
❑ Yes �§ No
❑ Yes KNo
k(Yes ❑ No
❑ Yes tgNo
❑ Yes 9No
❑ Yes Wk No
❑ Yes KNo
Yes ❑ No
(Yes ❑ No
❑ Yes allo
❑ Yes % No
El Yes nNo
❑ Yes No
❑ Yes No
Comments (refer to question. #): Explain. any YES answers and/or any"_'recommendations or any. other, comments-.,
Use.drawirigs'of facility, to better explain situations. (use additional pages as necessary):;
i1- -71 _`f) L , A- lr tWU__A- 1 . I) 1� - -
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date: -3 1 It I D 11/6/99

[3 Division of Soil and Water Conservation ❑ Other Agency
EVivision of Water Quality
Routine 0 Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection - Z3
Facility Number
Time of Inspection 0 24 hr. (hh:mm)
0 Registered Certified 0 Applied for Permit XPermitted 10 Not Operational Date Last Operated:
Farm Name: I'1. `:!.�j.. r .Y..'' ..... �. County: "` `t .b.."..tle_;J
r........... .................................."..... q..................................
Owner Name: .............. .....�`.[. ............................ ... . Phone No: �E.�..'. .r. �'�..............
.................... .............. ........ ........ .
Facility Contact:-•---------------•-----........................................ . Title:.................. ........ Phone No:
Mailing Address:.......... �k�.`r........... ........ c ��. 1 ?r.....,�✓.Y..�....2 y.....I.......... .......................... ..................... ...............
.M.''.� .{............."........................_.......... Integrator:.....x................_ Onsite Representative: .................. ......................
Certified Operator; ........... T)q hM (C/ ................................................... Operator Certification Number, .........................................
Location of Farm:
Latitude Longitude 0• ` "
' Design Current
°
Design Current ., Dgn , "; Current
Ste _ " Capacity: `PopulatJon
Poultry
Capacity Population Cattle ;. . , Capacity `PopulaEron :
n
❑ Wean to Feeder
❑ Layer
❑Dairy-
Ir.
Feeder to Finish
f
Non -Layer
❑ Non Dairy
-�
❑Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity rF
❑ Gilts
T©tal SSLW``
Boars
Nttmbe`r of Lagoons 1 Holding Pouds
❑Subsurface Drains Present ❑Lagoon Area
❑Spray Feld Area
h
Management System ❑N o Liquid Waste M gem
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
b Na
2. Is any discharge observed from any part of the operation?
❑ Yes
IAA No
l
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
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
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
9fNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
KNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
7125/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoonsJ1oldinQ Ponds, Flush Pits. etc.
❑ Yes (�(No
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes WNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............1.............2 ............................................................................................................................. ......................
Freeboard (ft): ....�.. u 1 !(
........ .............................................................................................................................................................................................
10. is seepage observed from any of the structures? ❑ Yes �No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes qNo
12. Do any of the structures need maintenance/improvement? ❑ Yes �No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste :application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
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?
0- No vio'latioils•or. deficiencies, were, noted, during this,visiC- You.will receive•n6ltirth:er :"
:. ctirrespondenee. about this. visit.-
❑ Yes XfNo
❑ Yes 4No
❑ Yes (fNo
❑ Yes BNo
❑ Yes VNo
❑ Yes RNo
Yes ONO
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes (gNo
❑ Yes r 0
2 z_ )Le-e-p CtIlWo-4 0 �- sd; i kj-I�k An- lys;s, a,n 5; -(e
t4 .13of� lesser-, f��rG(S a�- j) !I �a ffa� _p Is js: # ,y)4eelll t' -F�- G4ecc�,5 11,., tz"15
7/25/97

10-Routirie 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection lZ._ & E 1
- i
Time of Inspection I "(7- .cr 24 hr. (hh:mm)
tal Tune (bs hours) Spent onReview
Farm Status: To
or Inspection (includes travel and processing)
Farm Name: W_��' AL%�_ /C"/-------- County:
Owner Name:. _. _ _.r1 _ ..__ ------- PhoneNo:.__t!�
Mailing Address: 33 n7f
Onsite Representative: - ld/.. _. Integrator..... - 11°
Operator Certification
Location of Farm:
Latitude • E--3 Longitude • �6
10 Not Operational I Date Last Operated: ----- _..----- ....----.______WW—__----
of Operation and Design Capacity
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [W No
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)
3. 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
maintcnancrJunprovement?
❑ Yes R No
❑ Yes ra No
❑ Yes 0 No
❑ Yes
® No
❑ Yes
® No
❑ Yes
[j No
❑ Yes
® No
PKM
•T
im-

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/1/97)?
❑ Yes ® No
�. ❑ Yes J! No
8. Are there lagoons or storage ponds on site which need to be properly closed?
Struetures_(Lagoons and?or Holding Ponds)
9. -,Is structural freeboard less than adequate?
6, Freeboard (ft). Lagoon 1 Lagoon 2 Lagoon 3,
__—___......_.........-
I0. Is seepage`observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ
I5. Crop type!�.e��s
16. Do the active crops differ with 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 Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the 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?
Reviewer/Inspe:tor Name
Reviwer/Inspector Signature: Date:
❑ Yes ® No
JR Yes INNo
Lagoon 4
❑ Yes ® No
❑ Yes [R No
❑ Yes ® No
❑ Yes ® No
Q Yes 0 No
❑ Yes R No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JR No
❑ Yes ® No
Q Yes ER No
❑ Yes to No
Q Yes 0 No
J

Site Requires Immediate Attention: S
n Facility No.
�s DIVISION OF ENVIRONMENTAL MANAGEMENT
Q ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE= d U , 1935
Time: 3r�34
Farm Name/Owner: qf
Mailing Address: l �/
County: Integrator. a r a 177 A r c- Phone: 00,29 /q oC9
/%
On Site Representative: l �, Phone:
Physical Address/Location: of /d Z-I_o 2Lt bf r'r,
12/Yi ar �e
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 7 C/O Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or Actual Freeboard: _Ft. Inches
*-is
any seepage observed from the lagoon(s)? Yes or 0 Was any erosion observed? Yes or&
/� Is adequate land available for spry ? Z
or No s the cover crop adequate? 0 or No
Crop(s) being utilized: 043 tl �
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No '
100 Feet from Wells? V or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 19
Is animal waste land applied or s gated within 25 Feet of a USGS Map Blue Line? Yes O�&
Is animal waste discharged into of the state by roan -made ditch, flushing system, or other
similar man-made devices? o�V If Yes, Please Explain -
Does the facility maintain ade uat wasstteee management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes orJNo J
Additional Comments: l../
. L
_ Inspector Name
cc: Facility Assessment Unit (/ Use Attachments if Needed.
01 C)

Site Requires Immediate Attention:, 3&j
Facility No. 7 IPb
DIVISION OF ENVIRONMENTAL MANAGEMENT
. �-N ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: In 5-V
Farm Name/Owner: "
Mailing Address:
County: —P ✓&P,. ----- - -
Integrator. Phone: / rVd 0t_5 a /l 5
On Site Representative: _. Ati4 t 6iul-, A- _ Phone: (0-i5- BID
Physical Address/Location-
Type of Operation: Swine - ✓ Poultry - Cattle
Design Capacity: 25�91' Number of Animals on Site: �` Y `Ko�--
DEM Certification Number: ACE
Latitude: Longitude:
DEM Certification Number: ACNEW
Circle Yes or No
Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I -Foot + 7 inches) Yes o0 Actual Freeboard: --L—Ft. Inches 'W'`�'-'
iWas any seepage observed from the lagoon(s)? Yes o N Was any erosion observed? Yes o
Is adequate land available for spray? Y' s or No Is the cover crop adequate? (!Us or No
Crop(s) being utilized: 4--fl- /I
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? Oe or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into -waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o0NOIf Yes, Pleasd Explain_
Does the facility maintain adequate waste management records lumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o S
Additional Comm/tents: 2&/'/ A) , 6�aa
InspectorName
Signature
cc: Facility Assessment Unit Use Attachments if Needed:

•
•
r Site Requires Immediate Attention. `{ � S
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9-4 , 1995
Time:
Farm Name/Owner: o K a t 1-4 CIA AL)
Mailing Address: tv 0 %nZb
County: -e-
Integrator: lf`r 1w Phone: « 1 0) -
On Site Representative: [ram a�. Phone('310) ("J S - 3 $ t o
Physical Address/Location: rJ C s� 40 1
V S 12 14C
Type of Operation: • Swine Poultry Cattle
Design Capacity: _ z�`4-` `�' � c�
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: S4 ° _2,1_' a 9 " Longitude: -7.7- LIElevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes No Actual Freeboard: -L—Ft. Inches
No
Was any seepage observed from the lagoon(s)? Yes o as any erosion observed? Yes or�1V j
es
Is adequate land available for spray? r No Is the cover cro adequate. e r No �/
Crop(s) being utilized: -e C f S 4 CkG res )
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? Yes or No W i K tout-4-
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or&o
If Yes, Please Explain.
Does the facility maintain adequate waste management records (vo umes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes oCNo
Additional Comments: k 9 1
Yo
t h ff
S �2
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WO Pax:919-715-6048 Jul 20 '95 9:00 P.11/18
Sitc Requirc$ Immediate Attention
Facility Number:'?.I-
sm YisrrATION RECORD
DATE: — ,Luiy 17 - -- .1995
Owner: Hall Farm Name; §tonehoUae Road
County:
Agent Visiting Sitc: �..am & es ens _ �� - - Phone: [phone]
Operator: Donald Sera Hall phone: [phone]
On Site Representative: Phone:
Physical Address: 1=7 miles west Qf intersection of SR 1401 and SR 1400
Manias& Address: 4614 OS HWY 133
ROM Point, N.C. 28457
Type of Operation: 'Swint A— Poultry Cattle
Design Capacity: 3672 £inishiftnber of Animals on Site: 3672 Finishing
Latitude: ° ' Longitude;
Type of Inspection: Gmud x AcriA
Circle Yes or No
Does the Animal Waste Lagoon have, sufficient freeboard of 1 Fact + 25 year 24 hour storm event
(appraximarely 1 Foot + 7 inches) 'es or No Actual Freeboard; r —Feet inches
For facilities with more than one lag+ion, please addrtss the other lagoons' freeboard uuder the
comments section.
Was any seepage absezved from the ln;oon(s)? Yes o .No Was there erosion of the dam?. Yes or No
Is adequate land available for land application? Yes ado Is the cover crop adequate? Yes o a ,
Additional Comments: ,� erosion. Resume a new facility not a problem
to ity, No covet established for in - no clue as to plan, need
to check with Ken - pSWCD. Temporary storage has not beqbri satin£led.
Fax to [phone] Signature of Agent