310146_INSPECTIONS_20171231

NOHTH CAHULINA
Department of Environmental Quai

Date of Visit: Arrival Time: Departure Time: �I S' — County: Region: 1►�✓�
Farm Name: �1 (-rGr �(*r�rlst Owner Email:
Owner Name: �'✓'�� rf �i�Y} Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 3-.err '54n ,co, Integrator: Y4,-, 13
Certified Operator: Certification Number: �3S rq2&--Ik
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigu C►urrent
Swine Capacity Pop.
Wean to Finish
Desigu Curren# Desigu Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
De, P,ouItr. Ca aci P,o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Co
Wither
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Io ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? [:]Yes E�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
�o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
❑ 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 21417015 Continued

Facility, Number: jDate of Inspection: L
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D o 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure_ 4 Structure 5 Structure 6
Identifier: 13 V - - r_ [i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - i " -35 ;;
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ T'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 PNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental hreat, 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 eo ❑ 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 [rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes geNo ❑ 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 [✓KNo ❑ 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 <o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [�lo ❑ NA [] NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [,3"ONo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes do ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F�J<o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciliq Number: -AIA jDate of Inspection: /Z
00
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 ❑ YesF?<o❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes "eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [; '110 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes P<o ❑ 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 E'No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. j
Use drawings of facility to better egulain situations (use additional Daees as necessarv). 1
Reviewer/Inspector Name: ij . O' l I Phone: f0 12IY
Reviewer/Inspector Signature: r Date: ^� Z/fZ
Page 3 of 3 21412015

Type of Visit: ,&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �Ylkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: - 4 eparture Time: County: �� Region:!,-
Farm Name: , / Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
r
Onsite Representative: lb . 4
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: za
,z
Certification Number: ✓�-��
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poultry
Layer
Design Current
Capacity Pop. Cattle
Dairy Cow
Design Current
Capacity Pop.
Non -La er
I
Dairy Calf
D . P,oulh:
Layers
Dairy Heifer
Design Current D Cow
-a aci P,o Non -Dairy
Beef Stocker
Gilts
Non -Layers
eef Feeder
Boars
Pullets
HB--fn—ndCow
Other
Turke s
Turke Poults
Other
I I — 1 0
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ZNo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [n No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes 6 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 r[] 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 21412014 Continued
�IA

Facili Number: - Date of Ins ection:
f
1
Wastetollection & Treatment
-4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[/f No
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ Z 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
E No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
J
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
i� No
'
❑ NA
❑ NE
waste management or closure plan?
1
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
[XNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
14 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?
❑ Yes
'7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�
V1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[XNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Of No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 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
Q No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
r
❑ 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
A No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facili Number: Date of Inspection: Z E
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ 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. T
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CHINA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�fNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
❑J No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[;D No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES, answers and/or:any additional recommendation's or any; other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
P&^
CL Mid
Reviewer/InspectorNamc: iL, _ i �� 'C /Phone:�r �,
Reviewer/Inspector Signature; Date: —•—� Z«
Page 3 of 3 24/2014

Type of Visit: ompliance inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ��(r/®/'��j�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop. Wet Poultry
Layer
Design C*urrent
Capacity Pop. Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,ouI
ILayers
C►a aci P.o , -Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
as
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?
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes J�:rNo
❑ Yes ZNo
❑ Yes ONo
[—]Yes [2�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is%torage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes eNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
6p�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J'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 ,E5 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 )Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 1 P�rNo
❑ 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 ❑ Yel> 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? ❑ Yes 6 o ❑ 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 JZ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No DNA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box,
❑ WUP ❑Checklists [:]Design 0 Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ] No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑'RIo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo
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 ',ErNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fffNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JZ^rlo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZrNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ff No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional.. recommendations.or any other_ comments...
Use drawings of facility to better explain situations (use additional pages as necessary), m
❑ NA ❑ NE
D NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ONE
❑ Yes ,❑'No ❑ NA ❑ NE
(,UA
1.CS ��� �' C7( ��'rc� .� s�C i�C e
v � �
7 y 0
7 8 1
tC 36 G(5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: D 7 , L
Date: `
214/ZO14

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: IE7koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Accessf/ �
Date of Visit: 46' Arrival Time:� Departure Time: County: ff� Regione- J�
Farm Name: - (�;70W" �� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:���
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
integrator:
Certification Number: ' 2 a O/
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
LNon-La
er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P.oult . Ca aci Ro ,INon-Dalry
Layers
Da' Heifer
D Cow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Wither
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes J�TNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�j No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: &7 jDate of Inspection: L l
Waste CACction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ENo ❑ NA ❑ NE
Structured Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 15 U Y 3_
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes o 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 16 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 ,E] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes JEJ"'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jEt 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 0No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes L?'No ❑ NA ❑ NE
[:]Yes EfNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J2�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ 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 121,40
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes d No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci1ity Number: Date of Inspection:
24. Did th&facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes [3-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes _' No ❑ NA ❑ NE
❑ Yes J�J'No ❑ NA ❑ NE
❑ Yes J2-No ❑ NA ❑ NE
❑ Yes J'No ❑ NA ❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑/ "No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ,ETNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2�'No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
WA LL3
9 �lw'l /- /`(f 601-e6- lad-,
11303 1,17 6P _L
jleq
J, /7 GF /
�/_23//3
Reviewer/inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
2y.)-Y
2, oo
GF I
Phone: ? �wxjg
Date: 11-,6 13
1214126,

Type of Visit 04compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f O Arrival Time: ® Departure Time: County: U A/ Region:
Farm Name: �' AAQaLS F"d9-K Owner Email:
Owner Name: C . l m So/1l Phone: Qj0-g9?_5) 7%!
Mailing Address: `T �� /vX S 70Q E � �[-U��AU ILtE, M2
Physical Address:
Facility Contact: Title:
Onsite Representative: (1xq:T1 S ?AQA6�1UL. I �=2.y
Certified Operator: a 31 tip3C4
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Ceirtification Number:
Back-up Certification Number:
Latitude: = o ❑ i ❑ « Longitude: = o = g = u
Design Current_
Design" :,Current �"v gni� C rreut n
Swine =
.w ..
Capacity ,l'oputafigst Wet Poultry (Capacity Populatiiiu" Cattle : ��.`��Ca acl. Po alahon
P P.
❑ Wean to Finish
❑ Layer
.
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
""
, El Dairy Heifer
Farrow to Wean
t� ❑Dry Cow
Dry Poultry '"«
❑ Farrow to Feeder
" El Non -Dairy
El Farrow to Finish
ElLa Layers
❑ Beef Stocker
❑ Cilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
'; ❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Other.. .
❑ Turkey Pl
ure outs
✓
. _
, ❑ Other
r ❑ Other
=� t
NumherAofrt, ructures�
S
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes V No
❑ NA
El NE
Discharge originated at: [I Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes '0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ANo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

F?cility Number: 31 — J( &
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 (nStructure 3 Structure 4
Identifier: �F P I l� P
Spillway?:
Designed Freeboard (in): n
Observed Freeboard (in): lJ �} � L/ �( 0
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 XNo ❑ 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 KNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ yes .iltiJ No ❑ NA ❑ NE
maintenance or improvement? Y�
Waste ADDlieation
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 El Evidence of Wind Drift El Application Outside of Area
1L
12. Crop type(s) ,\L S G �-Xi T S IJ
13. Soiltype(s) r7ncus ooco 1 /� ]Liy ,oi,L. --E
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4No
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
J( No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments z=
Use'drawings of facility, to better explain situations. (use additional'pages as.necessary)"
woQ y_4A1G Ci At Dw G_ WALL- -- C2ras io/V O N `3e S 1 D Ir
o F Cz F
(-rnr-� LACR00Y OG-SIG/IS 'r PL'LT kA-f C` Re"Vr K-G-C(Z)F_F')g
Reviewer/Inspector Name Phone:
w
916 19 6
Reviewer/inspector Signature: Date:
L l I //o
Page 2 of 3 12128104 Continued

Facility umber: 31 —)97& Date of Inspection 1
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. 9WUP ❑Checklists ❑ Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis [Soil Analysis ❑ Waste Transfers ❑ 9dinual Certification
El Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections ❑ Monthly and 1" Rain Inspections E3 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
bo No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
NA
V
❑ 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
N�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:
n^)(��)
Nd So; t�v a009 Dui
7o �008 Sol L
asE ��T NIC) Soles �sAp
Page 3 of 3 I2/2"4

Type of Visit (&Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit tRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: B�j Arrival Time: Departure Time: County: U Region:
Farm Name: �N �S^ Owner Email:
Owner Name: — -soN Phone: n�`7��5
Mailing Address: w(n 1 N(ea L Ul �+ cC&s) Q c '_3 �
Physical Address:
Facility Contact: Q Title: Phone No:
Onsite Representative: �c.t`Q'T15 _t�fl2�-�Cl ]� �� Integrator: r-
Certified Operator: _ S 101 L� SQA/ Operator Certification Number: V T D 99
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ n = ' E__1 Longitude: = o ❑ i = fl
Design Current
Swine C--pacify .1) ulation
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
C*urrent
Population
El wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Non -Layer
❑ Dairy Calf
Dairy Heifer
Dr*J Poul#ry ❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑El Beef Feeder
Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑Other dumber of Structures:
Gilts
PBoars
Other
❑ Other
-
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 9 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P[No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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: GE1 QS P 1 �P a
Spillway?: n Q
Designed Freeboard (in): �nn� . oc q . S Inn• r�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes]
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
kNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
X No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
)4No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) f3 0. C oew LOOC}) 5 Y
13. Soil type(s) (, O )o V7VAA k N I LtE
J
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 jj�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA
❑ NE
;Comments (refer
to.question#)
E.xplai�
any YES,answ.ers and/or'any,.recommendations or a�ny�other comments.-
Tse`drawmgs i.bf
facittty to better explaan situations (use addifiafi A -
e.�c;.waa,-'..T r - 4
„, <'» w. ..r ".`fix t •-"` � a-a-�+1�.a�,��s.« � i�.
W`
C F!
Q P J
C0NTlNurc VaCe_Ic) XJ Cal O/V D f ice WOLL-s
►� jaN)o$
1.5
cs
- 1-:3,108
1.9
i.9
Reviewer/Inspector Name �-� m F}JI((J{� (� ��S Phone:�1
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

�t
Facility Number: 1 —JV, oj Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes oNo ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑bste Transfers ❑/hnual Certification
0 Rainfall 0 Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Zj No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
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
ANo
❑ 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
'C No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$No
❑ NA
❑ NE
Additional;Commerits,and/6r Drawings " w y
zr
H
Page 3 of 3 12128104

9
:
W Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
5a
Reason for Visit -Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p`�5 Arrival Time: ® Departure Time: County: u Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C /Title: Phone No:
Onsite Representative: J 1 (Y1 u IS ±�MIntegrator: Q�
Certified Operator: EUU, St Q1LPSCIA/ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = = « Longitude: = e =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
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
❑ Dai Calf
❑ Daity Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 oNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
PTNo
[]NA
❑ NE
12128104 Continued

il
FaCility•N'bmber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Stru. e 3 Structure 4
Identifier: a
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 ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes X 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 XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes %No ❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ElYes XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�j No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
oNo
❑ 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):
? F 6b fi �c �--rL� �1 F wo(tZ.IC . C C2 ��.,4ry TO Sir
Reviewer/Inspector Name (Y 41VD,4 Gat /V S Phone: (fir' ?17
I
Reviewer/Inspector Signature: _ Date: 3/ a�5 Q LS'
12128104 Continued

l
r',
c
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropiate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
vU No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
34 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
k�rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
94No
❑ 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

i . %
Type of Visit oCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:1.3/24/p 71 Arrival Time: 3.50 Departure Time: County:
Farm Name: (r�iy �s D!2!r Owner Email:
_r
Owner Name: — E2R t/ �/�PSn n1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Q Phone No:
Onsite Representative:.zFl12�/ P� �_ �27$ _ Integrator: IV � �—�
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: . �
Latitude: = o = i Longitude: E] ° = ` =
Swine
Design
Capacity
Current Design
Population Wet Poultry Capacity
Current Design C*urrent
Population Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
UD
❑ DairyHeifer
Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ La ers
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �] No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
12128104
Continued

. %
Facility Number --/ ZI
Date of Inspection 22 O
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: &io
Spillway?: A42
Designed Freeboard (in):
Observed Freeboard (in): 3 Z 12
a
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? PYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes
/11No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes qNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo
❑ 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 Soi
❑ Outside of Acceptable Crop Window El Evidence of Win�dr Drift ❑ Application Outside
,ofArea
12. Crop type(s) of �vns) ! f L�—%1���� . �� &AW54a�_ _ �, Cam!J__5n
13. Soil type(s)
❑ NA ❑ NE
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes AXNo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes�(No
[INA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes J[J No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes' 1 f No
❑ NA
❑ NE
l S. 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):
/]
7
Reviewer/Inspector Name
Phone: /L7 _ 2/2L.
Reviewer/Inspector Signature:
Date: y
Page 2 of'3 12128104 Continued

Facility Number: �jl —�c�� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X']
o❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
�&
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)�"No
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
XNo
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ZZYes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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?
ElYes
o
��T'
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2f3)
Xe � �- /-)
/7
Page 3 of 3 12128104

If
3
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C_,o/mpliance
(D Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: V UP4TN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J�22� �zMPSo�%
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = ° = , = "
�Designurrent
Swine Capacity Population
Wet Poultry
Design C►urient Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I ❑ Dairy Calf
❑x Feeder to Finish i Stiq
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑Non -La Non -Layers
❑ Pullets
El Turkeys
❑ Turkey Poults
JE1 Other
❑ Beef Feeder
ElBeef Brood Co
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
L N ❑ NA
[:3NE
❑ Yes
o ❑ NA
❑ NE
12128104 Continued

Fad fty Number: It —
Date of Inspection .4
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: LA&OW I lA6aaJ 2, CAGoa► l
Spillway?:
Designed Freeboard (in): °� , 3 / �f • r i g.
Observed Freeboard (in): 7fa Z g
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 E�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes PfNo ❑ NA ❑ NE
❑ Yes LJ 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? Z Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EJ 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) 150tM60A e6) 5(-D 6Nf
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
,[[
❑ NA
❑ NE
,L.�,/No
LI✓ No
❑ NA
❑ NE
ZNo��N/o
ElNA
ElNE
El NA
El NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any .other- comments . ,
Use drawings of facility to better explain situations. (use additional pages as necessary):
7.) bA600N 1 AMO LA6aVP-J Z. N(--Ch MAJaK. woR,lc
JrN (,AASS 6✓EJC, 45A..oS.LoA.) Euxo®NT,
5&V4 L Clro,. To DWW oN 44R_rA1T&VANCE
JUWAX9_ ,
1A) C"r uuzo Do,�E �o� l�qy, QNE ,SP2A `�
dI✓BC-,ynf J REQ�2REs C.eR,Ds/✓�a
Reviewer/Inspector Name '50ttjr Eli.
Phone: e✓4/0 796 - 7J
Reviewer/Inspector Signature:
Date: qh z.ozo
Page 2 of -1 12128104 Continued

41
Facility Number: 3 — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists El 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
❑ YeNs I_ 1'❑ NA El NE
El Yes LJ No ❑ NA ❑ NE
❑ Rainfall ❑ Stocking L/J C'rop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�fo
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
LJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[:Ko
❑ 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
2 N
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1I No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3 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?
ElO Yes
,_,/
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
` Xo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (3�Co/mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (3 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s aZ Arrival Time: g t.3c7 Departure Time: County: 0 P LIA Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone No:
Onsite Representative:-ZiAm Sung,.,) Integrator: CxiHALi1:E
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 i Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
I 134q
1 3SOO
❑ Farrow to Wean
❑ Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures: 7
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
El NE
❑ Yes
El Yes7No.
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — ry6 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CEI QP 1 13P 5L-
Spillway?:
Designed Freeboard (in): _ 1CV). cl , S 111- S
Observed Freeboard (in): : 4 ati 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 environ entaVN,o
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Alyes 54o ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ 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 > l0% 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. Croptype(s) 3�iRmuoA CQ -+ AS� CAS
13. Soil type(s) AUT0---4to_T tLc GoLas Go rZ_0
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
2.Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Z No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
ENo
❑ NA
❑ NE
2Yo ❑ NA ElNE
o ❑ NA ❑ NE
�. W hN.�N V� ►. 7f+--iC ..OP GRASS i.�l CA- o 4LA- "�bn-C E l�l� .S.
klE-CD Co NT+R L .
JV
1u �As�FAtc_.-�'SPE�C -i;.t� vQpATE pAr„ 56�H6 Ntlro R,nti
lieLp fio 13E
ReviewerllnspectorName 1-,✓0a�l � E�:� Ur_' Phone: Ott �}i(�.— 1 AS
Reviewer/Inspector Signature: Date: S
12128104 Continued

F eility Number: 31 — UL Date of Inspection aM OS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking 'Crop Yield V120 Minute Inspections Monthly and 1" 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
� o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El
[Uo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Zwo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
4�N
El NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ N ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes7No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes N El NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ElNA ElNE
33. Does facility require a follow-up visit by same agency? ElYes ;NoEl NA ❑ NE
Comments and/or Drawings:
12128104

of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint Q Follow up O Emergency Notification O Other © denied Access
Facility Number Date or Visit: I
(Permitted 0 Cer 'hied 0 Conditionally Certified [3Registered
Farm Name: �f}.F�r. �'Rh ..- ------ ............. .....
Owner Name :..... ........... ............iere ...«1�t .
Time:
Not Operational O Below
Date Last Operated
�r Above Threshold: ..
..........................
County:
Phone No:
Mailing Address: ....... .......... .. .. ............................
Facilitv Contact:...............•-------......Title:.--..............trJ C k Phone No: ............................ ............
Onsite Representative:..�,1...I��, Integrator: ...
. .... &.7...............................................
Certified Operator: . . .. ................ ........................ ........... ............ I ......... . ............. . ... Operator Certification Number:..........................................
Location of Farm:
Jd5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 46 Longitude • C «
Discharses & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ 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 State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
5 cture I S cure 2 cture 3 Structure 4 Structure 5 Structure 6
Identifier: ...... lEX............. . �......._....A ..... .. ...?................. ............._........... ... ........................ ...... ....... ................
Freeboard (inches): 32
12112103 Continued

Facil4 Number: , / —/G
Date of Inspection I f O
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.
❑ Excessive Ponding ❑ PAN _ ❑ Hydraulic Ovefloadr ❑ Frozen Ground ❑ Copper Vd/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
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?
❑ Yes XNo
❑ Yes ONO
❑ Yes XNo
❑ Yes ONO
❑ Yes XNo
❑ Yes XNo
❑ Yes yNo
' ❑ Yes XNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
2fYes ❑ No
❑ Yes ,8'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ENo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes/o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately-
0
Field Copy ❑ Final Notes
� RCN zC9�T (TovSf_ LJ-`RAss �N iQ F ZF—L� (6 RAM
_5/z3my
77A e
R�v��T 7�f✓D�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

! i�
4 Fa-c ty Number: f Date of Inspection
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,ff No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ 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 ZNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes gNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ❑ No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONO
28.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ;3 No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Pryes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes XNo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONO
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ,eNO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ONO
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 I" Rain
0120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtt�orial Coiisments aiid/oi°3Draw�ngsr - - ,
22).— �(j/I%f Ql��%S� ZOnJS ct� �AlL
�, Jr7 GEC01�1 �i{/ ��'. .�. �` �` /� ��p �� �� 2•
All,
wow
r-Z2,, I t�q
two ®A FIB 19S
� 06,
�
�v ��u /'� to �f �al✓�/ �.P
12/I2/03

Type of Visit 9F Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: /B OTi Time: TS
Not O erational Q Below Threshold
0 Permitted Q Ce rVied O Conditionally Cer ' ted 0 Registered Date Last Operated r bove Thres old:
Farm Name: County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: _ _ Phone No:
OnsiteRepresentative:(__11K72E�2 ✓-eA4.fl�---)FIKE1 Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' ° " Longitude ' °
�lkean to Feeder
Feeder to Finish
Farrow to Wean
Other
l,J Farrow to Finish
IM Gilts
Subsurface Drains Present IILI Lagoon Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collectign & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Styµctt 1 Structure Structure Structure 4 Structure 5
identifier: ((�1 1'
Freeboard (inches):
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
ElYes No
❑ Yes No
❑ Yes / No
Structure 6
05103101 Continued

Facility Number: 51 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
/
closure plan?
El 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?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
El Yes
�f
L1J No
/
11. is there evidence of over application? Excessive Ponding ❑ PAN ❑ Hydr ulic Overload
❑Yes
N
12. Crop type
�-
13. Do the receiving crops differ with those designated in the Afied Animal Waste Management Plan (CA )?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
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
N o
16. Is there a lack of adequate waste application equipment?
❑ Yes
!!!! No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
B. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
II
(ie/ WUP, checklists, design, maps, etc.)
El Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
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
XJ o
/
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?
ElYes
V
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El yes
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (defer to question ,Explain any`YESanswers,:and/or any recommendations or any o er comments:'-
e drawings of facility to tietter expLiin situations. (use ad i�tional-pages as necessary) Use Field Copy ❑Final Notes
.:. .-.
S�FC r2ow 0/l 81--;7/04. __4WA — Y - /vf�D LS>�
.. .:A
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
w
05/03/01 Continued

a
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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
A 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? (Le- 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?
I Aaaitionai comments and/or Drawings:
W 10, 6 Z, , 4 / F-,,,c t � v, � �e 10
❑ Yes ❑ No
❑ Yes o
❑ Yes *No
❑ Yes VJ No
t
❑ Yes o
❑ Yes No
❑ Yes ❑ No
�oo� v�c/C������
.Sow ��r2�s
05103101

Is
Facility Number j Date of Visit: 7 Q Time: t Z�J
Q Not O erational Q Below Threshold
Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...... ...».»» »..
Farm Name: a'Ld e s k County �t ».».._..... »_.
..G....».................. s.�Q �.................................... .........I................. .------.------��-1...-�............................. .
Owner Name:........�rlc r... ^!»�'............... ................. Phone No.
Facility Contact:............................................................................... Title:
Mailing Address:
PhoneNo: ..................».........................»
Onsite Representative:'..`Sr.o'................................................... Integrator: ...!�'`.''1..n+l°I''d.».» .........
......»e.e ,
Certified Operator:................................................................................................................ Operator Certification Number: ...... ............. ....... _....
» .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 6 «
: Design Cutrent-
e -Clinacity Ponnlation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design ' . Current.. Desi,
Poultry.- z-Cip-aci-ity, Po uladon , Cattle Ca aci I
. ❑Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total MMgn .Capacity: C
Total SSLW C
Nuinber of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area t_
Holduig Ponds /Solid Traps .[[:]No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 2rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ONo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ,4!1'No
c. If discharge is observed, what is the estimated flow in gal/min?
17 I Q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes 0%
2. Is there evidence of past discharge from any part of the operation?
❑ Yes1
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J�rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 21P.1 ......................Q.0.Z ....................(�..........................................................................................................................
................................q
Freeboard (inches): 33 3$
5/00
Continued on back

Fa ' 'ty Number: -7 / — / Sf Date of Inspection ff O t
• 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes _r10
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ErNo
(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 ETNo
8.. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes_j2'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes _07No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes .El -No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes_,j2rNo
12. Croptype ►�cf'Y1vd� Go ra t;', i�� �Wlai �-, o""I �1'Le�i' Sa eAns
GGa
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan ( AWMP)?
❑ Yes ffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
_0'les ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes -.ffNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ETNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Z'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
-ffNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �'No
ZNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes )Z'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,E! Na
24. Does facility require a follow-up visit by same agency?
❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[]Yes 13No
!•Yiola(i0#s'o r- deficiencies were ngted 04fiig tis:visit• Y60 00-tgye dho t'uOiter'
comes o dense: ahotrt. this visit:
heeds we46I2 r�s a�' l.t/; was4e j9)An and
�G 4{2-�err*�,�t r a�
receKdS jae-/'0 1
��. tiCPA +O 4,tke S41% S�''i/�Ief tam rOL", Gf'v? �iel-4j- 1-1 VC 4efS1 &4• ge sure
`fin v�se g waste � h a y s �"�(�d tM /�-ti;h 6D d a.%'- ox q 'r'; �'44"'9n
ere►745
-rAe Crary Qre Ve,-y well kejol - ave^% 11, Ac;/14ye?,d reco��f�`rel✓elf /�e�'�,
Reviewer/Inspector Name x/� eL,ca jj : % S'
.
Reviewer/Inspector Signature: � - Date: cef/%/Q'/ 1 $/pp

Fivility 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 Oyes ❑ 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 ja 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 O'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 E!rNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes_,Q No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
ati mments :andfor rawmgs:;-, z
5/00

r
Drvesion of Water Qual,ty f 1 1 •�s , {:
Q DrvEsion of Sod and .Water. Conservatlion �,
r Q Other Agency...
.. ;s.'.-r '.FJ- ._in a .. _�. es •_.":f�•-s".-'.'.
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Numberer
Date of Visit: U� `^GU Time: ® Printed on: 7/21/2000
�
Q Not Operational Q Below Threshold
.Permitted U Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
�.��
FarmName: ...... �,.--��...,....? c?>��........................................................... County..... �..........................................-........
Owner Name: ...........................................
Facilitv Contact:.......................................................
lsailingAddress: ......................... ......
Onsite Representative:-.,L,,r`r---• -
Certified Operator:..•.,
Location of Farm:
Title:
Phone No:
Phone No:
................................................................. --.................................... ..........................
................... Integrator:...... ..............................
................. Operator Certification Number:.......................
A.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• C�° Longitude �• �' �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle C apacity Population
❑ Wean to Feeder JEJ Layer I 1 ❑ Dairy
Feeder to Finish IP JE1 Non -Layer I I❑ Non -Dairy
l I
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present I❑ Spray Field Area
Holding Ponds / Solid Traps I I[] No Liquid Waste Management System .
Discharges & Stream Impact~
1. is any discharge observed from any part of the operation?
[-]Yes ONO
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. II' disclarge is observed, was the conveyance man-made?
❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the State'! (If yes, notify DWQ)
❑Yes ❑ No
c. II -discharge is observed. what is the cstimatctl 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 X'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes A No
Structure I Structure 2 Structure Structure 4 Structure S
Structure 6
identifier... ......................11- -........-.............- �.5�.........
J� f
Freeboard (inches): `i I IT? a�
5100
Continued on back

r FacAtty Number: 1 — I qg I Date of Inspection Printed on- 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 XNc
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q5Vo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes NNo
12. Crop type 6 15 Sb , r` I i"A I j- 5iy —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance: of the Certified AWMP?
yiolai%ons:or ifefieiencie5 *ere hbt;ed� during �his:visit: Yoit ;will receive Rio #wither •: •: •
....
omes• orideike: about: this :visit. • :::::::: :.::::: :::::::::::::: :
❑ Yes
❑ Yes
❑ Yes
❑ Yes
N(No
.(No
❑ No
❑ No
XNo
MNo
[-]Yes O(No
❑ Yes XNo
[]Yes J�<No
❑ Yes ONO
❑ Yes J KNo
❑ Yes NINo
❑ Yes bzpo
❑ Yes YNo
❑ Yes XNo
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):
V\10 lIV
11 x f i�
c 7A-)
(0-5 G C t—,3- Ao q8", cz V\_ytjk 4L
lReviewer/Inspector Name �I V 3 3q6 Q
Reviewer/Inspector Signature: Date: 10:­r-00 5100

Facility Number: —} Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below KYes I To '
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �INo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FfNo
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 P�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 o
31. Do the animals feed storage bins fail to have appropriate cover? ElYes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
'Additional : Comments an or.Drawings:
n
1�
UJk
ate- s
U 4�
S/00

sr� Dw�sion of Soiland Water Conservation = Operation-Revrew , `•
13 Division of Soil and,Water.TConservA n�--Compliance Inspection
Division.of.Water Quality - ' .irpliance.Inspection
Other Agency - Operation Review
j(D Routine 0 Complaint 0 Follow-up of l)WQ inspection 0 Follow-up cif DSWC review Q Other
Facility Number I } (,
Date of Inspection 2,
- ... _.J
I"ime of Inspection 24 hr. (hh:mm)
EpPermitted 0 Certified ©'Conditionally Certified © Registered 10 Not OperationalOperationall Daate Last Operated:
FarmName; ............ .�t tX.4...Ga(..---......f. a&r.c"'.....................--.......-..-..................... County:.........Du4.11!1�...................................... .......................
Owner Name: ..................Acr.rj.......................-..-..•At'.� SD........................................ Phone No: .... (D.I .. .6.......................................
Facility Contact: ..........................................
Mailing Address: S...........
�
Title: ........ . ...................................................... Phone No:...---..............................
Onsite Representative: &,Xtl �j"S}�,,,,,,,,,,,,,,,•
I
Certified Operator: .................... ....,..... .... Si "111S.pr.........
Location of Farm: { 1
.AKA$-04--,.... 1.... MI.
............. ........ .$t: VI0'uLit.1...N.cr......................................
............. Integrator:........ DQ�Vuoz�
............. Operator Certification Number:..,. t2ai ....................
o,F.....SR..to.f.......................................................... :................................... 1 A,
.................................................................. ............................................................ ......... ...... ........-....-.[ T
Latitude Longitude � • �� ��°
Design
awjne
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish_
❑ Gilts
r❑ Boars
Design Current Design Current
Poultry Capacity Population CattleCapacity Population
❑ Layer FEI
Dairy -
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity C
Total SSLW r
Number of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)'7
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`!
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. [f dischargc is observed- what is the estimated Ilow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2
Identifier: Gr
I% 4 I
Frechoard (inches):...............-11 ...............................
..............
Structure 3 Structure 4 Structure 5
gPz
Z S�
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes { No
❑ Yes No
❑ Yes T No
❑ Yes 4 No
Structure 6
1/6/99 Continued on back

Facility Number: 31 - 1 4fo Date of Inspection
r'
5.+Ai-e there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crop type ............................ ........s rr. ..i......sr st.'�.............................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement`? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0• No.vialations_or. deficiencies .were* noted. during'Niis.visit:. Vt6u'-v,01'rec'eive na further...:
O respgridehee: abbitt: this visit.: • ;
❑ Yes M No
❑ Yes ® No
j� Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes 10 No
Yes ❑ No
❑ Yes ® No
❑ Yes iM No
❑ Yes 09 No
❑ Yes ® No
(Yes PANo
El Yes W No
❑ Yes 14 No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
: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):'-'.'4
T �ros�ar. t� ar. ouY e1+IfAwl� o� ta�oor g� glei �— �`;iit�j
iz.5
14. n- (pas beer c,��Qc� �w cL 1i�1� ae.6-Nir<ako'Xz. r
)9. Most MVA ijo x� a��l�sii s�o�1U { be }led -ke ccLL1'1r'LTe +3!0-4 h i �Va I— Wwtes
/
a 4WO
Reviewerfinspector Name
Reviewer/Inspector Signature: Date: 4AM_- 1116/99

V
1�
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
outiue O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number i Time of Inspection 24 hr. (hh:mm)
© Registered © Certified [3 Applied for Permit WPermitted 113 Not Operational 11 Date Last Operated: __
Farm Name: +— Count
Owner Name:......: 1. .... .... ..... ....�`'� .......... Phone No: �o ... :..1. '`. .7 ...1 ................
.......................... ........
Facility Contact: .............................................................................. Title:.................... Phone No
................................................................................................
Mailing Address:......`' \`..-�1.................���...�.......g......
l S��
OnsiteRepresentative:..��'..G+--�1 ..... Integrator:......
Certified Operator:............................................................................................................... Operator Certification Number;.....................
Location of Farm:
.....
.... ...... ..... .�w. 1........ -••`• .. ..,. ....
,
t
O.K.
'ee.'.K
...... 4.f�r,.....1. Q............�';'`�......... :...:.....''1.......... Win....... .. "'kaS..
�A , Yltp
...... 7r_.... ..... A . .. ..A................................................................................................................
Latitude • ' " Longitude • ' "
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
CKNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
( No
b. If discharge is observed, did it reach Surface Water? (If yes, notify MATQ)
❑ 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
Ld No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
5(No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
O No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
$No
maintenance/improvement?
6.
Is facility not incompliance with any applicable setback criteria in effect at the time of design?
❑ Yes
A'No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ONo
7/25197

1
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds, Flush „Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Structure 2
Structure 3 Structure 4
Identifier:
Freeboard (ft): �
3............1� S`................:.
.....................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12, Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of W] �MP, or runoff entering waters of the State, notify DWQ)
15. Crop type ✓.' `....... Ste', j.................................................................................--...................
❑ Yes
XNo
Yes
O(No
Structure 5 Structure 6
❑ Yes
CqNo
❑ Yes
JM No
V[ Yes
❑ No
❑ Yes
OfNo
❑ Yes
(ANo
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 Iand 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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, No.vitilations•irr deficiencies. -Were ni 6ted-iitiring this. visit. A You:will receive•no' Airther
;�:-cgrrespondenceaUoutthis:visit:•:•:-:-:-:�:�.`.� -:�..:-:�:�:�• �: .•.::.��.•.
❑ Yes
No
❑ Yes
No
❑ Yes
O No
❑ Yes
bNo
❑ Yes
�fNo
❑ Yes
No
9Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
R[No
�e 'V__N Vel 47--, ��V �"5cxjt---� Vezr _"A�,
GLS !, 'Y 1 '��' i S?1 fit` Girl t-•mot \� 40 > Q. i
Gy—
S b � /CA` �({{y Sa
5/(�}/��P//Jye t.e.y 5/97
�� �l nM1�.— �r l/�� • �� t 7
Reviewertinspector Name
Reviewer/Inspector Signature:
� Hmillu

A
z
w

j �VED
J O L 11 1997
ANNUAL INSPECTION (DWQ)r:_
JERRY SIMPSON NUMBER ONE: BETSY PLACE FARM
ACTIONS TAKEN
I. HEADER
A. DRAIN ADDED TO PUMP
B. SHUT-OFF VALVE CLOSED AFTER USE
C_ BERM (SOIL ADDED AROUND Z-PIPE AND DITCH)
II. OUTER WALLS
A. MOWED VEGETATION
B. ADDED SOIL TO SOME AREAS
C. SEEDED AND SPRIGGED SOME AREAS
III. TOP OF DIKE
A. SOIL AND GRASS ADDED TO WHEEL RUTS
IV. OTHER
A. CONTINUOUS EFFORTS WILL BE MADE TO MAINTAIN LAGOON IN A SAFE
CONDITION
JERRY SIMPSON NUMBER TWO: GANDERS FORK FARM
ACTIONS TAKEN
SAME AS ABOVE
II. SAME AS ABOVE
III. TOP AND INNER LAGOON WALL
A. SOIL AND GRASS SPRIGS ADDED TO SOME AREAS
IV. CERTIFIED ANIMAL WASTES MANAGEMENT PLAN
A. NEW AND MODIFIED
V. APPLIED WASTE RECORDS
A. RECORDED
- --- r_- - - --- ---
IRY E_ SIIIPSON

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STTE VISITATION RECORD
. DATE: 147h 1995 LT
Time: 1�
Farm Name/Owner: i6ae6
Mailing Address: & ki NN
County: 7
Integrator. M die PIS Phone:
On Site Representative: _4/b6� _ �•� IZ� Phone:
Physical Address/Location: 2 • jvt-
IqW4 4-1
Type of Operation: S wL Poultry Cattle
Design Capacity: 7 7 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: U' q 4' 1�" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have uffcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboard: —,?,- Ft. -0-- Inches
Was any - seepage observed from the as on(s)? Yes Ve
es Was any erosion observed? Yes No
Is adequate land available for s ray Ye or No Isover crop adequate? or No
L
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells? e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o he state by man-made ditch, flushing system, or other
similar man-made devices? Yesee
If Yes, Please Explain.
Does the facility maintain adequateanagement records (volumes of manure, Iand applied,
spray irrigated on specific creage with cover crop)? Yes or No
Additional Comments: ft- UG %RC_ om Lme
�-
C
<XMA11L _ /,)/ polup MW (d luhlr l
G H
Inspector game JSi,,atuMrea
cc: Facility Assessment Unit Use Attachments if Needed.