310049_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

�vfsian of Water.
Facility Numberjor O Dlvislan of:So�l and-Water:Canservahon
7�
Cype of Visit: A'Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
[lesson for Visit:--Moutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: O County: Region: Region: �6ZI�-
Farm Name _ 1 Bro _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �j Title:
Onsite Representative: �J %l/5/ �(1�$ L-1
Certified Operator:
..-Phone:
Integrator: 03
Certification Number:
Back-up Operator: = Certification Number:
Location of Farm: Latitude: Longitude:
Di
Sw�nea wCa�
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
.'..
Farrow to Finish
.
Gilts
Boars
(Other=A y
Other
sign Current a ;FDesign ' Cia'rrent
acrtty Pop WetPoiultry=Capecrty Pop
Non -La er
Current°.
b
•;'Dry_-1?o.'ultryW�__�w Capacity .: Pop. "�
Discharges and Stream Impacts
Pullets
Turkeys
Turkey Poults
Other
y Cow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
'M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑'No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
E:I'No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑' No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[j No
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EfNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facili Number: - ! Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;j No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structur 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r2, '2!> \ o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2]No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/,or managed through a ❑ Yes ❑'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FZ] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �kNo [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [ 'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? -
❑ Yes qNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,21' No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E2-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes JZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes '[allo
❑ NA
D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 9No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Y _
Facility Number: jDate of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ONo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E3' io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1[jNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes J:I-No ❑ NA ❑ NE
❑ Yes ffrNo ❑ NA 0 NE
❑ Yes '0 No ❑ NA ❑ NE
[:]Yes
J-No
❑ NA
❑ NE
❑ Yes
[2-No
❑ NA
❑ NE
❑ Yes
[�J-No
❑ NA
❑ NE
Comments (refer to question #) Explain any.YES,answers and/or:any_ additional recommendations or any othei6co inents
Use drawings`of.facilrty«to better.explam situations(use additional pages -as necessary.):' ... , :."
s-7Ir 3Z sciw d.
Sew
Reviewer/Inspector Name: Phone: 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Division of Water Quality
Facility,, Number. �`� O Division of Soil and Water Conservation
O Other Agency,
type of Visit: j2rcompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine Q Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a p Departure Time: r County:i Region:
Farm Name: j �(S _EAjD&-3 5rJA ` Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: }
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Swine Capacity Pop.
Wet Poultry Capacity Pop.
,Current
Cattle Capacity.. Pop.
Wean to Finish
La er
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field Other: -
a. Was the conveyance man-made?
Cow
D ' Calf
Heifer
D Cow
Beef Stocker
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
ErNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
ffNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/412011 Continued

+ Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J21''No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
Z'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P�&o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
FNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VrNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
K No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ki No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;31No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
VTNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FrNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Fiffiq Number: ILM jDate of Ins ecti6n:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
•' 1` � r4
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�rNo " ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes VrNo
[:]Yes VNo
❑ Yes No
❑ Yes VfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E6 No ❑ NA ❑ NE
Reviewer/Inspector Name:
.. r
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0t5t-i iol -�5(j
Date: n ^j5- ] Lf
21412014

L Division.of Water Quality
Facility Number j -„�� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit erC.,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (3(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
�:� ,� Departure Time: s ` County: � Region:
Date of Visit: � Arrival Time: Court �
Farm Name:�� >E✓ D�►�_ _ �'} _ Owner Email: ( 1
Owner Name: ���\ Phone: t`/r V , `
Mailing Address: �O-� t C, due 1+`&~S\j `1T!
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: ?_j,NVN sU>r Integrator:
Certified Operator: w,l 1r Ww' y Qa+\ -�� -- Operator Certification Number: ` of
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = d =dl Longitude: ❑ ° = d ❑ IL
Swine'
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design .Current Design Current,
Capacity Population Wet Poultry Capacity Population'
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Cl Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle
Capacity rPopulation'° "
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number' of Structures: If;,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ffNo
❑ Yes
0-No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: - Date of Inspection:
Lj-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ao'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2L S
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): �low
—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
ff 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
E!fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DriftC ❑ Application Outside of Approved Area
12. Crop Type(s): �Lcawf:ee Cory" �_ J
13. Soil Type(s): 961e�r�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [fNo ❑ NA 0 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes ffNo ❑ NA ❑ NE
❑ Yes [2,�Io ❑ NA ❑ NE
❑ Yes Z^No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3"'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [] No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
� Yes
VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[]"'No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[3"No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[/To
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes dNo ❑ NA ❑ NE
❑ Yes [2fNo ❑ NA ❑ NE
Yes DNo ❑ NA ❑ NE
❑ Yes Zf No ❑ NA ❑ NE
[:]Yes [Ef-No
[] Yes ff No
[—]Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
(DNA FINE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
3kS�n� tAP�0� 1r AAe' P1 own
�,� 3 $ Li nt'e� +reu Cut` '.
Reviewer/Inspector Name: 4_ay 21:LVj�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: c�-SbM'a1
Date: 4�131 3
21412011

Division of Water Quality.
Facility Number - ® 0 Division of Soil°and Water Conservation
0 Other Agency
Type of Visit: &Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 3&Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: j t Departure Time: ® County:
Farm Name NAIL 0TH1W_S 4 �ec.aptl��Q1 L S—JOL60SOwner Email:
Owner Name: Phone:
Mailing Address: % aS Na a IN E oa� j 1 Lc—N ANS L L# , AIL 0D J 9 1
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator:
L A t—
`n W(�Q �A 1 C.
IR•
Certification Number:
_T9 a�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish 53) U
Farrow to Wean N0
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Capacity Pop.,
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design . Current.
Poults
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Pop:
Dairy Cow
Dairy Calf
Dairy Heifer
Dg Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yestzo
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection: (� /
WastcrCollecdon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes ❑ No ❑ NA ❑ NE
Structures 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .5'/Gt 5DL-_' 1 Sow A mow
Spillway?:
Designed Freeboard (in): 19.5 19.5 19 .S 19. S
Observed Freeboard (in): � �9 r- ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement? 7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
//C�
Window f _❑ Evidence of Wind
Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 'SG- L.�M w"'qT C�i_) 1�
13. Soil Type(s): CaK-L.IC _ Cjq_4oc-Pj _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JX(No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fo No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination? 9
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes KA No
[] Yes �Q No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ ya'ste Transfers
Q Rainfall [:]Stocking ❑ Crop Yield [] 120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Ll I Date of Inspection: L (D /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes pi
No
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes kNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otber comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�3aAT1c� � �e Doi 0�
�%Sc3.9 AMC 1 e
I i I � how 1 c,AGc�v�!
1�l .1ape of S Uwe �Ac.�or!
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[KNA ❑ NE
LLi.00' e
sat
t jy%
a
3 } pla
3
q
'5-n
Ll 5%
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: 5/6-1�'�3a
Date: �LO_ (221 0a.
21412011

ftiVacility
ision of Water Quality
1F'Number 3 - ivision of Soil and Water Conservation 4�
O Other Agency
Type of Visit: 1A Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I J 1 5 _ Departure Time: County Region:
FarmName: Q(a iL J` p� Owner Email:
Owner Name: �hWpl2S� 1L _ _ Phone: q1C)-0-9(0--/01 j
Mailing Address: / Y l� DL E KC—^/jQ �S UILLC , NC- Ore 3y9
Physical Address:
Facility Contact:
Onsite Representative
Certified Operator:
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
Title: Phone:
t� s�oN Integrator:
got 1
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
�+LaycrNon-Layer
Design Current
Dry Poultry C'anaeity Pon.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
1_:1FSas
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No
❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 1 -Ll I Date of Ins ection: J4 ) J/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes `" �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S e C=L>ue.(L �C�,C-J�l U0 He A 7 S
13. Soil Type(s): 1 V ((. C L'%<_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ® No
7�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 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.
QWUP ❑Checklists ❑Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No ❑ NA ❑ NE
Q Waste Application [j Weekly Freeboard [] Waste Analysis Q Soil Analysis ❑ V�6ste Transfers ❑ Weather Code
0 Rainfall ❑ Stacking 0 Crop Yield ❑ 120 Minute Inspections [] Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
TT
No
permit? (i.e., discharge, freeboard problems, over -application)
T'
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments "'
Use drawings of facility to better explain situations (use additional pages as necessary). M.LK
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q f ' +56 �3d6
Date: qRS &
21412011

r Jb Division of Water Quality
Facility Number ' y� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit I
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J3 Arrival Time: ® Departure Time: County: i�x4oC-1 Al _ Region:
Farm Name: �WA� 1 L S —� Ol „ „ Owner Email:
Owner Name: D W u �A 1 �-- Phone: C?J ()',g 90 —
Mailing Address: SS / V C 9L )C GW,4/V S V I LLC— / Y ol—L 01?3 L4
Physical Address:
Facility Contact: Title:
Onsite Representative:ROLLd {U _s7w/
Certified Operator: L ���+ ��A1 C.
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
10 Wean to Finish
❑ Wean to Feeder
Kj Feeder to Finish0
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
�Jb � ��5
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = S Longitude: = c = s = Il
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures :.`.�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 - y9 Date of Inspection /0
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 l Structure 2 Structure 3 Structure 4
Identifier: .7—/9
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 !XNo ❑ NA ❑ NE
❑ Yes YLNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S('-ti C109—At S 1
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 No ❑ NA [INE
❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes A No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes kNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ANo ❑ NA ❑ NE
,Comments (refer to question #) ;Explain any YES answers and/or any;recoinmendations or any other comments , r
Use drav4ings of;facility to better explain situations. (use additional pages as necessary) a NPo
Reviewer/Inspector Name
Phone: qlo
Reviewer/Inspector Signature: `� -
Date: Pd
Page 2 of 3 12128104 Continued

Facilify Number: 31 — tfi Date of Inspection J�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ 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. 0 WUP ❑ Checklists El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:1 Waste Transfers ❑ Anual Certification
E]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [] Monthly and V Rain Inspections O Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
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
ANo
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
Cl 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
t No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
) No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
12128104

,Dtvtston of water Quality
Fa A— Number: -Q Division of Soil and;Water Canservahau h
' C)"Other::Agenc}
Type of Visit Acompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ..Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 Arrival Time: ®C Departure Time: County: Al Region:
Farm Name: 7 i,WA2- 1.�V-11 - _ J_- 1 Owner Email:
Owner Name: LW CZ \6A I L- Phone: po-a9e3-4�a3
Mailing Address: ROLS f V CQ c- "i G 1C�/�RNs �, LSE . VC RSLIC?
Physical Address:
Facility Contact: (,� Title: Phone No:
Onsite Representative: Vole'-L-� 1 4AOuS 70A/ Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
�o
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La y er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
55 Feeder to Finish
(,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
El 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?
« Longitude: 000' 0
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: El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ElNA ❑ NE
ElYesjNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 1 — q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: —,5'10L
Spillway?:
Designed Freeboard (in): 19.
Observed Freeboard (in): IQ to
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes m 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 P_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 ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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) C<5Qkl LA—) T
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
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes]
No
,�\
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[No
El NA
❑ NE
~Co nents�(refer�to�q€re b �#) �Expla�n�anys ES�answers3andlor any recommendat�ons•or any other comments.
Use drawuags�of�facaitty�to betterEexplatn sttuahons(use addittonai pages�astnecessary}:
4il9_1m
Reviewer/Inspector Name C I'q S Phone: o--- 6(o -�3
Reviewer/Inspector Signature: Date:
rage L of -1 c,unnnuea

Facility Number: 3 1 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 appropirate box.
Q WUP 0 Checklists [J Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ taste Transfers ❑ p(nnual Certification
El Rainfall 0 Stocking ❑ Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections C] Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tK No
vvWo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U�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
ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gNNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
AID C3 I G DES ECivl�; 7 01V IN 1(Y) S - Wl L_L- G st s C-otZ nA S &V > > U
ULf-_16 H•Q�M H b,41 L WA UE AC i r U r C3 1 C
Page 3 of 3 12128104

V
Division of Water Quality
=Facifityumber 0 Division of Soil and Water Conservation
Z — 0 Other Agency
Type of Visit to Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit XRoutine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Q Arrival Time:Departure Time: r County: p Region: r^
Farm Name:r��-rJ�}2!� ZL/}; Owner Email:
Owner Name: � W� /9 �L _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ail- C 4/5 ;�-o� Integrator:
Certified Operator: Zi Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o = 6 =" Longitude: 0 ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
U�Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars i
Other
❑ Other T -,
❑ Layer
❑ Non -Layer k
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: rn
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ 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? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Straclure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan?
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) /
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ////�No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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 Acce ble Cro%p�Wi dow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) X0y(/ ni
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
P,No
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
(No
❑ NA
❑ NE
Reviewer/inspector Name I Cz Phone: %v 71 ' 32
Reviewer/Inspector Signature: Date: !7 O T _
12128104 Continued

Facility Number: — Date of Inspection `T---T—
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 [INo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
l
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
//
[]NA
El NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
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 XNo
❑ 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?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
/Additional Comments and/or Drawings:
❑ YesZiff No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes J[J No
❑ NA
❑ NE
❑ Yesd No
❑ NA
❑ NE
❑ Yes �No
❑ NA
El NE
❑ Yes ;dNo
❑ NA
❑ NE
I212RI04

• Division of Water Quality
Facility Number Division of Soil and Water Conservation
�=__ -- - - - 0 Other Agency Leo*
E
e of Visit (�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
son for Visit` Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: 7i Q Arrival Time: ( :19 Departure Time: y County: uP Region:
Farm Name: Owner Email:
Owner Name: ,D�cl,�]rzn LL Phone:
Mailing Address:
Physical Address:
Facility Contact: / 'Title:
Onsite Representative: (�
Certified Operator: Ae 6�c Z�
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
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 Longitude: = ° 0 f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
IT_T ❑ Non -La er I- EE1
Other
❑ Other -- - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: nl
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ 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?
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IQ 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?
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
❑ Yes
VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes �'No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �O/QJII (/(/f� 4OU�/lS _
i
13. Soil type(s) e7
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviiewerAnspector Name — — — — - _- Phone: /iI Y
Reviewer[Inspector Signature: Date: 216
Page 2 01'3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes IVNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;KNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
X
ElNA
ElNE
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
VfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,/
L�No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
// No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 3 I
I.
Division of Water Quality
0 Division of Soil. and Water Conservation .
O Other Agency
Type of Visit ,1
1 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 Arrival. Time: Departure Time: �.� County:
Farm Name: _ Ae,mo _ AEG���� Owner Email:
Owner Name: �OL.%A2i4 TTQ Phone: _
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: t !rzf]t-)
Certified Operator:
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
Gifts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region,401
Latitude: 0' 0' n Longitude: n OF--]' n"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I
❑ Layer
I
❑ Non -Layer
Other
❑ Other T
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I . 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
Number of Structures: 171
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1,No
ElNA
ElNE
ElYesNo ❑ NA ❑ NE
12128104 Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage.plus heavy rainfall) less than adequate?
❑ Yes
INo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
ElYes
/❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
jo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
V, 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 ❑ 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?
jo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) (Ae,.,! 0,(W" �,—
13. Soil type(s) Aklzf,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes In No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
yes VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[--]Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
7_1v- berZo.J yPgp-r
Reviewer/Inspector Name A2, Phone:
Reviewer/Inspector Signature: Date:
121281614 Continued

Facility Number: Date of Inspection G�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ElDesign ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. /ZYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking Ocrop Yield ❑ 120 Minute inspections gMonthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VJ No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes P�No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Addtti ahCornrnents:anW/or Drawings: c: &, t s{ ; `,_
12128104

[Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time: -0"
Q NotOperational erational Q Below Threshold
J!rPermitted *ertiified 0 Conditionally Certified [3 Registered Date Last Operated or Above reshold:----- ------- - .....
Farm Name: ...... ....CD1.!LV
.....�F.Hr_ .... .' 1-2-_..... .- ....._ County: . ��.......... .,
Owner Name: ---------------------------- Phone No:
MailingAddress: ................ .._.................................... ..... _..... ........... .......................... .....
Facility Contact: ....._............. ........ --•.---.--- __ _..... Title:
Onsite Representative:
Phone No:
7 �.'._ _._.... _....... _..,
Integrator: ri.l........................................
Certified Operator: ....................... . ................. ................... ................................ ... Operator Certification Number:....._.... .................
.... .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude 0 S «
Discharges 8 Stream Impacts
I. 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) [j Yes ❑ No
c. If discharge is observed, what is the estimated flow in gat/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 7NO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [IYes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U<O
Structprcc 1 ^- Structure 2 Structure 3 Structure 4 . Structure 5 Structure G
Identifier: .........�................ _............. ..... , ............-•------------
Freeboard (inches): 3 _'z'
12112103 Continued

Facility Number: 9 Date of Inspection I y f71
5. *Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Y,es/No:
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? Yes ❑
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance improvement? ❑ Yes o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes['1No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C5IJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes dLAD o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes o
b) Does the facility need a wettable acre determination? ❑ Yes ire
c) This facility is pended for a wettable acre determination? ❑ Yes db
15. Does the receiving crop need improvement? ❑ Yes 7NO
16. is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes b N
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ld 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 o
Air Quality representative immediately.
;Comments (refer to guestaon #) *Ezplsui zany YESaauswers and/or anyzi ecomrriendations or any ot1%er comments. "•
`Use drawings of lacdity to better exglarn sitoartons: {use adddevna! P� � r9) :� ❑ Wield COPY ❑ Fina! Note�s�-
WASIA0015 LOC-AVID -TA-� ibTN hVOT 'F=ELAS• 1sC-ED N.AZWEN(ANLE c5d
AL
W ftV*(L ►A '?S Ats 6 .
�•� ,LR6t1 2Eco".S (0az.
35.) C"P FoaLtnns n166D ro ge UP fw%0 r
WK - SE QT �3 RAa:�O VA LL-' Ev'60TS l eE D t6 6C wX-T14 QEGoX(O5,
�LjQX; TZQL-5 IrO-- AFTE2_ t� �} POT PX s Kft
A lyNlfAL Ck k=(:-x6A1_To J fbYZ M WaO S, ra 8E norm W"b 59\�t ZtJ
St,0bG,E 3&*-JEY f� 9-k D&J( 13'� AX, * , uo f
CALUOLAI'v-� Tc) 6C 0a,* �' AM 2A` U64, p�s-- 700j* trj �6 �•
Reviewer/Inspector Name b u
_
Reviewer/Inspector Signature: Date: 7 4
12112103 1 Continued

Facility Number: 3 Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Doe record keeping need improvement? If yes, check the appropriate box below.
Doe
Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes O No
❑ Y s O/No
Yes ❑ No
❑ Yes p N
❑ Yes No
❑ Yes 7No,
❑ Yes
❑ Yes
❑ Yes �No
Yes ❑ No
❑ Yes
❑ Yes No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Y ❑ No
35. Does record keeping fo DES required fo eed improv ent? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form Crop Yiel orm Rainfall Inspection After V Rain
❑ 120 Minute Inspections Annual Certification Form.
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

s
_
- -
Q'OtherA� e'
ncti�
Type of Visit O Compliance Inspection
O Operation Review Sjf Lagoon Evaluation
Reason for Visit O Routine o Complaint O Follow up 0 Emergency Notification
0 Other ❑ Denied Access
Facility Number Date of Visit:
E3 Permitted [3 Certified 0 Conditionally Certified © Registered
Farm Name: 2 WAR12 _
Owner Name:-4*,-7-L
Mailing Address:
Time:
Date Last Operated orAboveThreshold:
County:
Phone No:
Facility Contact: Title: Phone No:
r
Onsite Representative: file-,Q _ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude �' �4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Cavacitv Population
❑ Wean to Feeder I I I ❑ Layer I ❑ Dai
LO Feeder to Finish 1 IEJ Non -Layer Non -Dairy
El Farrow to Wean _ .. ILI. _
El Farrow to Feeder 10Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ goy Total SSLW
I Number of Lagoons % I JU Subsurface Drains Present_JILJ Lagoon Area JLJ Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ZNo
Discharge originated at: ❑ Lawoon ❑ 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 ANo
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 1�1No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�
Freeboard (inches): 23
05103101 Continued

i
Facility Number: 3 f — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Cl Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Avylication
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
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 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 Zo
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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'wP'
Comments(refer to question #) an ExploWany YES;sweis andfor- anv�4'recommendahons'orzany others©mments. e Y `'
tuse.drawtngs of facilrtyto better egplarnsituatsons (use addittonal pages�as necessary) i
�yA ❑ Field Copy ❑ Final Notes
Illy
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date:
0510310I
Continued

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
f :
Reason for Vis?C/Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Date of Vuir. Time:
Facility Number
O Not Os►eratiopal O Beiow Threshold
[3 Permitted [3 Certified ❑ Conditionally Certified 13Registered . Date Last Operate Above Threshold: ..._.„..._
Farm Name: __. � a . �.1 �� r � �,� Coup W &:.rA ............
Owner Name: .................. ED- ! r.), . � � ........... .------- Phone No:.
MailingAddress: ................................... „„..„... _......... „........ ............. ......... ............... .......... .......... ........... ............ '—................... ...........................
.. .............„......._..
FacilityContact: ................. ...:......„..... Title:.......„................. Phone No:................................. .............
Onsite Representative:. „9-L Integrator �O ......................„....
._. In ............_.................
Certified Operator: „„......... Operator Certification Number.
Location of Farm:
Uf Swine ❑ Poultry ❑ Cattle ❑ Horse IAatitude 0 ` K Longitude ' 4 "
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: © Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? I,] 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 gallmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity'(freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes No X
Yes No
❑ Yes No
Structure
Identifier: ..........„...... - _..„.„. .. �. ... .. _........ .--_....„..— ....
.................
_ .........
... — ..._...
Freeboard(inches): ........ A .............„ ..... ............ ................... ......................... .

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
11. Is there evidence of over application? - ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12_ Crop type
r - i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of -Coverage & General Permit or oilier Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample'reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. -Fail to notify regional DWQ of emergency situations as required by General Permit?
Cie/ discharge, freeboard problems, over application)
.23. Did Reviewer/Inspector.fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
Yes
X No
❑ Yes
P(No
,Yes
❑ No
Ll Yes
Q No
0 Yes
[/No
Yes /No
Yes ,INo
0 Yes 15No
0 Yes No
❑ Yes ❑ No
❑ Yes [ No
�] Yes No
❑ Yes Q No
El Yes �No
Yes �11 No
,VYes TTT0 No
❑ Yes No
❑ Yes No
[] Yes j No
El Yes No
�j Yes l
[:]Yes /1[/No
:No violations or deficiencies were noted.during.this visit. You will receive no further -correspondence about this visit
:.,..::�..:...-..: :.t:,::t:�t::�T: �_:} :- ..`.`:2}}}}:t.::::. , kT:::.:,:t:-.}:: , ilk:„ wT:.{.i...:,-sk..:.,,i•.`.:gst.: >i, .t, ` , s : ct.::.:x. a.4s G...:,,.,:.:. ..t:..t?t-}u.:a. ."R
t`Oui�ililitlp���
�-�+fa1-Li''
rt...:,... ?�:Tt£:
...::"trii�2`y'.ii:.:�:-:w'CYfiii-::.[d:L...t�'"!ikYiiLt.�:�.- vh ?{SYa
Field C j� Final Notes
.{<•: ?Y.y;.:: ..c:�a:t
v:.:.... .i- .: ..tt ... ..-..:.mot
.tvnvty- tii.}:v._.;•:.x vie' kt;_::tit:
- iYi.:y
.r::.i
..: :.IX....-.: . .i...t. ,:.: ..._.:i t§ :.:.0 .:.:?^::e%iRt... \._.. ..... ...vt�^:i<4 c...:�2....:.viiii'.�::s'yi:` :.T.:: ..kt�:<...i:; Ovt•?!•2:C{i-S.t :r:C{?ii ? C;Si \:YN?utvt... ':N. .X nukii.T:T...
..... SY .. ..... Y:Y. .)....,::: .... YYY.4 .- �. :..... Y.... ........... . . - ..{ t ."._^C:-fi.... S...
s....:v.:..::....:..:•...ft.::::v..:.:t�.t-
7;fE J� �,�� Iil��9LL S Qi�
ilea % 741:-F
Reviewer/inspector Name �-�-• -<' ' ' � � � � ' ' �.. �..-"
Reviewer/Impector Signature: Date:

Facility Number: / — Date of Inspection �f'J/per
41
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
'z9K'ro e'00,0,
❑ Yes ❑ No
❑ Yes (� o
❑ Yes / No
❑ Yes dNo
❑ Yes ;No
Yes
❑ Yes ❑ No
05103101

Type of Visit • %BkCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit OlRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number jDateof.visit: ^ X�(Time: �Q
O Not O erational O Below Threshold
OPermitted ❑ Certified U Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
�. 1 Y+ Farm Name: ......�................ .�... �..11'`~��................................................... County: ��,�-:,�
Owner Name:
Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ............................................................................................._............... ....................:.....
(1
{ a
Onsite Representative:...... ...!J1.�. Integrator:.....`.4.............................................
Certified Operator:.........................................._..................................................................... Operator Certification Number :..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� OFF Longitude �• �� ���
.. Design Current "Design' Current - Desrgn _- Current -
:.Swine Capacity Population Poultry - C21DaCitV Po elation 'Cattle Ca acr = Po elation
❑ Wean to Feeder ❑Layer ❑ Dairy -'
eeder to Finish �"760 ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean = .
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design`Capaeity
❑ Gilts
❑ Boars Total; SSLW
Number of -Lagoons ❑ Subsurface Drains Present ❑ Lagooa Area ❑ Spray Field Ares
Holding Ponds / Sofid Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
WNo
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 gaUmin?
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
Wlo
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
JXNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................................................................ ................................... .
Freeboard (inches):
5100
Continued on back

Facility Number: J ( -- ` C( Date of Inspection
Printed on:
: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 01
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
10/26/2000
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?. , ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management PIan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; i i •yio hWfis;or defdend'p$ •mere 000d ditrift ibis;visit; • Yo. will•r. eedt . ]io furth ; ;
correspondence. albout_ this visit
❑ Yes 0 No
❑ Yes klo
I es ❑ No
❑ Yes No
❑ Yes KNo
❑ Yes D�No
❑ Yes XNo
❑ Yes b`No
❑ Yes XNo
❑ Yes WNo
❑ Yes �No
❑ Yes D(No
❑ Yes $ No
❑ Yes KNo
❑ Yes IM No
(Yes ❑ No
❑ Yes [R"No
❑ Yes WNo
❑ Yes 0 No
❑ Yes KNo
❑ Yes WNo
❑ Yes WNo
Co-l"menti (re&r to question #): Eicplain any YES answers and/or any recommendations or;any other comments a
Use`drawings of facility to better explain.situations. (use additional pages as necessary)
Ave J�f
C� ��2� G+•1 3 \�' �� � ,Si..w �� �u-�T Sr..r�� f � +—� -iQ.� ,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: —�� d _ 5100

Facility Number: Date of inspection �-'-F d Printed on: 1/9/2001
Odor Issues - G i
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'H`No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P(No
I-Adoitional-Comments andfor' ravnngs:•
5100

Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 4 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ?Q Time: %5:ro Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold
Farm Name: ............... .P.l...L....... ................ �..................1....a V.V...S....... County:....................L�.1lL .(�.(/i ........................ ....
Y
Owner Name:......... .�.i �w`. Phone No: .......................................................................................
Facility Contact: .......i.K1 v ( ..�..WW. . Title: i/W1!t �I�`................... Phone i\io:...................................................
... ......
MailingAddress:....................................................................................................................
Onsite Representative:...(kG.lti .�......... �`.J................................................... Integrator :...... .................... .... Y.!r�.�..�..J.�..........................
Certified Operator: ..... ............................................. ................. I ................... ............... Operator Certification Number: ..........................................
Location of Farm:
Swine ❑ Poultry []Cattle ❑ Horse Latitude • ° ai Longitude 4 C�«
Design Current Design Current Design Current
Swine Capacig Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer I I Dairy
eeder to Finish �f ❑ Non -Layer I ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present ❑ Lag,x,n Area JETSpray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impact~
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; than -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 now 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
Stryutre I Structure 2 Structure ; Structure 4 Structure S
Identificr:............. ....�............ .............................. ...... .................................... .................................... .............................
Freeboard (inches):
5100
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
r- NA —
El Yes ❑ No
❑ Yes L&No
❑ Yes f.No
❑ Yes PNo
Structure 6
Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs ve ? (ie/ trees, severe erosion, Yes [�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )KNo
(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 (kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑`No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes P(No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
No
14- a) Does the facility lack adequate acreage for land application?
❑ Yes
No
h) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
[ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
j�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
o
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
j�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
o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
'ANo
K4 .*Uhtidtis :or• def uencies -were noted• dlirr'ifng this: visit; - You will-i-eeeiye Rio: further: :
corresooride' e:ab"ftK 'sit:'::'::':':':':::':':•:':':,:':':': ,:':':.:.:. ....:............
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):
t4f�g4 Wk -c.
ReviewerlInspector Name AA t
Reviewer/Inspector Signature: Date: f 2 6vII 5100

Facility Number: — Date of Inspection
Odor Issues 14d,
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j�I�}o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )&No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes CNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9�o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ?1�0
Additional Comments and/or -Drawings:...

.. 13 Division of Soil and Water.
J. E Division of Soil and Water"
iv�sron of Waiter'Quality
k l�•
;D Other Agency. Operatiofl_
�oiesei�va4on-'O}�er` anon Review , : • - =
� t<
�onser�ahon -_Compliance'Inspection `- Compliance Inspection - '
tevrew
outine Q Complaint Q Follow-up of DWQ inspection Q FollOW-Up of DSWC review Q Other
Facility Number Date of Inspection '7 Z
Time of Inspection 1 % : 4 24 hr. (hh:mm)
Permitted ocertified [3 Conditionally Certified © Registered [3 Not Oper—a-t—io'n—all Date Last Operated:
Farm Name:.......E0.W....!E1�....°t-c.................................................................. County:....._....u_.pL.�-•'f.--.............._.
Owner Name:
Facility Contact: ........
Mailing Address:
................
Phone No:
............... Title:................................................................ Phone No:.........
Onsite Representative: ...... -t?vs-...A!.,r................................................... Integrator: ........ N1-.............................................
Certified Operator: ...................................................................... Operator Certification Number:......].. W p .z ...............
Location of Farm:
............... _.............................. __...... ____________________...................................................................................................... ______........................
_____________________________________________________________ T
Latitude Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
t Dao
❑ Farrow to Finish
❑ Gilts,
❑ Boars
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'?
h. 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
❑ Yes .O No
❑ Yes WNO
❑ Yes .iJ No
❑ Yes EfNo
❑ Yes No
❑ Yes jj'No
❑ Yes O/No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:'
Freeboard (inches): !........... .......... .............. ................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 9NO
Continued on back
3/23/99

Facility Number: — Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops diffetwith those ddsignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. JVere any additional problems noted which cause noncompliance of the Certified AWMP?
z �
❑ Yes V(No
❑ Yes J No
❑ Yes &No
❑ Yes �No
❑ Yes ; 10
❑ Yes No
❑ Yes ANo
❑ Yes JG3'No
❑ Yes ,rNo
tkes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes)ErNo
❑ Yes e,3No
❑ Yes ;2rllqo
❑ Yes �?<o
❑ Yes ❑ No
❑ Yes )2 "No
❑ Yes O No
❑ Yes �No
[]Yes 'CO
N,6-yi6iati6iis :or- de#iciencies were p¢ted• ding �his:visit: • Y:oit :will-reeeiye lid fut ther' - : .
correspondence. aboait this visit:... . • .. .
Comments (refer to question #)::1✓xplain Ratty YES answets atid/nr any recommendations or.any other comments::
Use:drawings-of facility to bettef explain situat lids (use adiittronaf pages as:gecessary)
i� C JeEDS c.ALL_%Jtl,-r.`a4.V Fat— /Aei6AWZ Qt4Q;X V=4V7— I�
%) C—t,g,4c1 UECF-r-Ar'ra4 A�.►A�. F{t� n,. atir�',��L�tv3 �i f� +n,.+. �l[iC.�..LAG
E A 63 4 c i'0-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
7�o`
Date:
3/23199

Facility Number: Date of inspection 2q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
/Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes PTINo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes J2 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes [:INo
31 _ Do the animals feed storage bins fail to have appropriate cover?
❑ Yes 121<0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
—p4es ❑ No
Additional omments�an_. or rowtngsw .-
32J cvcAA, c) T-*-/- 9�D ag- J5 :..t r' lf4 �Cyc-LE- Lk ��+ inrcxcASt`S
//
� t4L`'r �3 c� i t_'J v P 4►-1� ��uz�3 9 �C� l�� S 3 � !�-£s'`1zlc�-r�o,J'S
T -rz 444� P,-,4A °.0 T"o �ps�, A40~«/CK£iaSEA /tl4rnll�ry�r�N
Al S To sC�; r�-Lo tj r i 7la '�- i..0 s rF `r�M ,c TO OSSr--"F- fP-4Pf=F-
3123199

IPI
0 Division of Soil and Water Conservation 0 Other Agency
0 Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection LL019 -�
l
Time of Inspection � 24 hr. (hh:mm)
© Registered ;3 Certified © Applied for Permit CTPermitted JE3 Not Operational Date Last Operated:
Farm Name:............ ...... .....
Owner Name : ............................... E"j...........
.oa�.....
Facility Contact: .............................................................................. Title:
Mailing Address: ........... .)!�...... N.t........5 ............................
Onsite Representative: .............1....U-A..............
Certified Operator:..................................................................
Location of Farm:
.. County: ......... tstkv.. ...................................
Phone No:....(%Aa12nk...... vaa........................................—
PhoneNo:...................................................
.....................s`v li�...r.1N..4.:.................................7 �iq.......
Integrator............ 4:" s..
Operator Certification Number;
r,..... nra.... 5,t . S.I� A.- .�9.t..sJ :..5 .....lr.�I � �.....t ltz�........ e...........Nt� �................................................................................
-----................................ .............. ...... .. ........... .....
Latitude 0 6 O4C Longitude • 4 96
❑ Wean to Feeder
Feeder to Finish
S`J Q
] o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2. Is any discharge observed from any part of the operation?
❑ Yes
19 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
EP 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
EP No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
S No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EP No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
`P No
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
( No
7125/97

Ai
Facility Number- -St 9,
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
El Yes 19 No
0 Yes 14 No
Structure I Structure 2 Structure'3 Structure 4 Structure 5 Structure 6
IdendFier: ................................... ................................... .................................... ........................ .....
Freeboard(ft): ............... 33 ............. .................................... ................................... ...... I ............................. .............. I ..................... ....................................
10. Is. seepage observed from any of the structures? 0 Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? El Yes No
12. Do any of the structures need maintenance/improvement? 0 Yes No
(It 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 WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. !4Pc!^ ........... A� ............ 4.�� ....................................... ................................................................................
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'la'tio'ni-'or'd6ri; ie'nc'ie's'w'e'r'e-noted-duiing this'.visit- You:will rie'ceii'veniottirtlier'',
........... .. .....
correspondencetihoiit
I Z. GWO� C_ 1AX 0" t "Wa- d i V-C
mat V � � at ki Tj -
El Yes 16 No
0 Yes EP No
0 Yes [,N No
0 Yes No
0 Yes No
0 Yes [3 No
0 Yes In No
0 Yes No
0 Yes No
❑ Yes P No
❑ Yes No
❑ Yes No
7/25/97
W '...g..M-T
CMRE!"
Reviewer/Inspector Name '2."'-
N.
'02
v
Reviewer/Inspector Signature: Date: jj� 1

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine O Cam laint O Follow-u of MV ins ection O Follow-up of DSkVC review O Other
Date of Inspection !0
Facility Number tI Time of Inspection�24 hr. (hh:mm)
® Registered © Certified © Applied for Permit 13 Permitted 113 Not O crational Date Last Operated:
Farm Name: 'yt County:..........v.�l�r►....................
Owner Name: ......f�;Jw .... 1 ..................................................... Phone No:..��1 N1).. '� G.-.Q.?............................................
Facility Contact:.......lsictia.......................................Title:......MYirava..................................... Phone No: .... 7..........
Mailing Address: 1`5....�.�r.....�.!�.�`�.....sec.��`.......................................... ....�SaIa (...I..C_-... .......
.......................... ..� 41........
Onsite Representative :............ .....Lm- ..... Integrator:...:.-C !l....1.fs..............................I.......I...---•-........
Certified Operator;..........
Location of Farm:
Operator Certification Number, .... ANSI. .....................
�i4....k�i�.y....Z...... ............. ....wx> 4...1AX.6......11 .1...an........( ,..1.x a.. s&rn .....,:A............ar........
...L t. t)............................................................................................................................................................................................................ .
Latitude • 4 " Longitude ` ' 0"
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. , If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated Floe.• in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
main tenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7- Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes
10 No
❑ Yes
el No
❑ Yes
14 No
❑ Yes
MNo
N
❑ Yes
® No
❑ Yes
(54 No
❑ Yes
® No
® Yes
❑ No
❑ Yes
[R No
❑ Yes
� No
Continued on back

Facility Number: 7t 1 —!T {�
8. Are there ]asoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lazoons Holdint< Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes R] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ........ 1:...1...............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
F°Vaste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ........ � .... ...................sp.-14.........................................W1 t o'A
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
I& Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement? ,
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
® No.violations•or deitcieitcie's.we. noted -during this:visit.- You.will iecei. eini o•ftirther-:
corres'pondehO about this:visit:-
❑ Yes. [31 No
❑ Yes CO No
'4 Yes ❑ No
❑ Yes ® No
❑ Yes Ed No
❑ Yes (A No
❑ Yes i54-No
❑ Yes ® No
❑ Yes No
❑ Yes JO No
❑ Yes ® No
® Yes ❑ No
❑ Yes �UNo
❑ Yes EgNo
❑ Yes (@ No
S WM .X%. ,r, r-:Ser �X� S6ovid lie PILA a-,J r,rc edeJ,
17 - Erewt\ fauk oh %%imr/auto- well of Jalm, sL�o be. � 16d Wyk day aij rf tce W. SMAY
l�• ��` ac1^co,��t lra lee. S�[� os` ���� � �i5it� +n �IGr- S�+Y� �f.o+r�S ��� fie-.
7/25/97
Reviewer/inspector8ame
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ReviewerlInspector Signature:
Date: lo%y-TIL4'}

Site Requires Immediate Attention:
' Facility No. 'I I - q�9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ff-2 JL _, 1995
Time: ZZ 'In� .
Farm Name/Owner: (:U�Q, , I
Mailin Address: �d�5 �1((� �( �'a21 . � j; , (te iV �� 2�� County: _ G3 ►ti•- _
Integrator: OQ r .r v t L S R Phone:
On Site Representative: 84EW iJl4 Phone: 9e - 0 76&1- _
Physical Address/Location:
Type of Operation: Swine -L/ Poultry Cattle ( h15 kj
Design Capacity: �7(o a ^ Number of Animals on Site: 76
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' Q4;" Longitude:? 7 3L) " 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) eorNo Actual Freeboard: _Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or, Was any erosion observed? Yes or d
Is adequate land available for spray? e or No Is the cover crop adequate? • es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?Oor No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o� .
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(@
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar, man-made devices? Yes `C N) If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
•
spray irrigated on specific acreage witivover crop)? Yes or No %
6?2 J, law —
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.