310065_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

�� h e DEVIS1onSof�WatefReSollrCe5v rM
.,.` of - �y ..rSv+•,� ^��w•
Facility Number 0 Division Sofit+Water C d and onse`aK-r 7ation : �r
.:0 Otli"er Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [oL� Arrival Time: I c^jjr1DQ4.%,Departure Time: 19-'�a.�, County: U194z7>nlRegion: [Nr%^
c 1
Farm Name: Owner Email:
Owner Name: C. 5;_J lip IGt�y Phone:
Mailing Address:
Physical Address:
Facility Contact: e !�+-,r� j0�✓ Title: Phone:
Onsite Representative: �r "t 571. Te�T_
Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Design
Current Des g
'Swene Capacity
Pop :Wet Poultry Capac11
_. ..
Wean to Finish
La er
Wean to Feeder rLOUvb
Non -Layer
Feeder to Finish
Farrow to Wean
Desigi
= Farrow to Feeder
aDr Poul Ca' ici
Farrow to Finish
Layers
Gilts
Non -La ers
Boars
Pullets
Other
—.Turkeys
Turkey Poults
F-r6iher
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?
Longitude:
rrent
on-.
Dairy Cow
Da'y Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder -
Beef Brood Cow
-
YS;
4Niyy '�" Y �euY•y�....i3
[—]Yes P�pNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
® NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

c
acili 'Number: IDate of Ins ection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1 9—-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
-1
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Structure 6
❑ Yes
F, No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ 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? to
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [_No ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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 Window ❑ Evidence of Wind Drift El Application Outside of Approved Area
12. Crop Type(s): cM5Ty✓!
13. Soil Type(s): 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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?
rj
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [?jNo
❑ 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 �] N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rM No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

acili `'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 [P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues T
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes �No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: 910 - L/ 3/ 7 r31�
Date:
21412015

"{ of Water�Re os urees
Fac,�l!ty Number -._O Dv1san5o�iaiid Water C©nservation"g
Cype of Visit: 7Routine
fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Qd Departure Time: County j�-,— Region: SL.,
Farm Name: ��7P, ���v�- ���] r Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
e �' = Capacity
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
'l Non -Layers I I I Beef Feeder
Pullets I I I Beef Brood Cow
ures
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes J:?.No ❑ NA ❑ NE
❑ Yes NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: IDate of Ins ection: y
Waste Qollection & Treatment
. 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
ST
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 V] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0. 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents 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.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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 [] N
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: 1 2
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
L T
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LEI'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 P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;31110 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �allo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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?
❑ Yes )ZI No ❑ NA ❑ NE
❑ Yes P�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes J:a No
❑ Yes R7rNo
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: p \ �? Phone: 9M 71?6 73�
Reviewer/Inspector Signature: Date: f Z
Page 3 of 3 2/4 Ol 5

ivision of Water Resources
Facility Number - Lot 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 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 0 Denied Access
Date of Visit: ] / Arrival Time: Departure Time: County:
Farm Name: Y l<&7� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: me 3AjLal —
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
Latitude:
Phone:
Integrator: %��/j
- I
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry Capacity Pop.
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �allo ❑ NA ❑ NE
❑ Yes -1!� No 0 NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes El No
❑ Yes 4 No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili ,Number: - Date of Ins ection:
Waste Collection & Treatment ��/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I yNo
a. If yes, is waste level into the structural freeboard? ❑ Yes T�No
❑NA ❑NE
❑ 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 D, o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 77
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes ❑/%lo ❑ NA ❑ NE
waste management or closure plan? 77
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
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes aNo ❑ 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 E2"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, etP.)
❑ 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 P�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �{Vo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes TP No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JZNo
❑ 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 PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �10
❑ 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 C2(No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA [] NE
Page 2 of 3 21412014 Continued

Facility umber: - Date inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑Yes
�No
❑ NA El NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
WNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
FIQo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
PNo
❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes
�No
[3NA
❑ NE
and report mortality rates that were higher than normal?
�'"
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
/ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
;i to
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
RrNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
( to
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer -to question # Explain any YES.answers and/or -any additional; recommendations ur�any other comments �" -4 ;.
Use drawin s:offacili g tyto`.b' tionapages as necessary.ettet ez lain-situationsuse addil°
CC4
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
8q
In
Phone: !V NZ. ..
Date: L�
21412014

Division of Water. Resources
Facility: Number 1 t O Division of Soil and Water Conservation
O Other Agency .
Type of visit: 91
Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,' U Departure Time: County:
Farm Name:}��., r 1 drZ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Phone:
Integrator: m
Certification Nu ber:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current Design Curreutx Design, Current
°- SWine Capacity : Pop.` � �' Wit Poultry `Capacity °Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La er
Non -La er
Design Curent
Dry Poaltr Ca ' aci 'Po
Layers
Non -Layers
Pullets
- Turkeys
Other Turkey Paults
Other Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
'
Non-DaITY
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts �f
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes fiNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes gNo
❑ 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 Z(No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
TdNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
L
Waste C llection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L'No
❑ NA
❑ NE
a
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes qNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P 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 A➢Dl►catlon
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 �9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 7�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
'No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
[:]Yes
❑ NA
❑ NE
Required Records & Documents5)*o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r"- No
Aj
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA NE
Page 2 of 3 21412014 Continued

Facitity 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.
O Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 0
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 0
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes V
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 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, addition- alrrecommendations;ar'tiany other comments
Use drawings of facili � Ito better explain, situations (use additional, a es:as,necessa
710 1 V /" ql I
7 9 r
�90 Z
/ 7a /
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7
Date:
4/2014

Division of Water Quality
iFacility Number J / = 0 Division of Soil and Water Conservation
0 Other Agency
type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Dvda
Farm Name ��r l p } l��r� 1 1 �- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �, 1- �P_ sk3Qb 1
Certified Operator:
Title:
Phone:
Phone:
Integrator: Kn Zf)
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other ..
Other
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Caaacity
Poo.
Layers
Non -Layers
Pullets
Turkeys
Poults
Turker-17y
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:
Cattle
Region: /"
Design Current-
Capacity Pop.
Daig Cow
Dairy Calf
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes ,E� No ❑ NA ❑ NE
❑ Yes '12 No ❑ NA ❑ NE
❑ Yes
r] o
❑ NA
❑ NE
❑ Yes
1No
❑ NA
❑ NE
❑ Yes
J23'No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection: In JC?
24: Did the facility fail to calibrate waste application equipment as required by the permit
❑ Yes ,ZNo
❑ 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 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes �2rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P?No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes PrNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes JZ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes A No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes 2No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Z No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes F!rNo
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
..3nntcr�rr
r(�� e SUril All I s
r s
1(9()y6 '500J 1
.r5arm
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: "7L
Date: O
/4/2 II

Facili Number: jDate of Inspection:
W,aste,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
E f No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: - ,Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZI 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
[j 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
E3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V' No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
PrNo
❑ 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
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff 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
[�rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E2rNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
i
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

Division of Water Quality
- -FACility Number 0 Division of Soil and -,Water Conservation
_ _ —J 7
I 0 Other Agency,.
Type of Visit Q16ompliance Inspection 0 Operation Review 0 Structure Evafuation 0 Technical Assistance
Reason for Visit IQ-9outine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
�
Date of Visit: L Arrival Time: if Departure Time: G z9 d County: Region:If
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
= Longitude: = ° =
Design. Current Desi . e
Curren"t D urre
Ca aci Population ry Capacity,,Poplation R Cattle Capan C nt
Swine . p ty Wet Poult g city +Pcpufahon,
❑ Layer
❑ Non -Layer
°Dry Poultry
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 91f4o ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ZNo
❑ Yes P'14o
❑ NA
❑ NE
❑ Yes 14 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: ` Date of Inspection
v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ­2 Z
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 (2"No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
R�No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any'of the structures need maintenance or improvement? ❑ Yes L_I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Auplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement? ,(
]I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land applicati6n? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA ❑ NE
[-�No [I NA El NE
[;,I No ❑ NA ❑ NE
[A No ❑ NA ❑ NE
Comments (refer to�question, #) Explain any YES answers and/or any:e ecomienda"bons or.�any other comments` `
Use s drawzn of fscili to better lain situations (use additional:pages as necessary)' $ `
r .
i.g. . t- ex p
Reviewerltnspector Name �� Phone:
Reviewerllnspector Signature: Date: ll �a
1 r s 1 810 Continued
P` _ J

Facility Number: Date of Inspection hA
Required Records & Documents 77
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,d No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ p Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? I
❑ Yes
XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
[__1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
k] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
f No
❑ NA
❑ NE
and report the mortality rates that were higher than nonnal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;3No
❑ 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
ONo
❑ 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
V]No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V1No
❑ NA
❑ NE
Additional CQinments and/or Drawings: Pr "` ,
z IVIC, CGL I"ex ceed 9` 1 n u t/ T7� Cam/ i
1 Jrr 1'S4 � ie Y� a n +Kee ee G� s v V '1
Page 3 of 3 12128104

a
_ Division of Water Quatity.7-1
FaeBig, Number:F r(jr] 1p 5 0 D%yision=of Soil;and;WaterConservahon ': ,° "
0 Other Agency a
Type of Visit 6Couftpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WPoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ('jQ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: EIJ o
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0e =' = Longitude: =° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
YDO
/ oo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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
❑ Daia Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ]of 3
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
[I Yes
❑No
❑ Yes
d
El NA
❑ NE
El Yes
7Noo
❑ NA
❑ NE
12128104 Continued

Facility Number: 61 —(i7 Date of Inspection
Waste Collection & Treatment
4� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: tA&<R tJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes E6 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 environmentaltheat, 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 E2(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 Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Id No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[ "No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2 No
❑ NA
❑ NE
17.
Does the facility tack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
D/No
❑ NA
❑ NE
a : ra, area a'a"ti.
Comments (refer _twqueWon #): 'Explarn. any YES',answers and/or any:recommendat�ons or any other comutents u
Use:drawings-of facility to,betteraexplain situations: (use, additional;pages as necessary): ::, _
6
,} j2 -4 !Y /!sN Z 1-10 NC-fo fe 11RV6 ►1Ap pa1Q, Z-�-10 fb tl+ra 7,qw-IO
Eoj a' Ar611 Ver./Aut- G)n 140 z.,Ae. Z (� ,3t..��) Cmak- h►, ne ►gjvm gSrs rj&, at ly F.ti r'Qa
O 1J A LA t� 0100 W "Ju k r6%",
,2g;) SV✓D6� SthtJE N66 DEA wzT 36 OA`l'J, CALV,eAT.�W D"C_M-Ci V(Af
Reviewer/Inspector Name U, Phone: I 79C� -73
Reviewer/Inspector Signature: Date: 014 to
Page 2 of 3 12128104 Continued

Facility Number: (Q i — (�j Date of Inspection L 1 ZO
&guired 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 ❑ Desi n ❑ Ma s ❑Other
g P
21.
Does record keeping need improvement? If yes, check the appropriate box below.
!11 Yes
❑ No
❑ NA
❑ NE
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes,
_,/❑
L�J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
C' No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,❑,/Yes
Id Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
16No
❑ 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
allo
❑ 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
ElL(J Yes
�f
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
U/No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
lei No
❑ NA
❑ NE
Additional Comments'and/or Drawin s:
g Wt'
AL
Page 3 of 3 12128104

I; -$'Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- — -- -- - — 0 Other Agency 11
Type of Visit J�)<6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 11111,40461 Arrival Time: �'O Departure Time: County: Region:
Farm Name: _ _ s Ol t�i� �f_6m/ �F Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: t� -0
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: = o = = Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
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 Cow
Number of Structures: �}
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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):
9 t 6G -5 u q r de j! S o �a Y dot . a q TI'CR eUe-
Reviewer/inspector Name _ Phone: l/-617 F&z
Reviewer/Inspector Signature: C Date: fl O
Page 2 of 3 12128/04 Continued

0
r �J [ (.!
arility 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. ❑ WDp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate bo elow. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ S it Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:1 No
❑ NA
❑ NE
f
24. id the facility fail to calibrate waste application equipment as required by the permit?
]'Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ 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
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/d//d/ 06
a,1 '5o I 0'yVu j L1 S 1 S
-� JO L'j-
a yl e�J i-o c6 C,0, [ I JOi(cl- �1G �A s -�O (` �-GO
J
Page 3 of 3 12128104

utvision of Water Qdality
F.cility NurnbeC 3 14�O Division of Soil and Water Conservation
�. (I Other Agency r
Type of Visit OXompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: Departure Time: County: Region: �2x
Farm Name: , Tns' o "mt.�l Ay1� .5yi O jlay- 1 4- )r— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: LS�bA g _
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
Boars
Other
❑ Other , ^
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = 11 Longitude: = ° = d 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j f �6(} ❑ Layer
�. ❑ Non -Layer
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Nitmber: — Date of Inspection 4 a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13-0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes Z 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 .ETNo ❑ 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 ZNo ❑ 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 ;alNo []NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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
El Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplicatiRn Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -ETNo ❑ NA ❑ NE
❑ Yes ,ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ;ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [;Ko ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes PK. ❑ NA ❑ NE
Reviewer/Inspector Name I : wq 3p t °` Phone:
r- f F. 9 r
Reviewerfinspector Signature: L �_ Date: Ar Ors
12/2V Continued

Facility N11mber: 3 Date of Inspection tro 0
�r
cr-
Reciuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes a<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2rNo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El 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 ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections EfMonthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JZNA
❑ 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
ONA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
P.-KE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J2 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
ZNo
❑ 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
7No
❑ 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
2/ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;214o
❑ NA
❑ NE
Additional Comments and/or Drawings:
a r i a-i���' 1' ` ,r�`a 1 �1 11 n 5 FP_C;rL0y_\-
J�I�.r�� Zing 4ve-1 & Z. � Aotlf
Puri-G� �j. Jr� , fh�� 4 a o 0
12128104

Type of VisitCompliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number jDateofViSit- /V oVTithe• GC]
10zNot Operational O Below Threshold
frmitted�erMed ❑ Conditionally Certified 13Registered Date -Last Opera or Above Threshold:
Farm Name:.�L�. OLC FDMIi� County:.
Owner Name:
M-- wing address:
Facility Contact: ..... '���� �1 . Title:._...
Onsite Representative: s-!.f�.�i O . _ .
Certified Operator -
Location of Farm:
Phone No:
Phone N
Integrator:
Operator Certification umber.
L
wine ❑ Pau" ❑ Cattle ❑ Horse Latitude • 4 " Longitude < "
Discharses 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Z'Ro
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes _0-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Stare other than from a discharge? ❑ Yes ,0'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes_0'90
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: -__ . _ -2—-
Freeboard (inches): QZ
12112103 Continued

Fa[Facility
her:�� — Date of Inspection d G4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance -improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessi-,
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
loads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately-
❑ Yes ,,ONo
❑ Yes .ETNo
❑ Yes , f No
❑ Yes ENo
❑ Yes EfNo
❑ Yes E31qo
❑ Yes 2FNo
❑ Yes ONo
❑ Yes d-No
❑ Yes ..QNo
❑ Yes fno
❑ Yes 1d1Qo
❑ Yes QJVO
❑ Yes 'Eno
❑ Yes ETgo
❑ Yes ,B-Ro
❑ Yes „ONo
Camntenfs (refer tvigan°) aEYP3am aa}' YES:answers auuil6r aay _ cr an9 oft commeatx.
r _
Use dxaw of fad tp bettsrplaen sutrsatio�s. (n a adduhcaai Pages as ?rYy veld C Fina! Notes
m
c04��G�
.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /fJ
12112103 Confinued

Facility. Number: Z Date of Inspection C G-
-�t
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
00
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
[:I Yes
['!Go
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
;2WO
27. Did Reviewer/tnspector fail to discuss r,eviewlinspection with on -site representative?
❑ Yes
J'No
28. Does facility require a follow-up visit by same agency?
❑ Yes
OWo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
OrNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
f1oaf 6? ev/-/ k /-`r
,�;- )!:/Z- �- 1V
�c oryiine�r c � a � _ZCA'
T�v1r sr
ll 1l1l
4ca
D�
�. r
12112fO3

Date of Visit: % Time:
Facility Number 3
10 Not O erationai Q Below Threshold
M Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: /j'_." l Q' Z_ County: � Q�h
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: )4e ag riles Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 u Longitude ' 4
Design Current
5wme Capacity Population
WanFeder T7A9
L Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Number of Lagoons
Holding Ponds 1 Solid Traps 0
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dai
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area 1 .-..... .--.... - - - - - - - - -
❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes & No
Discharge originated at: ❑ Lagoon ❑ Sprav 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 KNo
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 [9No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: I I. -
Freeboard (inches): 23
05103101 Continued
l

Facility Number: '31 — d- Date of Inspection 2 Z
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Ammlication
❑ Yes M No
❑ Yes RNO
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
10,
Are there any buffers that need maintenance/improvement?
❑ Yes
14 No
11.
Is there evidence ofapplication? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
10 No
12.
�cover
Crop type l.LP�•!i'� �r �✓ _� s�� 149.:c QdGs�11_1
-
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CgNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
M 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
[�R No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
M No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[9 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
[0 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
E4 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
14 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes [Z No
24. Does facility require a follow-up visit by same agency? ❑ Yes [9 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ommets{refer tognesrion#Explain a y YES answersndlor any recommendationsorany other comments.
Use drawings of facility to betterrexplatn situations. {use additional pages as necessary}: ❑Field Cony El Final Notes
.r
hl"&f ll/e7Lft41e zel-e,5 !,,-"' S (,ow-4f do
e�d? 14, E
(.IG4DI� �av[� / 2 �✓LS Z3 i b T:s �leC�* �8 4e-�ir✓d�•T
6 /D..>cr AAle/ a f 'flits 4!,* t
Reviewer/Inspector Name r - ��Cq CAI
Reviewer/Inspector Signature: Date: G Z7 lJ�
05103101 Continued

i
Facility Number: f —&;-- I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
a
Jh (d 5 f //t sI QGTIOr4 .
— /y!«t -,,5 .oma., l wt
Vl e!l 40 e0A ii}i1 v-e eS711 is ks'
lktz'-'ell `rift d— /t L6rer�ef �di �OUGf"�
❑ Yes M No
Cl Yes g] No
❑ Yes UZ No
❑ Yes ® No
❑ Yes M No
❑ Yes ® No
❑ Yes MNo
05103101

t
of Visit ,WCompliance Inspection O Operation Review Q Lagoon Evaluation
for Visit QfRoutine Q Complaint. O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number I
Date of Visit: I
Permitted [3 CertiCfied [,Conditionally Certified [3 Registered
Farm Name: �._.?...............11%Q..........-...... ....................
Owner Name: .....,---).49F�.......... . ... tiLL`J.(rt�
ry/ iTime: : DD
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ... » _ ..
County:....�Cl.Lz/✓............... __._.. _�.
PhoneNo: . ............... : ........................... .. .. .. r .._� .
FacilityContact: ............... ............................................ I................... Title: ............ -.................................. ................. Phone No:............................... _W .
MailingAddress:..............----.............................../.............................................................................................. 1-••---........'../................ ......._ ..
OnsiteRepresentative: .... .......,4�.v.......................................... Integrator: ff�f/-/.�pf� ....................... ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:. - - -• W. ....
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� ��
��� Longitude �• ��
Design. Current
_._ Design
..Current =Design Cntrrnpt
aci Population
Poultry
CPCaacPouaon "n._Ca
.
❑ Wean to Feeder
❑ Layer
❑ Dairy
--
❑ Feeder to Finish
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
-_
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
TOW vesign'C. pad
Gilts
❑ Boars
Total SSLWF -
Ntaiber of Dons = ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Lag:...,
raps.:. ❑ No Liquid Waste Management S ma' _ :Iloiduig Ponds / Solid T g ag stem y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaVmin?
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
00
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Ao
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[:]Yes
fi3�No
Structure/ 1 Structu e 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..... �f !q- ..............5f ........... ................... .
....................... ...........
Freeboard (inches): - 3(P
5100
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [j 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 � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
No
P.
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
.
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
YNO
Waste Anylication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Pondi g ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type&MLL
13. Do the receiving crops differ with those designated to the &rtified Animal Waste Management Plan (CAWMP)?
❑Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
V�'No
b) Does the facility need a wettable acre determination?
❑ Yes
'ago
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
g No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
Coverage
17.
Fail to have Certificate of & General Permit readily available?
❑ Yes
XfNo
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-No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
eNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
dNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
IVINo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
yiQlaW- Os'o re pQfed... �h�s:v�s}ti York wig sec lye do fui�t�gr . .
coriespo deuce: shoot; this visit: .............................................
c.ommemts Ereter ra ques5uon op,jr-xptaw any, zp answers annror, any, recommenuauous or any outer coaament . �
Use dia of facility_to better a pWn situation (use addibonsd pages nec p T
a�
7�
Wings�A- _ _..fir]'
AL
40
7) 1_5z 2!�V -ZOO J
Reviewer/Iaspector Name F
Reviewer/Inspector Signature: Date: p 5/00

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[:]Yes
F(No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
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
VNO
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Po
Additionall'Commentsand/orDrawings:
/ n C&5 /�
J1 5 Vz-V�,Or5IJ
Am Goo ohs 6090tsf�p (�ap
5100

0 Dtvisron of Soil and- Water Consei va oa x
r �� Other Agency x
Type of Visit 33,Gompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date or visit: "Time: G 0 1 Printed on: 7/21/2000
NNot O erational O Below Threshold
6Permitted © Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ��� �-�- Countv:.....1 ..,
........................................-.......................................................................... 1�-.
OwnerName:........................................................................................................................... Phone No:
FacilityContact: ..............................................................................Title:
Phone No:
MailingAddress: ........................................................................................................ ..........................
Onsite Representative.......J.- ...lF ..................................................... integrator:..........
Certified Operator: -------- ............. ...... ................ * .......... ................. Operator Certification Number:..........................................
Location of Farm:
A.
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° �'° Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder J❑ Layer I I JE] Dairy
❑ Feeder to Finish JE1 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 i ❑ Subsurface Drains Present ❑ Lag—n .Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
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 disvhartze is observed_ what is the estimated flow in gal/tnin?
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 NINo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes &No
Structure I Structure 2 Structure ? Structure 4 Structure 5 Structure 6
Identifier: ................................ ....................................
Freeboard (inches):
5/00 Continued on back

Fadlity Number: Bate of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes h�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 19No
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 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes X No
12. Crop type \D\, , S <k
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes �gfNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
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
)�rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
$1No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�dNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
wYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
. ❑ Yes
JKrNo
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?
(ic/ discharge, freeboard problems, over application) ❑ Yes WNo
23. Did Reviewer/Inspector fail to discuss reviewtinspection with on -site representative'? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ffNo
�: Io yiulatioris or deticier�ci.. were noted during (his* visit'. Y66 will-f&dye trio. further
rorrespotidence. about this visit. _ .... .... .. ..
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C)�
V�•�\�� S\�K-S � rt-. S-P�..��� Yz.l�-fir �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
39�51-3 x
Date: Lr-GG 5100

acelity Number: 3 - Date of Inspection \ �p printed on: 7/2112000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hielow ❑ Yes o'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �'1CTo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or `�
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes `J�('No
Comments and/orDrawings:
i
_tS. R.J�U
5�,k
✓►�'-�E� �.�==td�, tea- +�-2-2`�S-2�"C�� 5,� y-o'']` �l
5100

Lagoon Dike Inspection Report
Name of Farm./Facility(�
Location of Farm/FaciIity 570
Owner's Name, Address
7SOC97 , j(��.� p�7�1/►.� ��
and Telephone Number
Date of Inspection
2 Names of Inspectorsyj�,�
.�s c:
Structural Height, Feet
�t Freeboard, Feet �� ^
Lagoon Surface Area, Acres
f
(}a'Z� Top Width, Feet 11111^
Upstream Slope,xH:IV
k
2`. \ Downstream Slope, xH:IV 3 4
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
Seepage?
Yes -No
(Check One, Describe if Yes) -
- -
Erosion?
Yes �o
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes —No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes �No
/
Engineering Study Needed?
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _Z�No
Other Comments

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted p Certified ■ Conditionally Certified p Registered 113 Not Opera Date Last Operated:
Farm Name: lop,.&.Dwight.Sholar-IFarm..l&z.......................................................... County: Duplin WIRO
Owner Name: Jot ........................................... Shala.r.......................................................... Phone No: 91II-28;5:11124........
FacilityContact: .................".............".........".....................................Title:............................................................... Phone No:....................................................
Mailing Address: 1440.1)ieep.6ta110m.Rd..........................:............................................ WNallacr— C........................................................... 28466i..............
Onsile Representative:............................................................................................ lnte;rator-:1 Ltr.phy..Family.Farms......................................
Certified Operator: Dwigbtom............................. Sholar ............................................... Operator Certification Number: 119AI .............................
Location of Farm:
Latitude ®• ®� ©�� Longitude ©• ®� ©��
Swine Capacity Population
® can to Feeder
5200
Ij Feeder to ims
❑ arrow to can
❑ Farrow to Feeder
p Farrow to Finish
❑ Gilts
❑ Boars
esrgn urrent Design urrentz "
`Poultry -Capacity . Population. Cattle Capacity Population
❑ Layer 11 airy
p Non -Layer ❑ Non -Dairy
❑Other
Total Design_Capacity 5,200
Total SSLW00 ' = 156,0
Numbereof Lago-0ris 4 2 =❑ Subsurface Drains Present C] agaon rea JE3 Spray �e rea
'Holding Ponds./ 5ohd Traps , ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes oNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes p No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldenti(ier:
Freeboard (inches): ...............3.6............... ...............3...............
5- Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes p No
seepage, etc.)
3/23/94 Continued on back

Facility Number: 31-65
Date of Inspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[]No
Waste Application
l0. Are there any buffers that need maintenance/improvement?
❑ Yes
p No
11. Is there evidence of over application? ❑ Excessive Ponding p PAN
❑ 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 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.)
p Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
❑ No
Q : Xo.vinlations.or. 'deficieh'eras-wexe'uoted'during. this visit.: Yilu, wvill .>' ece'ivc na further.:.: .
!CO rQsA dehCe. a ou# this.vls�t.
Comments (refer to question #) Explain any YES answers and7or any recommendations or any outer comments
Ilse drawings of facdity to better explain situations (aseaddrt�onal pages as necessary) xry _ _
freeboard availble. No problems detected. Good grass cover.
Reviewer/Inspector Name �l'atrick Fus"sell Richard Moor {DLQ)���T
Reviewer/Inspector Signature: Date:

17�
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream SIope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Lagoon Dike Inspection Report
C�
--So(g
C_ Z64
Names of Inspectors,
ri.
r�
Freeboard, Feet 3�
r
Top Width, Feet _�
2^. Downstream Slope, xH:IV r
Follow -Up Inspection Needed?
Engineering Shady Needed?
6t
Yes No
Yes -No
Yes
Yes --No If Yes, Depth of Overtopping, Feet
Yes Z�fNo
Yes 'o
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes _z�- NO

13 Division of Soil and Water Conservation ❑ Other AgencyON
Y
sion of Water Quality
'R FOR -
Routine 0 Com faint 0 Follow-up of DWQ inspection 0 Follow-up of DSVVC review 0 Other
Date of Inspection Z !R
Facility Number I
Time of InspeTtion fD: 24 hr. (hh:mm)
©Registered ® Certified 13Applied for Permit M Permitted 113Not Operational Date Last Operated:
Farm Name:
!?e... ski. fo-(..... Lr� ..... ..I. ... ±&.......... County:... 4Yl...................................................... -..........
OwnerName:........ Cle<..............................................................................•....... Phone No:...CSu]� 41.4..24.--•--.........................................
Facility Contact:.... ....................................... Title:...................... . Phone No:
MailingAddress: AAb.. hetIdom ..... ,t}............................................................. ...QgAkac...t.iNz.................................................. zz4v..........
Onsite Representative: ...... 4Cz,,..-&6 ........................... . Integrator: ...... NI". .............
Certified Operator:
Location of Farm:
Operator Certification Number ,...... 1...+(.1. j..............
m...i.....fi?�.... s ...S� ... ...sb.. f....I.................................... ................ •.............. •..........................................
'.t!rki.. a.�.
Latitude 0 =' =11 Longitude ' 6 =11
Design Current
Design Current f , Design Current k
Capacity :P6ptilatton
Poultry '± Capacity. Population Cattle w Capacity PopuLahon
�Ip Wean to Feeder
yp
❑Layer
❑Dairy
❑ Feeder to Finish
❑ Non -Layer
I
❑ Non -Dairy
❑ Farrow to Wean
_ , ,.. -. '.
❑Farrow to Feeder
❑ Other `
�4� Total Design Capacity` Z
❑ Farrow to Finish
❑ Gilts
z
f
❑ Boars
z Total SSLW
r
—LEA
v
Number of Lagoons I 1161dmg Pands
0
❑ Subsurface Drains Present ❑ Lagoon Area
10 Spray Field Area
Put,
e
❑ No Liquid Waste Management System
y
n
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/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?
7/25/97
❑ Yes [$j No
❑ Yes [$5 No
❑ Yes
® No
❑ Yes
g] No
❑ Yes
No
❑ Yes
No
❑ Yes
No
.M Yes
❑ No
❑ Yes P No
❑ Yes R No
Continued on back

8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons.Iiolding Ponds, _Flush Fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ,� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.` ................ ............�.......
freeboard(1t): ...........t.5................. U................ ..... ,.............................. ....................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other- threats to the integrity of any of the structures observed? ❑ Yes ® No
12.. Do any of the structures need maimenancelimhrovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
1 '
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..................�e,Y e►•aL...................................................... �Milt- ............... .......... ..._........................................
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?
7
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?
F
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.violations oc deficieneies.were"noted"ducing this:visit. Xoumill receive no further
correspondence dhout this.visit..:. :..
W Yes ❑ No
❑ Yes
® No
❑ Yes
No t
.........................
❑ Yes
Cd No
❑ Yes
W No
❑ Yes ® No
❑ Yes ® No
(M Yes ❑ No
❑ Yes ® No
$ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
Comments:(refer, to.question ..ExplainAny YES answers and/or any recommendations or any other eomments
t�
Use drawings of facility to better explain situationsJuse additioQal pages"as necessary) v,
1 r
fkc1t� sitC�c��rJ �� �Oot� v tl %kovIj foe (4W?_V4 � /`QjU4"k-4
6wt *+ �Kso(`�,t
t N a PB%�M Z, � lv L, trv�rryt ►+�r p rive lNfvt e f ra.:y. -rrt &(- +o KSPi!c 4. (n .r� ;
rl
Z &VOS c h �, r`n.t'u,r- ode v, W "[ 1 i Lip 64t_ (&Pi' s 5 u� - f (� fiJ t74� 1 G6�
?am W wr ice- �n5 0, -,Wv9 6 m5pejed, f l
Z-7— waste otno.lyi" be, L�JOM, OvOc `-
cv�evSQe.d
7/25/97
Reviewer/Inspector Name-�� , 2 � e� � � �
Reviewer/Inspector Signature: Date:
�--� -

Routine O Com faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number b p ©
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for i hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational t Date Last Operated:._..
r.........._................._......_..... ......... ...... ..... .............._.......... � ..............._......
Farm Name: _....s1AL.labq4kL..f,..,.C....................... _...
,_......_.,...
Land Owner Name. .. iG . _. ... Phone No:
Facility Conctact:.. l ..... S�aiG1tl..................... ...._.............. Title:.......Ok? .... .......... .......— Phone No:.Lu.g..�..Z$�
]Mailing Address: ' .. �ri� ,1.��t. Pr ..iL51.� _......................... ...... U.Q.L:Le..p.'t1-x.._..... ......... ...._....... _ ......
Onsite Representative: 1�..__.. _ ...., ............_ ..... ..._ - Integrator: .........__.Sl.... _... __............ ......,.....
..�
Certified Operator: ..... ...�1�.. _.SVtq���. / y`e _........ Operator Certification Number: �-nuom ....
Location of Farm:
Latitude ©• ®� Longitude ©• G} u
Type of Operation and Design Capacity
y . Designs x Currents :} Design Current _ Design Current
Swine _Ca acr _Po elation rc< * Poul a x Cattle Po ulat,on M = Ca "acyty `. Po elation _Ca aci
Wean to Feeder ._ ❑ Layer ❑ Dairy
❑ Feeder to Finish 'a Non -La er_g,: ❑ Non -Da'
Farrow to Wean
�� �' _.n uj
11 Farrow to Feeder Total Design Capacity 3'Zoo�
�yL
Mae
Farrow to Finish
u IT
��otal�SSLW I oce �a
�❑ other
�--c�;:�x '."'; �'• Vie- ��.q „� �
k
` �� � �` �
Number o0-44 ons . Holdmg Ponds ❑Subsurface Drains Present
k
q E� ❑Lagoon Area ❑Spray Field Area
.� ... �?.
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes 0 No
❑ Yes WNo
❑ Yes 5INo
❑ Yes
h6111
KNo
A'
❑ Yes
[�j No
❑ Yes
MfNo
❑ Yes C No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes MNo
Continued on back

Facility Number:...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La+oons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.�5..-_. �...... S ..._ ............................
10_ Is seepage observed from any of the structures?
Structure 4
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 Ievel markers?
Waste Apdsl ication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
CM�L.DeYt�lu�lL�... _ . , ....._........
15. Crop type �................ .......
❑ Yes B No
❑ Yes IN No
❑ Yes IgNo
❑ Yes X No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Onlx
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
9 No
❑ Yes
® No
Yes
[:]No
❑ Yes
N No
❑ Yes
Wo
❑ Yes
R3 No
❑ Yes
P No
❑ Yes
0 No
❑ Yes
Ca No
❑ Yes
E3 No
❑ Yes
13 No
❑ Yes JRNo
❑ Yes §?ZNo
IN Yes ❑ No
. . . . . . . . . .
Comments (refer toeshan' Ezplam any YES answers and/or any recommendations or any other comments x
Use diawengs; of facility to better explain situations ` (use ad�t�onaI.pages as necessary) r
s
agoon
P_VO Z c eG� S ou)U 6e_ back'iLtJ a.n_el 1^csee3td, Rare-, C-re-a-s or. (480on z
Sho')W fee �eseedec}, ��c�ost� ��� e q�{ ��Usi. '{ar,Kz s�e�I lae. Ceverec�.
24 S IV -coca, shwlj 6e recwr oA 1RP-Z � rr o, or �rrvtrol
otu�`tOns
SYxq't(; K16.r dy 01 oo'3 loci arws 6e
( r,'KVt lvbAs ov, c re� i �unori`,
cc: Division of water Vuattry, water !Vuattty Section, Pacility Assessment unit 4/30/97

r Site Requires Immediate Attention:
Facility No. 3 1 -
DIVISION OF ENVIRONMENTAL MANAGEMENT -
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owns
Mailing Address:
County: -�D, - - - - - - _ -
Integrator. Phone:
On Site Representative: c7 o Phone:
c
Physical Address/Location: _ _ , _ s� _X _.Q. 7
Y 0
Type of Operation: Swine v Poultry Cattle 14 n
Design Capacity: 2--G b Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:_)'-Y Longitude: 77 47' " , 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) (9 or No Actual Freeboard: 2- Ft. Inches
Was any seepage observed from.the lagoon(s)? Yes o6? Was any erosion observed? Yes or621
Is adequate land available for spray? es -or No Is the cover crop adequate? CzDor No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingsAffs or No
100 Feet from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oro
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 o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage/with cover crop)? Yes o r
Additional Comments: c dJ C C� (� C� r4
L,
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

0
Site Requires Immediate Attention:
Facility No.�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: -3
Farm Name/Owner: CZ r__-
Mailing Address: N 410"_ c eU 2 ig iicryn _R o*0 (i0ai_ 4 c e ; hl . Co f
County:
Integrator: Phone:
On Site Representative: c79sE ►: S C{r► 014 ` Phone:$. a 7 c!
Physical Address/Location: G
Type of Operation: Swine, ✓ Poultry Cattle U-4
Design Capacity: r 1;, &E) Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° % ' a Longitude: 7 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 gor No Actual Freeboard: Ft. inches
Was any seepage observed from the lag n(s)? Yes orb Was any erosion observed? Yes or(
Is adequate land available for spray? iMr No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?or No
100 Feet from Wells? Oor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ors
Is animal waste land applied or spray irrigated within 25 Feet of a USGS. Map Blue Line? Yes o�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o0Nq If Yes, Please Explain.
"Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: w CI 1 11411
ctor Name
Z3, 19�
Signature
cc: Facility Assessmdnt Unit
Use Attachments if Needed.