310797_INSPECTIONS_20171231

NORTH CAROLINA
E-.�
Department of Environmental Qual

Type of Visit: ,Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
.7-16
Date of Visit: 111.11ir Arrival Time: Departure Time: 0 County:
Farm Name: OW Owner g , Owner Email:
Owner Name: ,ry. 'TG Phone: O Z9 6 3 2_7 (�
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: :1L ] Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
wl-f► C" 1 oWt� *� - tv S J at 1Gv0_ lS n0 J tra; f o ff- -fip IDU 1
14
Region:
y cam! 1 IrN
Design
SwAil
ine Capacity
Wean to Finish
C►urrent Design Current
Pop. Wet Poultry C*apacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyLE Heifer
Wean to Feeder
Feeder to Finish
Non -La er
Farrow to Wean
Design Gu1.rrent
D Cow
Farrow to Feeder
Farrow to Finish
Dry P.oultr, Ga aci P,o
Layers I
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes [2 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Q NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
14
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4_6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ 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): ler AA4 A Pdz -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�o No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
iceI No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]'Yes
[ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[R 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
[ ] No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E] No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA ® NE
Page 2 of 3
21412015 Continued

Facility Numher:, 3 1 - JDate of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? fll Yes 6*No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E� Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
CR 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?
0 Yes
[] No
❑ NA ❑ NE
27. Did the facili y fail to secure a phosphorus loss assessments (PLAT) certification?
II
[]Yes
❑ No
EDNA ❑ NE
Other Issues
28. Did the faci* fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA R 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
rw,
Wu ao
kpo III rV0
ro
vtfos
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
37 %.
[:]IX No ❑NA ❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
i No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
561 is : l ip jr4D��,rgk, ajj�
(arp­
Phone: i�01 b-134
Date: l
II
- 2412015

Date of Visit: Arrival Time: Departure Time: County: l� �'I� Region:(&
IV
Farm Name: � Can Owner Email: '�"
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
�r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:!-c��?
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C+apacity Pop.
ean to Finish
Wet Poultry
Layer
Design Current Design Current
Capacity Pop. C►aEtle Capacity Pop.
Dai Cow
ean to Feeder
f
Q
Non -La er
Dai Calf
eder to Finish
Farrow to Wean
Farrow to Feeder
ltr,
airy Heifer
Design Current D Cow
Ca acit P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
1 Beef Feeder
Boars
ANcrs
Beef Brood Cow
her
Other
oults
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,,,ffNo
❑ Yes ,�No
❑ Yes R!rNo
❑ Yes JZ No
❑ Yes JZ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: / Z`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo
❑ 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 JZNo
❑ 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (?No
❑ NA El NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes "d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J21 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
'Comments -1ti°ty
(refer to,questton;#) ,Explain any YE$answers and/ar anyFrecom€mendatt�ons or an othe r commen �
Use. drawtrigs'of facility, to better:explain situations. (use,additi°`nal pages as necesgsary,)f s
f,S:�k£.'.'r�.
6 oo �p AL
l o O' f sl _'ZVUA
�%ly�iS' D. �'Z- 3 //�jls- f • a � �`_rnrrJJ""
4 6 c►
Reviewer/InspectorName ti? ,`t 1'':k�;'S�,�:u. # }'x,. }:, :,. , �_,., Phone:
ReviewerlInspector Signature: Date:
Page 2 of 3
121,78104 Continued

Date of Visit: Arrival Time: arture Timer County: Region: '-`
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: , 242c ke ���yA.,p Integrator:
Certified Operator: Certification Number: -2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
EEDai
Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, I;oultr.
Layers
Design
Ca aci
Current
Pao
D Cow
Non -Dairy
Beef Stocker
Gilts'
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other JE=0ther
Turke s
Turke Poults
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes _4E!rNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes—j!�`No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes. No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes �fNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Ds ection:
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 PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�allo ❑ 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 ENo ❑ NA 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes p"No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff 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):
t3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes r� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes O'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;no
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2!rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P!rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VfNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date bf Inspection.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo E] 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,;30&o ❑ 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 �ro
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes nj 14o ❑ NA ❑ NE
❑ Yes Po ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes gNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinas of facilitv to better explain situations (use additional nacres as necessary).
N 4V2- s 1- 3 �� G
0,6S- 3Y70
rlf//Y� a- �CFGor O S 1 6d� cJa�
7)11l�y o�by za
0.)2, -71 Ca i lk"4�Ao �S&&
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

0 Other Agency _ �I
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O.Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 6 Arrival Time: G eparture Time: County: Region:
Farm Name: 1 ` Owner Email:
I Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Q[ J�J��, �y�.� r/•l S Integrator: /y r+
/AgS
Certified Operator: Certification Number: �� ���• F
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
aE�
Pop.
Wet Poultry
C*apacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
aia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
_Dry Cow
Farrow to Feeder
D , P■ouitr.
Ca aci
P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I 113eef
Brood Cow
Turkeys
it
Turke Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes )Z No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes Z, No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ZNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [�Ao [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 5 '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 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o"
�
❑ NA
'o
❑ NE
a. If yes, is waste level into the structural freeboard?
Yes
NA
ONE
Struc e l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �2No
❑ 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 ,Ej No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T�
9. Does any part of the waste management system other than the waste structures require
❑ Yes Fe�o
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )2�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes T;�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ 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 J[a.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )ETNo
❑ NA
❑ NE
Required Rec_o_rds_&_ Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ):ErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes PT 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 [3-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,2-No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number; Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes [2 No
❑ NA ❑ NE
25. Is the 'facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes E!fNo
❑ 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 Z] No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ,E�fNo
❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ZNo
❑ 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 ;lo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ZNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
['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
V'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
ZNo
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ 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).
A--, _ '��� fecors
-711011
/ f// 11 6'(1.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/ 2011

J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O rrival Time: %11� Departure Time: County: Region:
Farm Name: Owner Email: �J
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��r� 0 " L I ►=
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
I Phone No:
Integrator: '
2
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ ` ❑" Longitude: ❑ o "
:% 4y4
b 3`l.. YC k.Y Yt� � 4 .A3 Ai r, �:9 .-yiY {' k.:4N kktl •' Yi b ._�; Y'i � R4k kXr�kl S%'� 8?4: 1 4 `'A'R Y' SI&
Design Current, ; . ` ' t, , Destgw § Current',a , t .. � "{Desalt . Current; .
Swine•` n,Cii 'aci I'o Mahon°� We �Poultry'Ca 3aci't Fti ulatton " �Ca�ttlel�f 4` �'Ca `Acit Po�u anon
, Y P .4 �p� Y�. p� io
' ❑Wean to Finish ❑ Layer
❑Dai Cow?
❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
El Feeder to Finish } �' ti y ° ty " i4 k El DairyHeifer
` i i yF { 4 i
El Farrow to Wean �i k ' ❑ D Cow
>.: prFy Poultry. tt-:. " .. , .
z, ❑Farrow to Feeder [] Non-Dai
El Farrow to Finish ❑ Beef Stocker
❑ Gilts` ❑ Beef Feeder "
❑ Boars i ❑ Beef Brood Cow
Otber;50
: r`
: ❑ Other W� PlumDer, (of Structures: ,
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ 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?
❑ Yes �1Vo ❑ NA ❑ NE
❑ Ye�o
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ,]"No
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes �1 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facili Number: Ci - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o
a. If yes, is waste level into the structural freeboard? ❑ Yes %o
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes,,ff No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes o
❑ NA
❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yeo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o
❑ NA
❑ NE
maintenance or improvement? 7
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5�'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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes�ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesETNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements
[] Yes 'o ❑ NA ❑ NE
❑ Yes,,;;kNo ❑ NA ❑ NE
❑ Yes_,Q'No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,E]'No ❑ NA ❑ NE
❑ Waste Application [3 Weekly Freeboard [] Waste Analysis ❑ Soil Analysis [] Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &N' o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is tE'ie facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [� o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT') certification? ❑ Yes tNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0. No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes U)No ❑ NA ❑ NE
Comments (refer to question #): Explal any YES answers and/or any additional reeo&niendations or. any other comments.''.
Ose`drawin s of facility to better ex ia-m.rsi-tua�t.io.n�suse additional gages. as neces'
s' ry' ' `
-
11131;1
U'7/
a. ry
f3
Reviewer/Inspector Name:
Reviewer/Inspector Signature: C. v
Page 3 of 3
❑ Yes
;allo
❑ NA
❑ NE
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ;dNo ❑ NA ❑ NE
Phone: lJ - 7-6- 7V—JC
Date: d z
4a0

Type of Visit: QKompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance {
Reason for Visit: OC—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access {I
Date of Visit: I / Arrival Time: O Departure Time: County: CZ)Region: %
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
.1-
Onsite Representative: �QA& LS
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:ZOZZ
Certification Number:
Longitude:
Design Currenk
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
C*urrent
Pop.
Cattle
Dairy Cow
Design Current
C►apacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
DryCow
Non -Dairy
Farrow to Wean
Farrow to Feeder
KWe7kign
Dr, P,ouItr, Ca acit
Current
P,o
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
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 �No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes 2 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes �14o' ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes );Er5o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA [3NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condnued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4 `Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes �allo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ 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 PrNo ❑ 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 ',Fe�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [3 Yes /�Io [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ 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 V6No ❑ 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 VNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[2 Yes �No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes �No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. OyesjJI!Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 14 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
Page 2 of 3 121412011 Continued

Facility Number: -72V Date of Inspection
24. Did, the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ZrNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P�&o ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ZNo ❑ 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 [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes L!J �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 ex lain situations (use additionah pages as necessary)." C
A/ "C&j
C71 GlALC,lYsIss
1/164 qC? 2L 3 )Qr'41V;- le-C "'-0/2
Reviewer/Inspector Name: A &L&WPhone:
7Q__
Reviewer/Inspector Signature: rzL �_/ Date:
Page 3 of 3
I

FactLty Number �.
>bst,
. I;:4 .'a:. jhtt,i , .- - -sad -�zk.f
ater Conservi
Type of Visit erC6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ICJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: //old Arrival Time: Departure Time: County: Region:r%
Farm Name: �� l�/.�x �.��.Ci grZy_, '! l d Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `��cT���in�fC �Li Integrator:
Certified'Operator: Operator Certification Number: ��`3
Back-up Operator: Back-up Certification Number:
Zz�6 y
Location of Farm: Latitude: = c = 1 = Longitude: = ° = € =
it
kDesign
Current= _a Designs Current aDes�gnr�aCurrent:
S.wineywFCapacity .Popul>ation Wet .Poultry °CapacitylPopulatton€
Cottle i. x'Ca acrt Po Mahon
❑ Layer
❑ Dairy Cow
❑ Non La er
❑ DairyCalf
t� = tf�
❑ DairyHeifer
�r �� i r43 s�❑
'
D Cow
t nryipo,It' y ,
.. , , a ;
❑ Non
❑ Layers
f
-Dairy
❑ Beef Stocker
❑Non -Layers
❑ Beef Feeder
El Pullets
❑ Beef Brood Cowl I
, ❑ Turkeys
ther' £ ❑Turke Points
µµ
9
❑Other
❑ Other
Number of",Structures"
g
an-k r1-
ftj i_
- ❑Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
' ❑Farrow to Finish
❑ Gilts
❑ Boars
der;
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ,❑'No ❑ NA ❑ NE
❑ Yes ZNO ❑ NA ❑ NE
❑ Yes �TNo ❑ NA ❑ NE
12/28/04 Continued
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ,❑'No ❑ NA ❑ NE
❑ Yes ZNO ❑ NA ❑ NE
❑ Yes �TNo ❑ NA ❑ NE
12/28/04 Continued
12/28/04 Continued

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes JZFNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� No
ElNA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes ZNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes J' No
❑ NA [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes QNo
❑ 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 /ETNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PTNo
❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
.E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
Comments (refer to qui st to #) Explain' any YESinswers and/or any, recoinniendations or any other_commentst `F f e Jr
:Use draivin s af.tacilit' `to better explain; situations.use additional pagesas neeessar ", '' '•
Reviewer/Inspector Name _ - — - - _ - _ 77 - -- -- Phone: L&7
Reviewer/Inspector Signature: Date: /l
12128104 ' Continued

Facility Number: — Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;3 No ❑ NA ❑ NE
20. Does the facility fail to have ali components of the CAWMP readily available? If yes, check ❑ Yes PKNo ❑ 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 ONo ❑ 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
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
12"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
' /U 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
W(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
El NA
❑ NE
33,
Does facility require a follow-up visit by same agency? •
El Yes
,q,(No
E I No
❑ NA
❑ NE
Additional Commentsa/nd/or Drawings:
.
MZ
////, fro '0, ?3 31140 1,3
� 6`7
19 �0
/
pt �' di
bj-w 0• jV 29/
�� 6
�• 3
z
h -7
L. et 06 P1 .2 d � . 1 i4�-ei 4m 4 levc �.
14 a A'� -- Se'K
w
Page 3 of 3 12128104

(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �LLL�LC��J Arrival Time: 0 dr/ parture Time: County: -0I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:` " 1A�5_
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I =61 Longitude: = o 0
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
on -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Ciits
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes [:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes [2o&o
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes,01NIc
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes If No
❑ NA
❑ NE
other than from a discharge?
Page I 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?
❑ Y*No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes AE No
❑ NA ❑ NE
Structu ure 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 RNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes EffNo
❑ 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 9.No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�M-No
9. Does any part of the waste management system other than the waste structures require
❑ Yes _1;iNo
❑ NA ❑ NE
maintenance or improvement?
Waste AUDIICation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'tO—No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
t5. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ❑*o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes /.0-50- ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes A0Ko ❑ NA ❑ NE
ReviewerlInspector Name "�:' ;� `�, ;'.�'.`�`.' Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/0Continued

f Facility Number: JZ— Date of Inspection &. AI�M
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,,O-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes W10
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
e No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VfNo
❑ 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
6No
❑ 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
PTNo
❑ 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
to No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additi6naC Comment's and/or Draw, ngs
j v
-f
/0"
2
7 ``P old
��0/� � �-.e� les
�e s�1'Q
call C? Ild-1-15
d• 3
lalc.f/0�
Page 3 of 3 12128104

it
;Facility Number:' 3 7
pater Quality
)il and Water Conservation
0:>Other 'Agepcy
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Tech al Assistance
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arriva Time: Departure Time: County: %' Region:
Farm Name: D1 ✓ Y r �` Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: C to S Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Sack -up Certification Number:
Location of Farm: Latitude: ❑ e Longitude: = ° 0
�� ' Design; �' Current ; t � " r�� � ..... rgn'° Cui rent Design ; Current
Swerve Capacitty Populatton V1'et Poultry y_Capacity ftpulatlon Cattle Capacity Population
can to Feeder O p 15 1710Q 1
[IFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
►er
Other
ILJ Non -Layer I I I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
LI No
Er
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
dNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continues!

Facility Number: -- Date of Inspection f/ 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oZ
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 .2 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2NO ❑ NA ❑ NE
❑ Yes PAo ❑ 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',2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes PNo ❑ 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 Z'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo []NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Ca<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 2-f4o
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes .R o
❑ NA
❑ NE
Comments (refer to questionft Explain any YES answers and/or any recommendations or;any,other .comments
Use drawings or facility to better explain situations. (use additional pages as necessary):. ,
Reviewer/Inspector Name I Lc Phone: 6i
16 Reviewer/Inspector Signature: G. Date: C/
Page 2 of 3 12128/04 Continued

Facility Number: Date of Inspection 1fl f/�I
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 El NA El NE
the appropriate box. ❑ WUP El Checklists [3 Design El 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ob
id the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Z'No
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
12rYes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes 9/ No
❑ NA
❑ NE
❑ Yes 9 No
❑ NA 1zNE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes,L3"No [:]NA ❑ NE
❑ Yes '1:�No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes Q,No ❑ NA ❑ NE
❑ Yes [;KNo ❑ NA ❑ NE
Additional Comments and/or Drawings: elk
— �z S ve/_ _ •
/006 a q D� e i`� ��SS /eve is f0�H a lcr7
/were .su4�1
b tcYL S wed � car'
o- 36�l y o"ass b�-e,
QS Sv�Y` s T
/,lr U 1. z
,5 /�,3/66 �- Y
�r L/
^fir
3
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: �,Departure Time: County: Region:
Owner Email:
Phone:
Facility Contact: v Title: Phone No:
Onsite Representative: �ltC.h-i c- P 1i�'�1►15 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
' Vean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certificati n Number:
Back-up Certification Number:
Latitude: = c ❑ t ❑ Longitude: ❑ ° = ' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
OCR ❑ Non -La er
Dry Poultry
❑ Layers
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 4ff'�o
❑ NA
❑ NE
❑ Yes U No
❑ NA
❑ NE
12128104 Continued

Facility Number: g — 7 Date of Inspection
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ;2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Z
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
CRINo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
6 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
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;ZNo
❑ NA ❑ NE
(Not applicable to rooted 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
;24No
❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drih ❑ Application Outside of
Area
12. Crop type(s)--
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ET�o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9.No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
0 Yes
[�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�'No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�TNo
❑ NA ❑ NE
. mments (refer to question #): Explain nny. YEStanswers an f, any reeommendatron's or ally other:comrrtents
Use;tlrawings of facility to' better explain situations (rise addihonal`pages;as necessary) .
ReviewerlInspector Name �UJW� Phone: �
Reviewer/Inspector Signature: Date: �� G
12/2&W Continued

Facility Number: 31 - I Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
21 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check J] Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El 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? ❑ Yes /ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No 0NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ONA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No ZNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
7NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
12 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E:fNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[:I/No
❑ NA
❑ NE
Addiittional Comments and/or.Drawings:-,
Cct�y
S hR-e�` mot- cer-Vt 4tcr—Va-V Q F Co\1erc, -Cray,—
dL d ems. e r C. c&Q' A-o Q uyy\el � re- Lo r of S
�Fa Y-Y-�-\ t S
orkv
12128104

Type of Visit Ff Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine p Complaint p Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: 16gagl'rnanel
Facility Number 3
O Not Operational O Below Threshold
ermitted erttfied 0 C��o to all Certiled Registered Date Last Opera J or AboveTThreshold:
Farm Name: Q (.cJl »�.tr4 _.�_..vqe/d�i� County:..»..F� ll,»»»..»»
OwnerName: _. _ »». » .__.._ ..» .....__...». » »» » . »» ..» ».»... » . .»... Phone No:..»....»»._...
MailingAddress:.._.......»..».- ......................._»._._._..._.».. ._.»...._......»..». »..._
FacilityContact: ....................................._..............».____._... Title:................................_...............»__..__.. Phone No: _ ... ....__.... .. ... .._.................... .....
Onsite Representative:. s ,,C Integrator:...,! . .... . . ......
Certified Operator:___-_—..--_. » »_ . _.._ . _ ... _ Operator Certification Number
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude ' 6 64
Mcharees &• Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2<o
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 .814o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4EMo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PXO
Structure I Struc e 2 Structure 3 Structure 4 Structure 5 Stricture 6
IdentiFer: L.� �j___...�._...»......_.__...W.................W_......_.»_ ._------_.._...._._..... »__._ _..._._.»
Freeboard (inches):
12112103 Continued

Facility Number:3 -- Date of Inspection i
5. Are there.any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �0'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes L3No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ONo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes •EINo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 4allo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,2�No
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes .ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type IGt j , ")rC�c'r�
13. Do the receiving crops differ with thos designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0*90
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 'E No
b) Does the facility need a wettable acre determination? ❑ Yes ;2No
c) This facility is pended for a wettable acre determination? ❑ Yes .Q'So
I5. Does the receiving crop need improvement? ❑ Yes 'Ea1Qo
16. Is there a lack of adequate waste application equipment? ❑ Yes F.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 , RPO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 21T6
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ';34co
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 'P�No
Air Quality representative immediately.
�x..��-...-,-• :em�w..4. r�..s.��°-- �.:#� �'..;ttrr�- rrw��� r,�-{eo-w..c �r�r,
j,Commmts (referwto cl6&fion,#)�Explarn;a y YBS answers, and/or _ py or arry other camp eats: ,y:� , I �
'.'yy,�';� ftiltNi�Hil"'�'"w'gfl€ ��-'N�15�a{ ^' �..���i �^a^-.^-= .�p ,�'i .
Lase drawnsgs of laepetytobetter exglaus situations. (nse sdditiatsaipages astnecessary)= A ❑Field Copy ❑Final Notes
N lfi�a 't s u< ii i R y 7 fk.;t � �' 4j
YM '�."i9s n `�? ,U
sa o i a :s. � -�.:., a 'u•:.:.:sii a
Pl eo se 7`/ /' /7 A Ole S 906'k-1 Gc,► q MS
&'QCA-
Mr X
Hv
(fIPi.,1C..1k01150
ReVlewerIn$pector Name
Reviewer/Inspector Signature: Date: D 6ZC
LZ/lZ/U3 Lonnnuea

Facility Number: — 7,9 Date of Inspection CC7 D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? Oyes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.) ❑ Yes ETRo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,0-No
❑ 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? [I Yes ;]-No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes .moo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Feeboard problems, over application) ❑ Yes '�2No
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative? ❑ Yes JLR-No
28. Does facility require a follow-up visit by same agency? ❑ Yes „8'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �;Fgo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes �o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number fate of Visit: D Time:
It Not erational BelowThr o d
#Permitted Cerrttified [3 Conditionally Certified �!] Registered Date Last Operator Above Threshold:
Farm Name: t-�QU)0 `Ian)DCR �i�12M� #Ft County: up4o�"
1
Owner Name: [oM_� � C �L ��f�n� ��-Iyri Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: k = �t ` F jJ :N) S
Certified Operator:
Location of Farm:
Phone No:
Integrator: W Er
Operator Certification Number:
Pf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� r- !" Longitude 0 G 14
`�rlPelnn i ["'nrra�
S ine Ca aci
Po dlation
Wean to Feeder
0
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
D`esigis Current Design Current
Poultry Capacity, Population Cattle capacity Population
❑ Layer ❑ Dai
❑ -Non-Layer ❑ Non -Dairy
❑ Other
s
TotalDesign Capacity
Total SSLW
� %
Numbefie r of Lagoons ❑Subsurface Drains Present ❑ La oon Area M � � a w ❑ Spray Field Area i
Holden IPands I.Salid Tra s
r? �
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection 8& Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [XNo
Stru9ture I �"cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Freeboard (inches):
(inches):
05103101 Continued

Facility Number: I I — Bate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes j 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 No
Waste A11plication /
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application i ❑ Excessive Ponding ❑ PAN El Hydraulic Overload El Yes VNo
12. Croptype L (J-RK7_ J 2W I UVt_,A!5ER>
13.
Do the receiving crops differ with those designate in & Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
A No
16.
Is there a lack of adequate waste application equipment?
ElYes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
19.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
/// No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
ElYes
No
V
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
El Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP7
El Yes
No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to uestion # ,'B" 1 in'iin 'YES answers and/or an er commendations or. an !Per, comments
Use di awmgs of;facilityto befter�explain situations: (use additional pages as necessary}: Field Copy El Final NoteJAP
r
J tJu E 70 l idoRK Do SmgLL Aar. aFi 5 r 1,llC.0 1v Pitt.,
Fof.5 ors, i�� B CO�F.,2 k OFF ' �-r� I���{ goy
TO RZEv y
LEf^f ©J E2 ,Pj{rr
15) i-� F-ZrLO5.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 vI 1 Continued

Facility Number: 3 1 — 7TJ Date of Inspection
Qllor hau
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
o
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
w
,AdditJ6haI C61hh ents an orA raORO
1� aC . ON ..-
6m-,:5 'Foiz Fo -vf)
�ZCLD S OF
rlrR�E�o2E
�f ysy,LOD
Nofaqr
05103101

P E rI
Divtston of Water
i
QualityI�'
Dtvrsron of Soiland Water Canservatton
Other�►,gency
i
Q
SY".".1... �dl 6�.4i;.�„ ._3,l ,' _., .. ��. �.. G,f ur�.�
..L =i ... �,.. ..I . . IT:1•J".. �.. •y .I& _.. .. ...'.i',
Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit QD Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
bate or visit: Z l of Time: � Printed on: 7/21/2000
�
Q Not Operational Q Below Threshold
®..Permitted 12 Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
n // P.� ........... County: ............ .i�!.G.'�..................
Farm Name: ...... lA�........Y .........t em..'5..............� .� ��
Owner Name: .......Tl�' 1t—.T G,e...........ti%C..1?�.,............................................. Phone No: ..... ...........
FacilityContact: ............................................. .................................Title:................................................................ Phone No:...................................................
Mailing Address:................
.......................................................................................................................................................................................... ..........................
Onsite Representative:............!................................................................................... Integrator:..... !'. ..... ... fiwn5.......
Certified Operator:................................................................................................................ Operator Certification Number:.................. ..................
Location'of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ° 4 .1 Longitude �' �4 «
Design ' :Carreiit
Cgnacity _ Pomiiatian
Wean to Feeder
Feeder to Finish
Farrow to Wean
J3 Farrow to Feeder
P Farrow to Finish
z Gilts
ipj_t. $oars
Design Current Design Current
Poultry Capacity population Cattle - Po illation
❑ Layer ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Tot WWW ,'
}} ❑ Subsurface Drains Present ❑ I.agMm Ares Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. 11' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes J4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes In No
Suructure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................z .................................................. ........ ............................ .................................... ....................................
Freeboard (inches): 3 7
5100 Continued on back

Facility Number: — 2J2 Date of Inspection Printer! 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
C&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
ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAIN ❑ Hydraulic Overload
❑ Yes
[,No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�&No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KINo
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[KNo
15. Does the receiving crop need improvement?
❑ Yes
ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
qNo
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�Z No
yiolafigris.o. dgfici ... rv�re otec1 dRx itig �h#s;visat; Yoh wild tie. .. t.. #'uirth�tt
corres' orideit& ab6n f this visit.. ' ............ 4 .... ... • .
iYrl -, .. , t i it - ' 1t 1 ^nk S-.c- a 4." a-?K :X''t`ih 1-t42 ••xtr;1}a n,� I.�xi - f ;'s
Comments (refer quesboit #) Explain"any YES answers and/or any recommendations or any4other comments,
Use'drawings:of facility.to;bettek,.ekplain,sttuations. (use adcligoi al,page rr,4I�p,Lp. ,}.{r�1r �, yµp yt
. J as.neeessary) l� 1M,01 "<V4R d±'i
pp
gear), � �klrmS eKe_ well m¢rti4�r k� � ,`n �voD� .S�k�C
�.t
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /��/3�0�_ 5100

Facility Number: f — 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
❑ Yes
V,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
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
0 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
M 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
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
ttona :..omments an or .ra ngs:.
it
S/00

Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection t3--
Time of Inspection © 24 hr. (hh:mm)
Permitted [] Certified [3 Conditionally Certified [] Registered 10 Not O erational Date Last Operated:
Farm Name• �....YG'"i.rz 1 County: ........ �ti.`................................ .......................
............ .................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
Facility Contact: ............................................................ Title: .. ....... Phone No:
MailingAddress: .......................................................... ... .............................. ........................ .................1........
Onsite Representative:........... ...'11K.2: ,q. -?-k=;.......... .......... Integrator:.......... ✓..........................................
Certified Operator:.................................................:.............................................................. Operator Certification Number:............... ............
Location of Farm:
}........................................ .............................................................................................................................................................. :..................................,.,:.................I V I
Latitude ' '"�" Longitude • ° "
'Curre
Designt Ea s
u'rrentDet
I , ;._,..
`'
apci Palaon
'`e
a ai PoulationSwine
".Cti
Ca at Po laton. ,
,
Wean to Feeder
'aCJ4
❑ Layer
�',;
❑ Dair y
.'
❑ Feeder to Finish
❑ Non -Layer
�`
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total DesigR'Capacity',,
❑ Gilts
❑ Boars
Total SSL W
E , , ,N g ber af,I,agoo�raps�� � 1 ❑ No Liquid Waste Management System Area Spray�€ 1 ea
lE ii
;, g ❑ Ii teld Ar
t Holdin Ponds 1`Sohd
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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/ruin?
d. Dues discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: n ......................[.�
Freeboard(inches): .................` I. )` L, t.3.................................................... ........................................................
.....[fi.................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes A(No
Continued on back
3/23/99

Facility Number: `3 r7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
C<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
j(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
❑ Yes
YNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
$�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
VNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
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
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
t<No
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
S2"No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
N(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
I� No
(ie/discharge, freeboard problems, over application)
J�
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
Xf No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P'No
�'Vq viola�igrjs'o;r d�iF�etertcies re nQte� d�rr'ing th s;visitf Yoit wii� rseegiye o; #'urth� ,
ctiries�oride' 'e:abi kthis vesit...::::...:::..::::::::::::....... .
am si ations use'ad.d.ito:na.l.lp,a:.es asInecessaL 1se' rawmgs a thce i o' better expo
��•--ems �'� �'��� h��� ��� � ���� 5'�r�,��` � .
t
ill­
ReVleWer�n5peetar Name ! 3 t}V! b+
Reviewer/Inspector Signature: a Q Date: 90 ..{1d

M.^ •S
Facility Number: 3 r] Date of Inspection G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Arc there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VNo
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 x No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a pe rm anon t/te mporary cover? ❑ Yes ONo
Ytiona 1.nmmen an or raw s:
A.1

p Division of Soil and Water` Coiiserviition -Operation Review
p DiVISIpn 0f SiJ I' and Water Conservation - COn) in Inspection
mi
Did ision of Water Quality -Compliance Inspection
Other
Revie-
p ency -Operation w i
0 Routine p Complaint p Follow-up of 5WQ inspection p o ow -up of DSWC review 40 Other
Facility Number �37 Date of Inspection
_ _ __ ] Time of Inspection � 24 hr. (hh:mm)
[3 Permitted p Certified E Conditionally Certified p Registered p 1q0t peratunta Date Last Operated:
Farm Name: Dowxai..Y.oader.Farms.#]..&.#2................................................................ County: Duplin WIRO
Owner Namc: T.am..&.dackia.................... dratkins....
Facility Contact: .......................................................
Phone No:(9.14.).285-4.7.22.(Iame)..285-7R6&.(farm)..
Title: ............................................................... Phone No:............. .......................................
Mailing Address:.1.d9.Ael].Brack.Road........................ . Eeatulaxille,.NC'.....................................................
Onsite Representative: ................... ............................................ I ...... 4 ..... I ............................ Integl•ator:Murpthy..Fami]X.Farms................ 4...
.................
.
Certified Operator: Rahert.11ho.m.as................. Jeahjux ............................................. Operator Certification Number-22564 ............................
Location of Farm:
ast.al.Ghxn�iu�xn�;;auXhi+r..aiL,S>3..1 �.1 S..apxQ.;;Q,;znxl;'tk a;R;#1.7.......................................................................................................
Latitude ®• ®� ©�° Longitude �• ®i ®��
Design Current, esign Current lles lgn current
Swine, ;Cppaclty Population �' Y; Capacity Population Cattle Capacity Population.
oultr
® Wean to Feeder
5200
❑ Feeder to Finish
Cl Farrow to can
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of -Lagoons., F ❑Subsurface rams resen ❑ Lagoon rca p pray re rea
�t E Oldln 'hOI1dS �Solldra Sig ' [ € ` � � €�s.g � � �.P E I❑o l ui Waste ManagementSystem s
Drschaq!es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes p No
C. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Sti-LICtUre 3 Stroetui'e 41 Structure 5 Structure 6
Identifier:
I"rccboard (inches): 4A. ........4.8 ............... ....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3t_797 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
p 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?
p Yes
[]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
[]No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
[:]Yes
p No
Waste Application
10. Are there any buffers that need maintenancelimprove ment?
p Yes
p No
11. Is there evidence of over application? p Excessive Ponding Cl PAN
[]Yes
[]No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p Yes
p No
14. a) Does the facility lack adequate acreage for land application?
p Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
p Yes
p No
15. Does the receiving crop need improvement?
p Yes
p No
16. Is there a lack of adequate waste application equipment?
p Yes
p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily'available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
p No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
0. • N.o.viofations;or..defieien'cies.were 'nioted -during. this visit.: You. will :receive no. further. ' . ' .
o
. •crrespvfldek . Obit( this.visit,'' ..
ent with DLO 1 &
fficient freeboard available. No problems detected. Has good vegetative cover on dike walls.
Reviewer/Insp ector Namenn >rnr ;sG3`! ti ,Et�`��srt��>n^�^ttR;€rjj n �rtre �t g1 1In��s€assln�y Mtn,,.
f�►lall�(:Ohn30[I'}s iitt��_i?E��i� Eh�.-'33aC'�?�.00ntZ(D�Q�i� �e�"4i��� i�� i `t'!��E,e.,����i 13a{ �� i ��.��,�'-a�
1 i.:p�i•,...�9;n.�.�,�°��4tY[�. t t�L'; I,..i c'�i� lug... car�.ai}t�.c,-.��C�� a�gs+[c.,. r:,i'� ��1�. �,-s�'.. �,�, L.l.. 4„ �.iE,. €€ ,..la e a�af..i a, �a.R
Reviewer/Inspector Signature: Date:

Division of Soil and! Water `Conervati son' Operation Reew vi' `,
fl
Water E IEe'
E { E , e Division of Soil and Coinsrvationl Comphauce Inspection
€ tE
lvision of Wateri'QI Bali II,Yon,',.V RI CeiOV;I'ienWplil13 Other Agency, 0eraitllla-°iiirEii ce c In's- �rec4i ani, S ��� � sl3a I, s iE EtEIr.i -k�,kE., 71 Ekb7 ;i "�.I F iI ,-`,ll,i l,Id
E3,
Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection E=Z4 hr. (hh:mm)
© Permitted © Certified (3 Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
Farm Name: .:.....a,�11.�Gt-��E� 1�11,wS County:......... ii.............................................
Owner Name:........?.........1............... .........5......... Phone No "i
..........................................................��...
.........
Facility Contact: .. Title. Phone No: .. ..... b,..... ...... ..
MailingAddress:................................................................................................. ;.........................................
......
t�
,.,.......,.... ...... I...................
Onsite Representative: .......................... Integrator:........................... ..,.. ................. I............................ Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
............................................. ........................................................I............. ............
Latitude ='° 11 Longitude • =` =11
Design Current
�Swfne Canacity Population
to Feeder
aGQ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Er
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current Design Cuwent
Poultry'' Ca acity Population Cattle Capacity Population `.
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
` Total -Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Ai JE1 Spray Field Area
Holding3Ponds`/ Solid Traps 0 ❑iquid Waste Management System
Discharges & Stream Impacks
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 roan -made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (Il'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes gNo
❑ Yes ❑ No
, ❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
4No
❑ Yes
�rNo
❑ Yes A No
Structure 6
Identifier: �� �
Freeboard(inches): ...............................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes &KNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 `--�q� Date uf' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence,of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit`?
(icl discharge, freeboard problems, over application)
23. Did ReviewerlInspector 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?
No • , iolaiioris :or• d�flcie'ncies' mere nofed• doing •thls' Visit; - YOlt Will •teegiye do; cucthor; .
cor... .. de' * e. about. this visit:
❑ Yes C'No
❑ Yes XNo
❑ Yes JI(No
❑ Yes bNo
❑ Yes N No
❑ Yes �No
❑ Yes XNo
❑ Yes �'No
❑ Yes J�rNo
❑ Yes 9 No
❑ Yes [XNo
❑ Yes CR'No
❑ Yes ONo
%Yes ❑ No
❑ Yes ONo
❑ Yes [KNo
❑ Yes KNo
❑.Ycs kNo
❑ Yes P No
❑ Yes eNo
❑ Yes Kf No
Use;draw�ti s offaceltt toibetker-ex lattt`sikuattnris use`addrtranal=' a es as inecessa
����flred SGc 1 . ` St..3 5, � �1LJc �t�.l� ` �IIf
l � J�r S 151fJ
r�
r�,
10 �b� �I SSG1w �. r �\ r Qf�w a21-1 s� 1�
qq�
Reviewer/Inspector Name i t `I'�, . E `: � .. ,n ..
Reviewer/Inspector Signature: Date: c]
3/23/99

Facility Numbers — hate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ 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 4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ''No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes No
is and/or,
Additional
ommen awmgs
� r- � ,.<.�...... A �m
J
3/23/99

:,:,,..11.,;17—....J,,4,s. .a.<:,.'w.t,.,s..,,.:::.s.;':€::;:.;....—M
N.:—,azias„114�r
Division of Soil and Water Conservation ❑ Other Agency "
Division of Water QualityIss
tO Routine 0 Complaint 0 Follo%%-up of DXV12 inspection 0 Follow-up of.DSWC review 0 Other
Date of Inspection
Facility Number L .. . . .. ...... Time of Inspection 24 ht. (hh:mm)
13Registered ®Certified © Applied for Permit 0 Permitted 113 Not Operational Date Last Operated:
Farm Name i Count
Rts?ltl� ..... d ..ttr.....rQ�A'm ...... .......... .z ....,..........,.....,..... Y ...,� �xyh..,.,.............................................................
OwnerName:....,.. ( fps . .......................:........ isa..........,....................................... Phone No:.���D� $ :.., E. �i.....,........,,......,,......,..,...........
Facility Contact: .............................................. Title Phone No:
Mailing Address: ... 6....ZDp.....�l�Rt4..... U........................... i3tryc�ua��. . ................................. .U..SZ.(...........
Onsite Representative:... ...... a............................................................... Integrator;..�iiitcA.................................... I ............ I..............
Certified Operator;............................................................................................................... Operators Certification Number........ ..
J
Locution of Farm: `
,,//��,��� yy--�� .... .1.:....4! .........�.� iiA� ..I?1A.....5......�c,lJit". ....�....�i.l.....�...............................ii.r:..LKT....J.d..Q.�..... .. }�... ... ........... �..........................
..
Latitude =' =' =11 Longitude =0 =' "
Design ': Current ' Designs Current " F Desi n ° t
$wu►e `, Capactty Population
Poultry Capacity ..Populattan,
.CurJr.e-n
a Cattle Capacity Population
[31 Wean to Feeder
5 Q
❑Layer
r :
❑ Dairy
"z
❑ Feeder to Finish
JE1 Non -Layer
I
Non Dairy
❑ Farrow to Weanj
s
El Farrow to Feeder
❑Other R a,{
y
Total Design Capacity;' Z�
❑ Farrow to Finish
❑ Gilts
El Boars
v. TotalSLW
a
Num Or of Lagoons I Haldin 4 Ponds.'®J
❑Subsurface Drains Present
❑Lagoon Area ❑Spray Field Area
Y A H^ .; fL
}{'
a
.. a
❑ No Liquid Waste Management System m
A
.,
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. 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
[!j No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
AJ
•d. Does discharge bypass a lagoon system? (If yet, notify DWQ)
❑ Yes
[ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoonslholding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97 'Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (L-woons.11oldiln; Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure l Structure n Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ...........` ..I ................ .....oz . ....................................
...................................
Freeboard(ft): < <.4.... ..............�................. ................................... .................................... ................ .................... ....................................
10. Is seepage observed from any of the structures?
❑ Yes
No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
1 Yes
❑ No
(If any of questions 9-12 was answered yes,4nd 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?
❑ Yes
f9 No
WastC Ap licatioll
14, Is there physical evidence of over application?
Yes
❑ No
(If in excess of WMP, orrunoffentering waters of the State, notify DWQ)
15. Crop type ....... '4it1�!.V.46.........................................................................................51(l!1��,f...�gtcattu►...................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[A No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
Yes
No
21. Did Reviewer/[nspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement?
j D Yes
❑ No
For Certified or Permitted Facilities Only_
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[I No
0' No.violitions'or de'ficien664' ere notM-during this.visit.' Yoti'will receive ito farther ,
•correspo>i�de�tcealioutthis.visit:•:.�. .�.� •�•.• �.•... ... :.. :.. .': .•.,... .. ,.•.,. ,.. ;
1Z., ea^ ovtax et, loOP, 1ptnooni 5%odp i]e Meejej.
14. ?644 Writ r1 IDOft_ �'ie(ds . Na - ('[,1no alaservcol
ZZ: l}st coYYtc'� acvtia.�e. t,�ha.r• �A�G��a�trt� t1iT+r'4gt?V� �oaf�inc, .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
7/25/97

Routine O Complaint O Follow-up of DW inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 a3
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr .15 min)) Spent on Review
19Certified ❑ Permitted or Inspection (includes travel and processing)
❑ Not Operational Date Last Operated:.................................................................................................................................................
FarmName:... L31n h.......Y.J.W........{..................................................._....... county: ..... D.uOn..................................... .......................
LandOwner Name:.....Sycdf &............Q�,S?........................................................ Phone No: ..... L.ijazyS:.aun................................... .....
Facility Conctact:...... jxG� .i.R...............�# � .......................... Title: .......(?la?.hW....................... Phone No:..��1� �. :.g%�.`�................
Mailing Address:..... �3,25.... .... i S.... ..�KL+.�Y......1 ) .................................. Ir .1Y? 11��,1!].�....h 4..........._......, ..T � !......
OnsiteRepresentative:... �Y ),e....... : w............................................................ Integrator:..... ("l�[.tt il�f............ ................................................
Certified Operator: ..... FrAl !1.t........E..............HPAL R............................................ Operator Certification Number:.... ,.�.ZQ ..................
Location of Farm:
lsrw ....... .... )..aaa . Arx►.........►n. K :... In........ +rex .. r..' ...... .......... I.S.�... Kea►..... PS...... 4
......,h.....l�^S.i.t.Sc..... ..4.........SPi.....1P...1.. ...t7k ....Z! .V&...SOL%.'A`& ...L.� � ............................................... tj
Latitude ®' 1 96 Longitude ©' ©4 44
Qeneral
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
14 No
2.
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 Surface Water? (If yes, notify DWQ)
❑ Yes
W No
c. If discharge is observed, what is the estimated flow in gal/min?
N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
KNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
�&No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
IZI Yes
❑ No
4/30/97 maintenance/improvement?
Continued on back

Facility Number:.3� ...... —..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
F�No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
7
(PNo
Structures (Lagoons andhor Holding duds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
PANo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
:S.... ............................ ........................... ............................ ............................
................
......... _
10. Is seepage observed from any of the structures?
❑ Yes
'O No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
f No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
IgNo
Waste Appligation
14. Is there physical evidence of over application?
❑ Yes
1Z No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �P-a ll..... 'Y.14&................................................. YSv ►.11....t tiL%.........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
J&No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
10 Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
UNo
20. Does facility require a follow-up visit by same agency?
.❑ Yes
tB,No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EN No
For_C —tified Facilities Dilly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JKNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
O'Yes
UNo
24. Does record keeping need improvement?
tO Yes
❑ No
Comments ,(refer to queshan #) Explain*any YES'aianswers and/or any recommentlations or any other comments':;
Use drawings of facility to better explain situations (use additional. pages as necessary} 4 K
h m �.
s• Oros}or-, rw� a65 3'%46ru in �Iclt} l 5tw��f� _..��, 4'14(,[� a4v) a ID' �i lAr sP 4
St QecJ.
�� Ram o rcaS Z3. WoAt keo, beer„ 11?d -1� �el k hO+
a 1ho. rsepJ�. rroo r��
lg51 GYb 5�1oL�iU fie, im Y16VeU. th 'rVtit` iaaS� U�-i�iL�CIOn ���`n
C cv e e- c� qq MT_N V s6vj j be i nd c, d 'h `,L-
do�'�Ci� �nt i 1N i a' �V S n S �IeU[U b -e- ► h c-"W 1O 5 re �aYc�S
S. e ( ,{ Inc ti„t # r 1F� e # . l�o l Y V Oz� 1 i nvct�Oo Or
fA AAA) LA
Ho
Reviewer/Inspector Name
Reviewer/Inspectar Signature: Date: 417
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 2�
Facility Number
Time of Inspection El� 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
0 Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated :...... ............................ ............:.................................1...................................................................
FarmName: ......... �QLol1L...�.'OnAcj(....... �r.............. ......................................... county: ....... �o„tip.I►n...................... .............. ............ .........
LandOwner Name:...L.. i.i......... Hahe ............................................................... Phone No:... ...............................
Facility Conctact:....... r.1Q.........Q$92 ............................. �T7it�le:.....C1.U.W. ........................... Phone No:.���.Q..�.�8�.- �'i7r�1..............
Mailing Address:.... ....... ,Q`L?....... �.kl�A .... 1c .L! !rs........................... ..11tsfl rY i�f.i)r....L............. ................ ... ,�.�7.d.....
Onsite Representative: ....rix.,1f ............. .l:�GL-so ................................................... Integrator:......11.4v�........... .... .............................. ..........
Certified Operator:.... F:f2AJT..Q............ .F.... ....... H.c,,.6.................................... Operator Certification Number:..-.,1.Vl:q................ I
Location of Farm:
Latitude ®•®` 1z « Longitude ©• FM, , Do 6.
Type of Operation and Design Capacity
Qeneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. 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 5 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes � No
c. If discharge is observed, what is the estimated flow in gal/min? N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes W No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require D(Yes ❑ No
4/30/97 maintenance/improvement? Continued on back

Facility Nttmber:.... I.t..... Z..�TZ
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structure, ,agoons_and/oz—Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
2-V
10. Is seepage observed from any of the structures?
❑ Yes q No
❑ Yes tO No
❑ Yes Rj No
❑ Yes WNo
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or n noftf entering waters of the State, notify DWQ)
15. Crop type ............. .0.��Y��....11x1�M1d�.................................. ..........',�mJ.... ..............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 19 No
❑ Yes [Z No
10 Yes ❑ No
❑ Yes jR No
❑ Yes J' No
❑ Yes &No
❑ Yes VT.No
aYes ' ❑ No
❑ Yes MN
❑ Yes ® No
❑ Yes No
❑ Yes 14 No
❑ Yes 29:No
R Yes ❑ No
Comments (refer to guest�onv#) Explain ariy YES answersand/or:any recommendations or any other comments a
Use drawings of facilityto better explairi.situations. fuse additional pages as necessary). b w
yl- %-6ul� Vse i(N rKers att, 'r,JAe+i4�►ds. 4
12. Gros i or areas or,, ALA : vNW V)aNll o+ � (66oah S hou be (j�� w ciu
CSC }er} 3are, areas sJ,wj� be �CcSeet)e� .
tT. CaaSk cyo� & 6J3 be 'irn�ro%4-
z.. exfm oz"e cxv) y ; v� s4p uid be! -I; +�LjJeci
c�es� ri �. 41'f �n� •rr',�ja�'o� S Sfem S6did be. in CAW 5�P
1eqGvV+tl tTl'!v Aumld"e/; t li O�T7 l 1 ;r\SeCI OWs�
Reviewer/Inspector Nameh
Reviewer/Inspector Signature: Date: 11-7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97