310839_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

M Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number: 310839
Facility Status: Active Permit: AWS310839
❑ Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine
County: Duplin Region:
Wilmington
Date of Visit: 0311412017 Entry Time: 11.30 am Exit Time: 12:30 pm Incident #
Farm Name: Pig Life III
Owner Email:
cavenaugh0871 @gmail.
Owner: Pig Life LLC
Phone:
910-289-6089
Mailing Address: 2946 S NC Hwy 50
Beulaville NC 28518
Physical Address:
Facility Status: ❑ Compliant ❑
Not Compliant Integrator: Murphy -Brown LLC
Location of Farm:
Latitude: 34° 51' 26" Longitude:
77° 53' 36"
North of Greenevers. On South side of SR 1954 approx. 0.8 mile West of Hwy 50. Second site on farm path.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat Waste Application
Records and Documents
Other Issues
Certified Operator: Ricky Alan Bostic
Operator Certification Number:
24112
Secondary OIC(s):
On -Site Representative(s): Name
Title Phone
On -site representative Ricky Bostic Phone
Primary Inspector: Kevin Rowland
Phone:
Inspector Signature:
Date:
Secondary tnspector(s):
Inspection Summary:
page: 1

Permit: AWS310839 Owner - Facility : Pig Life LLC Facility Number: 310839
Inspection Date: 03/14/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Disignated Observed
Type . Identifier Closed bate Start Date Freeboard Freeboard
Lagoon i 19.50
page: 2

Permit: AWS310839 Owner - Facility : Pig Life LLC Facility Number: 310639
Inspection Date. 03/14/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Imeacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
.
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M [] ❑
If yes, check the appropriate box below,
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manureisludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
M
Application outside of application area?
❑
page: 3

Permit: AWS310839 Owner - Facility: Pig Life LLC Facility Number:
310839
Inspection Date: 03/14/17 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na Ne
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
IN ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18- Is there a lack of properly operating waste application equipment?
❑
N ❑
❑
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
N ❑ ❑
20 Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310839 Owner - Facility : Pig Life LLC Facility Number: 310839
Inspection Date: 03/14/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
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?
❑
0 ❑
❑
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
[]
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

Division of Water QuaErty &�
FalLilit;�Vumber . O UiVlSlon of Soil and Water Conserv.atton k �"
Q Other Agency,
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r % Arrival Time: ® Departure Time: County:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ` ` Title: Phone No:
Onsite Representative: �1 C( lid �LS_t C1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number -
Back -up Certification Number:
Region:
Latitude: [= o [� I [� d Longitude: = o = g = ;,
Des�gu Current Design C"urrent
Slyine. - .Caaci p. ty,Populatioii Wet:Poultry_ :.CapacityPopulahon
�. ❑ Wean to Finish ti ❑ Layer
Wean to Feeder Q �' ❑ Non -Layer
El Feeder to Finish
❑ Farrow to Wean DryPoultry
m ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other '
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood 1
N
Discharmes & 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?
3.1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
rE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes No
❑ NA
El NE
,t
❑.Yes P 'No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ff No
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facili Number: - Date of Inspection: E
Waste Colle+ Pion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): JT�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ 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
[2jNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
„0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
JZ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Jallo
❑ 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
�TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Po
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2`No
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes �To
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

IFacHity Number: - WTTDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J�TNo ❑ 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
;a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
ETNo
❑ 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 ,D No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[:]Yes PrNo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes jo� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CJ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Z No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
.lam
o7
12-1�/1y I,sz
Reviewer/Inspector Name: VV V—O-,J`''---`
Reviewerllnspector Signature: ��- 9--K—,j
Page 3 of 3
Phone: Q T-t 6-'S23
Date: ) q I kJ
214,12014

Type of Visit: jXeompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: f'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: JJVL, / Arrival Time: O Departure Time: County: i (lam Region:
IF
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 61r_,�c �. ��-s Integrator: m M/
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine MGapacity
Wean to Finish
Design
Current
Pop.
Design
Wet Poultry C*apacity
Layer
Current
Pop. Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to FeederUjNon-Layer
I
Dairy Calf
Dairy heifer
Current Dry Cow
P,o , Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Design
D , P�oult . Ca aci
Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Boars
Other
Other
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes PT'No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes Jallo
❑ 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 0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes E No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes _Ee N!o
❑ NA
❑ NE
of the State other than from a discharge?
Page I 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 P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes UNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes �"No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2fNo
❑ 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Vf 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 �ZrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9f 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 P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes UNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes LA No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ff No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 01
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �I'No
D NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection: all 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes TNo ❑ NA ❑ NE
25. Is.the fgciiity out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ 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 JZ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [Z(No
❑ Yes ;2 No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes 2j No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;!I No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Vr No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes V1 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Z (�
14/20I

Type of Visit: compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 6Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: ®! Arrival Time: L1�Y_'� Departure Time: : 5Q /i9 County: l 1�r1
Farm Name:IQp �S I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: R� 64i -
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region: L/r i 1
integrator: j
Certification Number: o+
Certification Number:
Longitude:
Design
Swine CapacityWet
Wean to Finish
Current Design Current
Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyEE] Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult , Ca ati P,o ,
Layers
JITurke
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Other
Other
s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ff 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VrNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection: '1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RfNo ❑ 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: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ;a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes V' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes VTNo
❑ 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 Imo ] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [�fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes VfNo
❑ 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 EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZrNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VrNo ❑ 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?
0 Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
[_]:NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
21412011 Continued

Facility Number: 1 - ZW jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ET No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No ❑ NA ONE
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 iT No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VrNo
❑ 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
VfNo
❑ 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
V] 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.
0 Yes
PTNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PD No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Vr No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[X No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments.
Use drawings or facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: /� OAA;�]
Reviewer/Inspector Signature:
Page 3 of 3
Phone: o959
Date: 1 a 1 V21
21412011

I]lvis`ion of Water Quality
=Scilimber ©1 - 3 O Division of Soil and Water Conservation ✓
0 Other Agency
Type of visit: Q Compliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
[season for Visit: 0 Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: County: Region:
Farm Name: f3 ) }S ( 4N f�> * S Owner Email:
Owner Name: �l G A LA-N q�oST )CG Phone:
Mailing Address:
Physical Address:
lysvI(_k-C 0 NC. 10),W3y
Facility Contact: Title: Phone:
Onsite Representative: V—i C.r-B 5 71C— Inte rator:
v I GL1
Certified Operator: `Z �� ACC Jl �pS7 L Certification Number: 9j / pa
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design C*urrent
Swine Capacity op.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Finish
Layer
Da' Cow
Feeder (opCa (p
Non -La er
Da' Calf
o Finish
DairyHeifer
o Wean
Design Current
D Cow
to Feeder
Dr.. P�oul C+_a aci Plo ,
Non-Dai
to Finish
pBoars
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
'Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
xNo
❑ 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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 l of 3 21412011 Continued

Facility Number: 1 - Date of Inspection: a
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): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? EA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t No ❑ NA FINE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes `I,! I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S(f'-) beq,( �
13. Soil Type(s): Lu.�
14. Do the receiving crops differ from t ose designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
ftquired_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
` No
A
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
M. Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑,Waste Tr sfers
0 Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
nSludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Faciji Number: a y - S39 1 jDate of Inspection: q105110
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes EANo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 14 No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
L/ I IG�49
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L Departure Time: County:
Farm Name: Q.4 (2,Z / T ) S CAW +__� -# 3 Owner Email:
Owner Name: iCK- LGAJ Phone:
Mailing Address: 1 `1 _2�' S COtIA, 1 UA CC..t�� p � K&YAN S OI CLE , C DS�L/9
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current Design C►urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oultr., C•_a acity P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ YesA�o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: _RITI jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �[ .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z/ 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): 5 6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWW?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
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.
0 WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes tNo ❑ NA ❑ NE
❑ Yes Iq No ❑ NA ❑ NE
❑ Yes -4 No ❑ NA ❑ NE
❑ Ye,&No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Mste Transfers
Q Rainfall ❑ Stocking 0 Crop Yield [j 120 Minute inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �N
o
❑NA ❑NE
[] Weather Code
Q Sludge Survey
❑NA ❑NE
❑NA [3 NE
Page 2 of 3 21412011 Continued

Facility Number: -3 ( _ Kci jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below. '
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? VAYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ANA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes N0
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
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 j�No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
7'C
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0
No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any othercomments:::. _ «`
Use drawings of facility to better,explain situations (use additional pages as necessary).
CAcI G1Q4 7 1ca1V C)LC � I `3
T c, 4C�AM4
G�V_') S � C� f '4c 7 10 E_
� � M
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'i/G 1 9
Date: SI V///
21412011

Division of Water Quality
Facility NumberA1--Z, Division of Soil and Water Conservation
Other Agency
M -M.-
Type of Visit ACompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit h-Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: LI IC1 %� Arrival Time: /I y Departure Time: County: b" cl N Region:
Farm Name: A ! T S J1IQ Owner Email:
Owner Name: I C Li4,V S71C- Phone.. 916 a9l9'rr��(��000q _
Mailing Address: lqs Cc"MM t___zt c(3 Q CE/V,4NS U)UE,/ C DO443L4
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator: n
Certified Operator: N eo S T! L Operatorrr CCeertification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = i =, Longitude: 0 ° = ' =
Design C*urrent
Design
Current
Design C++urrent
Swine C*Ti 5- —ac i! A Population
Wet Poultry Capacity
Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
JEI Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl I
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Numher of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes X�No ❑ NA ❑ NE
❑Yes []No
❑NA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes ❑No
El NA
❑NE
❑ Yes NMo
❑ NA
❑ NE
❑ Yes✓"Co
❑ NA
❑ NE
12128104 Continued

FwAcility plumber: 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
��ru�
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �Fx
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes AfNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require E] Yes ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesNo ❑ 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) Sew g_� L_64+� _
13. Soil type(s) Q a U i t-L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ 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 acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
C6mmenis (refer�to'question #): Explain any YES answers and/or any recommendations or any nftier comments c
c y;.
Use drawings.of facility to better explain situations. (use. additional "pages as necessary) a`
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: C4 / 4 l a
Page 2 of 3 12128104 Continued

Facility Number:Date of Inspection y 4 s7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. 0 WUp El Checklists El Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑,)P4ste Transfers ❑�nnual Certification
0 Rainfall 0 Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and i" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
to
❑ NA
❑ NE
Additional Comments and/or Drawings:
C-S
s/o9 s
4�;7 T %+,,,/ tw> p A-7 G 1�:. C (Zae 1-tl G I- � *'� VXA ;
Page 3 of 3 I2/28/04

Type of Visit )9�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
lt�Date of Visit: Arrival Time: Departure Time: County: /%` Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative: C 1. ! d
Certified Operator: Operator Certification Number:
Owner Email:
Phone:
Back-up Operator:
Phone No:
Integrator•
Back-up Certification Number:
Location of Farm: Latitude: = 0 = = Longitude: = ° =' =
Design Current
Design Current Design Current
Swine. Capacity. P.opulafion
E:, �; 1:, . �r .._ �.•.;.� .
Wet Poultry ti
,Capacity Poulattori Cattle C
_ -- �.� ;.. apacity Population...
❑ Wean to Finish
I
❑ Dairy Cow
91 Wean to Feeder
6j&66
❑Non -La et
❑ Dairy Calf
Feeder to Finish
s '
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turke s
Other
TINS
❑ urke Poults
❑ Other
❑Other
Number of Strucnures
5T
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
) No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
DfNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

FacilityNumber: —� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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: 4:!4 C)0"y
Spillway?:
Designed Freeboard (in): 1� • '
Observed Freeboard (in): CZ'
ft c r'-'6 4 R.V_sw Vol
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 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 KNo ❑ 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 E�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �TNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
%No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ln�No
ElNA
ElNE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
IS.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
iUse drawings of facility to better explain situations. (use additional pages as necessary):
5EF 1NSQ6_-c ► 6,,V FOR 7)-80 +
Reviewer/Inspector Name HM4,114 GA 1l! S Phone:LL
Reviewer/inspector Signature: Date: —1 5LO L ]
12128104 Continued

r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Dq No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tdNo ❑ 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
'� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�IrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
h NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J0 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
kj 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
1Y No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�0 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

lFacirity Number
QO'ffivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0-e6mnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access _`®
Date of Visit:P7,/./
Arrival Time: � Departure Time: County: Region.�L1�
.i — r �f
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone o:
Onsite Representative: e✓ Integrator: 'Op/_-, / Z-3
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =] o E:D ' 0 Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 J❑ La er
O Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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 Heifei
ODry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures: E:1I
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. P-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
RTNo
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
�Ko
❑ NA
❑ NE
12128104 Continued

[Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 ;2No ❑ 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 oNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //—
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
ld. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (2'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ✓���////
❑ PAN ❑ PAN > 10% or I 0 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
pf�0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Flo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments
Use drawings of facility to better explain situations. (use additional pages, as necessary):-
Reviewer/Inspector Name I Phone: Z
ReviewerAnspector Signature: _ ��__ Date: �� 7
Page 2 of 3 l a8/04 Continued

'Facility Number- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box. ❑ "P ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E)Ao ❑ 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
PTo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
To
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes�J'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;RfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V(No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[F
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,_,,
L�'No
El NA
El 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
o
❑ 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
VYo
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
'5113Cr off, /��SClir "_ cS r
�r 1
12128104

Facility. Number. �}
Q Division of Water Quality
Q Division of.Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival T'me: r eparture Time: County: 1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: _ VV
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design
Swine Capacity
❑ Wean to Finish
can to Feeder r�
M`
ElFeeder to Finish
ElFarrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
Back-up Certification Number:
Latitude: = c = 1 Longitude: C
Current Design Current
Population Wet Poultry Capacity. Population .. Cattle
j �one-
r
I(_,I Boars L J�
Other
❑ Other j
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Q ❑ L = {/
Design Current .T.
-Capacity --Population'-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
_ J
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'0No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
No
❑ Yes
,❑l
I{�J No
❑ NA
❑ NE
❑ Yes
J2 No
❑ NA
❑ NE
12128104 Continued

I--
Facility.Number-.2,1-831 Date of Inspection o 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?
Struc re 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ,ZNo ❑ NA ❑ NE
❑ Yes IQ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Z 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 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1p
9. Does any part of the waste management system other than the waste structures require ❑ Yes Pallo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,INo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1Q% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo ❑ NA ❑ NE
PTNo ❑ NA ❑ NE
21 No ❑ NA ❑ NE
V1No ❑ NA ❑ NE
?No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I Phone: 6 --Z
Reviewer/Inspector Signature: Date: t�
pine 2 of 3 12/2R/0 Continued

Facility Number: -- 3 Date of Inspection
14—
Requi ed 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 [,TVo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
�2No
/P
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
eNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
FTNo
❑ 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
PNo
❑ 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
gfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2
11#; C1)
Gj 1, 3
C3 �` 7
C a�
C3 a� 1
�f>
&0
C3)
Z\b'Vf a o -ed
Page 3 of 3 12/2&04

Type of Visit CrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit:
Farm Name: '
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: f Departure Time: County:
)bl+ TSI,43 Owner Email:
Facility Contact: Title:
Onsite Representative: 1 4 SAi(121__..P
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator: _ VL Y la
Operator Certification Number:
Back-up Certification Number:
Region: U I L?g
Latitude: = 0 0 . =61 Longitude: = o ❑ ` = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other --- -- ----
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
EFDry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes,,E]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
,❑�No
ET'No
❑ NA
❑ NE
❑ Yes 1 No ❑ NA ❑ NE
12128104 Continued

401,410
Facility Number:3 I— Date of Inspection
if
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes redo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes A No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 41 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 J:;j-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes .ENO ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes -ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes,,Q'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,ffNo ❑ 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 Wipdow ❑ 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 00No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i
, ❑ Yes -ffNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JEtNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: Q
12128104 Continued

•Facfkty Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 00'No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j2"No ❑ NA ❑ NE
the appropirate box.
❑ WUF ❑Checklists El Design [I Maps El Other
21, Does record keeping need improvement? if yes, check the appropriate box below. "i Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking Pj'Cr-op Yie1d,,E1_120 Minute Inspections341onthiy and ] "Rain Inspections 101V�eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ErNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes .❑ No
.�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
-EfrNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
20r[A
❑ 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
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;�j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes P�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 pKo
❑ 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 ;Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes Ko
❑ NA
❑ NE
Additional) Comments and/or Drawings:
el', C C� C4 u� cV S
Valo
A ��
Pe c Ord we cVr'ar codes
a�Fc_-t{ M 1 S
0 eq r 3, c-
12128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit QrRoutine O CompWnt O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: / �4 Tune:
ci Fall ' tify Num—__ber - - .. O Not Operational O Bel
E3 Permitted 0 Ca-tified 13 Conditionally 9rdfied [3Registered Date -Last Opera or Above Threshold:
fe
Farm Name: ,_ . _ .. County:
Owner Name:. M .. _ Phone No:
Mauling address: _ .._-- _ . _ _ 7 R 6 3
Facility Contact: .... Title: .. Phone No:
Onsite Representative: _sv�, , , ,. , _,_,w,__,,, _. Integrator: w w/'
Certified Operator: _ ,.. ..... _ . Operator Certification NumBFF
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • Longitude • < «
Discbarzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes, -ENO
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 ga.Umin?
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 ff i To
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Rfo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __I._
Freeboard (inches): 170
12112103 Continued

Facility, Number:' — 1 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
j2No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
[I Yes
��!!
�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
)'No
s
8. Does any part of the waste management system other than waste structures require rnaintenancerirnprovement?
❑ Yes
PVo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
'2No
❑ Excessive Ponding ❑ PAN ❑ Hy c Overload ❑ Frozen Ground ❑ Cop er and/or Zinc
12_ Crop type 'If I � �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVNW)?
❑ Yes
EfNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
2<0
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
�io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes dNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[3No
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
❑ No
Air Quality representative immediately.
P ,.�;"� .� �":,a�z,� 'r r�"�,^, �"^�'<-� �'�•t ,<
a3).E�}.aunyYffi`'areJrs�snd%i any'. SLy _ ru5ommentS.:
aUse drawurgs^o£ fac�t9,to lretter'� � (��'p$g� � �?' ❑Feld Copy ❑Final Notes
g � p7 00, field a S
/ V/_1 /wa4CG7
Ave -
tea` s-�� d
�' sf Af
�G
a 0 717
_ -
�A
Reviewer _
or Name
ReviewerAUmpector Signature: A_ Date: l a a
12112M3 Continued

Facility Number: 3 —k3 Date of inspection �C!
Renuired Records & Documents
21r Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ YesNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 'ONO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes�o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'ETRo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes J2,&o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, fteeboard problems, over application) ❑ Yes .,Ofio
27. Did Reviewerhmpector fail to discuss review/inspection with on -site representative? ❑ Yes O'Ro
28. Does facility require a follow-up visit by same agency? ❑ Yes [ *o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 01 o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes P fqo
3I. 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

t.,
Type of Visit V Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit C Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Time:
[tt/ 3
Not O erational Q Below Threshold
S Permitted ®Ce
r
ti
fied O Co/n'ditionally Certified D Registered Date Last Operated or Above Threshold:
zo-
Farm Name: ICG kjitb r1�5! County: ' iln
Owner Name:
Mailing Address:
Facility Contact: �j Title:
Onsite Representative -
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' 4
Design Current
Design Current
Design Current
Swine Ca aci P;o ulation Poultry
Feeder ZL Q ❑ Layer
Ca aci P,o ulation Cattle Ca aci P,o ulation
❑ Dairy
Finish ❑ Non -Layer
❑ Non -Dairy
Wean
UFarrowFeeder ❑ Other
El Finish
Total Design C►apaei
Total SSLW f77-
Number f LagoonsM E�
___. ❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Holding Ponds / Solid JTraps
❑ No
Liquid Waste Management System
Discharves & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 93 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes LgNo
Waste Collection - Treatment pper�.,,
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ElLYes ]i No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): 2
05103101 Continued

Facility Number: yj Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, 0 Yes B,No
seepage, etc.)
6. Are there structures on -site which are not property 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 ❑ Yes "Al No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes VS:No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [KNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes �Uo
I t_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 91 No
12. Crop type Z" e - -OWu, oCk /�4l'04
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 29 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
1❑ 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
M No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
(ANo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
U1No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5.No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
KLNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KLNo
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
C.NO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
x� .... .3 L`,- r'r 4 Y -4
Gonintents (refer to questtan #) Fxplam any YES'answers aedlor any recommeniiahons or any other comments.
._
�IIse drawings of facility to better explain sttuahons: (use addthanal pages astnecessary) ❑ Field Copy ❑ F ores final N
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 v Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes a No
Iiquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes allo
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 6No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,UNo
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes bj�No
Additional Comments and/or Drawings:
05103101

Facility Number Date or visit: ER i, ! Time: �+
3
NNot Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... ._... _....
t 1
Farm Name:4<5 ... u ..........
_ .. 3.................. County:..........
OwnerName:........., ic�-y/.t ......... ),a a ............................................................................... Phone No:............................ ............ ...... ........ .........
_........._w.
Facility Contact:
MailingAddress: ...................................................................
Onsite Representative:._..._ 09.1
Certified Operator:
Location of Farm:
Title:
Phone No:
..................................................yy..�jj..............•--.................. ..................... ..
integrator: ...... ..l. 1Pr,,$j C.....
Operator Certification Number: .............. . ...... .. .........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 6 it Longitude ' 4 I�u
Design Current _ Desi� Current
Capacity Ponulatioii Poultry . Caaacity Povulation . Catde _, .. ,,. I
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
I❑ Non -Layer I I I ❑ Non -Dairy
❑ Other
Total -Design Capacity;,'
Total SSLW,.'
-Number of Lagoons ❑ Subsurface Drains Present C� Lagoon Area ❑ Spray Field Ares
7
No Liquid - ",:Holding Ponds %Solid:T.. g y raps- ❑ uid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
❑ No
2. is there evidence of past discharge from any part of the operation?
❑ Yes
0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
EZj-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
14 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .............a .................. ........................ ........ ...................................................................................................................................................
Freeboard (inches):
5/00
Continued on back

Facility Number: 3 f — Date of Inspection L.LL��LlJ
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 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 V No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes El No.
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes E ,No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Pondingn ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type how &y Z$iu&,,Am n l�✓4,s�c('
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No-
b) Does the facility need a wettable acre determination? ❑ Yes F] No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ 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
J@ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Yes
E] No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
CgNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
5a No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IS No
.. R YiOnti4rls.ot dgficiendi $ •wire pgted. diking ths:vjsjt* - Ybn vtw11-t eoiye no fu>�-i.t��r'
comes arideim& about: this visit ... .... . .
Comments (re%rWto question #) "Explain kM 'XES answers and/or any irecnmmendation� of a_ ny other contthents.
Use drawings of facility.to Tdettermexpiain sitnations. {use additional pages as.necessar}�
56 1 -'re,flik- `Taf *r _Ph SAXOes I $ f!r`h�. / h �L�►ne nee $ v �c 4rdA' 't0 - r�liC.
`-741C1'/*/ 614s -7� �& (/ 101 /Aih-1Xihej !r* pod CAA.
I
Reviewer/Inspector Name :`0.��� ��y T.... =: ", .•
Reviewer/Inspector Signature: �' _ Dater _lz��
��
5100

Date of Inspection 1Z
Facility Number:
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
Eg No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
%No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
SINo
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
P No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
19 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
JO No
lAdditionalomments an or rawings:: _
5100

Type of Visit) Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit © Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
LF�a�cffl-y Number 31 S39 Date of Visit: 7�-20110 Time: 1700
10 Not Operational O Below Threshold
Permitted MCertilied E3 Conditionally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: f3altlai�t.Islau�d.,#�........ County: D.upfia._.._.._.._.._.._.._.._.... .................................................................................. ......... ....._.
Owner Name: Ekky.AIM.................
.. D!usti�...................... -..................... Phone No: 9LR 6fiR0.4_ I129S1.-2912.(M---------------
Facility Contact: - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ---- Title:. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- - Phone No: -- -- -- -- -- -- -- -- -- -- -- -- --
Mailing Address: 193.South.Ciuu.ntry-•C1uh.DAVC..................................................... KMAR&Yifle.NC................................................... 28349 ..............
Onsite Representative: QlXncr.MCWrd4.................................................... Integrator: �R�,� ............................
Certified Certified Operator- -- -- -- -- -- -- -- -- -- -- -- -- - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- Operator Certification Number: - -_ _- -- -- -_ -. -- -- --
Location of Farm:
north of Greenevers. On South side of SR 1954 approx. 0.8 mile West of Hwy 50. Second site on farm path.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 51 E° 38 :« Longitude i 77 • 53 37 u
Dgsign...:.. Current .......'.: Design€€ € urrent .... ....Design::€ €: Current....
Swine. :Ca aci :€ Po elation :Poultry: ........ Capacity :Population: Cattle Capacity €€Population
_. _ _
® Wean to Feeder
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes M No
❑ Yes M No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway . ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. _-• _-• _-- _-- _-. _......... _.. _.. _.. _.
Freeboard(inches): -- -- -- ..29-- -- -- -- - - -- -- ---- -- -- - -- -- -- -- -- -- -- -- -- - -- -- -- -- -- -- -- -- - -- -- - -- -- -- - -- - -- -- -- -- --

Facillty-NurAber. 31-839 Date of Inspection 7-6 2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
[:onanuea on Dacx
❑ Yes
N No
❑ Yes
0 No
N Yes
❑ No
❑ Yes
N No
❑ .Yes
® No
❑ Yes
N No
❑ Yes
N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
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?
I & 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? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
7. Work on increasing grassed vegetation on dike walls and reducing weeds.
18. Obtain new aerial photo of farm from district or Murphy.
19. Suggest taking new soil samples since lime is highly elevated since last report. Apply this fall according to analysis
results. No pumping as of 6-29-2000.
21. No OIC designated for facility in database. Grower is re -certified after failing to pay annual fee. Forgot to leave OIC
designation form on -site. Will send via mail (Added after inspection).
23. Owner on -site for record review previous week — rained out from doing physical inspection. Notified grower of intent to
perform rest of visit if he wished to attend which he did not show up. Cont. ->
L
zj:
IReviewer/InspectorNome DeattHutnke[e

RD Routine 0 Com taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection E]= 24 hr. (hh:mm)
6�ermitted Certified © Conditionally Certified [3 Registered [3 Not Operational Date Last Operated:
Farm Name: [.... y� ...... ..(cs. 1.................................- --..
�... .................................................. Count -
�a..
OwnerName:........................................................................................................................... Phone No: ....................................................................... I...............
FacilityContact: .......................................................................... .... Title:............................................................._.. Phone No: ...................................................
Mailing Address: ................................... .......................................................... ....
..
Onsite Representative:. ...................... l�tc"`..................................... InEegrator:.....Z �l�RC........................................._._
Certified Operator: .......... I ........................................ ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =11 Longitude =• =' "
> Design -`Current
Design Curretst Design Current
j
wine., , _ _: -- =_Capacity-=YPo elation
-.. Poultry . Ca aci Po Mahon:..,, Cattle T -
-Ca
:' ❑ Layer ❑ Dairy
❑ Non -Layer „ ❑Non -Dairy
_.
❑ Other
.Total Desi In Ca aci
Total SSLW"
Number of. Lagoons
❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
e
HoldtngrtPonds / Sohd Trapsa ❑ No Liquid Waste Management System s
Wean to Feeder
dU
Feeder to Finish
v ❑Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes XNo
• Discharge originated at:. ❑Lagoon ❑Spray Field ❑Other
a. if discharge is observed, was the conveyance man-made? ❑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 ycs, notify DWQ) ❑Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes allo
Waste Collection &Treatment
G. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑Yes [5,N0
Structure 1 Structure 2 Structure 3 Structure A Structure 5 Structure 6
Identifier:
Freeboard (inchesk .......�.......... ...... .........................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erasion, ❑yes ZNo
seepage, etc.)
3123/99 Continued on back

r
Facility Number: ­K31 Date of Inspection
6. Are there structures on -site which are not property 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
❑ Yes [<No
Yes ❑ No
[]Yes ONo
❑ Yes [�(No
❑ Yes A No
❑ Yes KNo
13. Do the receiving cropstdifter with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PONJ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
C'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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24_ Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�: Vo yiolatitjr..... .. e..... mere noted during �his:visit:... .. t"ec4 i 4e #'urther
• ,correspondence. about. this .visit`. •
❑ Yes 0 No
❑ Yes ONo
❑ Yes birNo
❑ Yes 14 No
❑ Yes WNo
❑ Yes No
❑ Yes No
❑ Yes ' No
❑ Yes No
❑ Yes No
❑ Yes No
Comments refer to . u"bri # Ex lain an YE5 answers and/or an recominendaiions or any other comments
Use,drawangs of factltty to better explain situations (use addr tonal pages as necessary] '
77 J
-� vre I­�
cse
GY�Q_14 Ca 4dtt- 1 �,p ____4 h-ejs �a `i Ll� h64, _ w
...
Reviewer/Inspector Name �--� LI'l" -
Reviewer/Inspector Signature: Date:

Facility Number: — S 3 Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes j (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 �fNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 Q�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 NfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes e(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes dNo
N t
Additional: Comments .and/or : rawings:p
i

E3 Division of Soil and'Witer Conservation`—Operation=Review y „_
n. [3 Division of Soil and- WaterConservabon CtitnpiianeemmIilspection
ivision,of Water Quality 'compliiificeInspeaion
s Other Agency_ Operation Review: -:
Mtoutine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review
0 Other
I L Facility Number l Date of Inspection LLL_r7
Time of Inspection 24 hr. (hh:mm)
Permitted JZCertified 13 Conditionally Certified © Registered p Not O erdtional Date Last Operated:
..........................
'VL0 3
Farm Name- f�.43..1.T.....L.S. i- A.I....... �V1, t..�•.—.� .V? ,,`�' County:........5..C�—...Cl....................................
Owner Name:... -:.L.0 -V—..—-e.............. ... UCAI.ST.I..C.�...................... flc. " .. .. L.._4... . . ............. Phone No: ......... ..... �..�..�.......
Facility Contact: LC- I,4..t.......t:?.QSt...LC...... Title:..... .? Y;L— .............. Phone No: ......5A-1 IC.............
Mailing Address:... z-G.�. ..... ?.5, 1 1.....�vL-.c....... H.S....O.Y..............Q „�.f / SI..E.!,.�.
Onsite Representative:.��l-L. 1 .`1'............ .Q. �.C._......................... Integrator:...✓1�i„�.�„?:�, .�.I-l..`�.......... ..........
Certified Operator:., .. ............. 410—s..r ................ Operator Certification Number:., 2,,, �?„L,.�.Z,,,
Location of Farm:
.1............. .. uL s........ n.. ,.... .... C)..n..... l-t_t ].Y...�.Q.............. -"L.Aj.. -
......i.l ... �. l..-,. �..r...T-c_.1. . t::-i...... .. �:.x=
Latitude �• �� �• Longitude ©• �' ©'= © �`�T
_• ' Design Current _ _ _> Design Current Design Current
,Swine = Capacity Population. Poultry Capacity Population . _ Cattle Capacity Population
Wean to Feeder ❑Layer I Dairy
❑ Feeder to Finish ❑ Non -Layer I I JE3 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑Farrow to Finish Total Design- Capacity
❑ Gilts
❑Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Gagnon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
-
_. _ - _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes BNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made.? ❑ Yes No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes RNo
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 K`No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes '19rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N�&o
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:
Freeboard(inches): .".....�.t ......... . ............... .......................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 15;;No
seepage, etc.)
3/23/99 Continued on back

Facility Number: ! — Dale of Inspection ®�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(If any of questions 4-6 was answered yes, and the situation Poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes b;VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Apj2lic�ition
10. Are there any buffers that need maintenance/improvement? [:]Yes ;TNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes MNo
12. Crop type
11 Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
to
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
qNo
c) This facility is pended for a wettable acre determination?
❑ Yes
13TNo
15. Does the receiving crop need improvement?
❑ Yes
'N0
16. Is there a lack of adequate waste application equipment?
❑ Yes
N0
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
liNo
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?
El Yes
KNo
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
NNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Ko
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
`<No
Rio yiolaiicjris or• defd neies wLe're noted during phis:visit: Yotk will•r;eeeiye ti© futrtW :
corres'pondence. abbut. this viset: - . - . -
Comments (refer to gtiiestion-,#): Eiplain ahy: YES'. answers anid/or aqy tocommendations or any outer conunents:�- `.
Use drawings of facility to -better explain situatibias {use additional pages as necessary)
A,
Reviewer/Inspector Name
Reviewer/Inspector Signature:_' r Jw A A A at, Date: l l
3/23/99

Facility Number: — I)ate 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 J<No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �NO
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �10
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Rio
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ,Yes /❑`No
Additional -Comments an_gs=
C-X7-- J:3 C3 t T 1-, S1- " b "V%O
•
3) L S E1'T-i tZ .�
I.__.00 IGS 'L� l c I--
'ln ti t7 _ E3 O S T 1 CG W t. t—t_-C�
�T-t-t s , N lc� r�li
C- LA A-, --I
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number3 3 Time of Inspection 5o: �� 24 hr. =(hh:mm)
0 Registered A Certified © Applied for Permit 0 Permitted 10 Not Operational I Date Last Operated „..........
Farm Name: ..........Fit....... 13J...... ....... County:..... pl.oil ...................
Owner Name:
.......gZkSt........1.!L...................................................-----•----.----........... Phone No:.... Qla7..Pik.%.-.3..71I............................................
Facility Contact: ......................................................... .... .... Title:............ .. Phone No:
f.
MailingAddress: ...... 1.10.7 ...... S .... .pG....r�..................................................... .... A'............................................... .Z f l .........
OnsiteRepresentative:....._ . G-...........�kSTi�.......................................-•------•---........... Integrator: ......l.at 44 .................... .........................................
Certified Operator:......................................................
Location of Farm:
II rr��
........ Operator Certification Number;..........1 S.13 ... T .........
!L ...... ..i� Q �..lthx.. ..... .
14Y1r.........1. ....OY1....... j.... a�...................................................... i a
................. ... .........I..... ... ................... .... _ .. ....... ............ ....
Latitude Longitude �• �' �"
-°
Design F Cur"rent
Resign Design Current
5wme Capacity 'Population `
_s ,Current:_
Poullry Capacity, Population xCattle , Capacity'` Populatiron
r
�L] Wean to Feeder
❑ Layer
_
__
❑Dairy
❑ Feeder to Finish
JEI Non -Layer
I I
❑ Non -Dairy
❑ Farrow to Wean
: _: -
❑ Other-E
❑ Farrow to Feeder
.:
ElFarrow to Finish
Total Design Capacity.r
.
❑ Gilts
.
ors
h
❑Boars
Total SSi�W
Numbeir of Lagoons /Holding Ponds
��
agoon
❑ Subsurface Drains Prest LArea
en ❑
ID Spray Feld Area
-
:
❑ No Liquid Waste Management System
h z
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
-® No
2. Is any discharge observed from any part of the operation?
❑ Yes
ER No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[N 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?
Na
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
® No
maintenancelimprovement?
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: 31 — 1l3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 59 No
Structures (Lagoons.liolding Ponds, Flush Pits, ete.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 51 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft)...........z.:l...............................................................................,................................................
10. Is seepage observed from any of the structures'?
El Yes
[A No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
0 No
12.. Do any of the structures need maintenance/improvement?
[;R Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
L
13, Do any of the structures lack adequate: minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of W/MP, or runoff entering waters ofE the State, notify DWQ}
15. Crop type ' C...'<`QII:L......F�An,#t�....1..................Oa.................................tt.. �. i�� A�.......D41t�..................................................................
'
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWy1P)?
❑ Yes
N 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?
CZ Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[N No
r
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
A
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[9 No
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
OU Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
0 No.violations or deficiencies. were noted during this. visit. .You.will receive no further
correspondence shout this.visit'.• .
Comments.(refer.to question #i.j:,. Explain any YES answers and/or any recommendattons.or any.;other comments:
Use'drawymgs, of facility to better explain situati(in_s. (use additional pages'as necessary).
Iz• � arias 5 � fie. �s�z�� ]rr:r . ; s sirr, o*4i- d;/ers M shav+J be— t-epj&,J-
Zz. �eY1�11 Sl'tOdp..,As1s t) be lJtadr
z�. Gr•a�� 1,`� +�o�` �la.�-eJ � � ��� �:�P'rn'ral c1`�`' ;" � ���Lfi�� ►o�gf p�
7/25197
.ikaw
p
Reviewer/Inspector Name �Lwk
Reviewer/Inspector Signature: �, %, ,.� Date: 1117AY

I.Moutine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 0= ZD 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
[XCertified ❑ Permitted I or Inspection includes travel andprocessing)
❑ NNot`` fOperationall Date Last Operated:
Farm Name: ...L�..I�. ..� . _..- .... �. - .. County:... ,iFa.... Y...._............................
Land Owner Name: � G [_
.. ...f] OS►C .... ...... .................. _..... ...... Phone No:.L,1L.. ......... _...... ......................
Facility Conctact:. 4s L..._.... _.. Title: _..i~'T Y... ..... ....._. Phone No:
1VlailingAddress: ....1p..?...Q.. _.... _....._.._....5!lAL�l`.........................a?........
Onsite Representative:..... ........... .... .......... r....... ................ integrator:... 1
Certified Operator: ........_ ................................ ..... .................__........ Operator Certification
Location of Farm:
z 5,..... �. SR19sr. Farm... 9z fats ...... ��.�. _. _..... ,....... _ .....
Latitude 0 4 ®u Longitude • ` ©u
Type of Operation and Design Capacity
rr a Des n Current nt K Desr n Current
Sw�ne.PCa ag Po `iilation �oultry4' _.Ca a'Po iilation . Cattle :Ca agCi:Po atahon
Wean to Feeder w
Feeder to Finish
Farrow to Wean z
Farrow to Feeder TOt�al�Des�gAC p i y �
Farrow to Finish
�-
,.� .. ::. xTtital LW' 7e
Other
77
� «� . " �r ❑ La oon Area -
�Number of Lagoons 7Hotding Ponds ❑ Subsurface Drains Present
/g f
g =� ❑ S
f ❑ La er
�� �
❑ Da
llon-Layer
❑Non Da
eral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes Jallo
❑ Yes 0 No
❑ Yes §CNo
❑ Yes %No
❑ Yes � No
❑ Yes Jallo
❑ Yes J�,No
❑ yes Fcn No
Continued on buck

Facility Number:.,.-,3j.„.
6.�Js 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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure l Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 15�No
❑ Yes WNo
❑ Yes 0 No
Structure 5 Structure 6
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 runoff entering waters of the State, notify DWQ)
15. Crop type „...._x ml.A. __........_.�....._..... ......... .................a�M .._............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For CQrOed_Facilities Only
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?
Comments (refer to question #) Explain any YES answers,and/oi any recommendarions or any other cdrnments.,t
Use drawings of facrlity to better explain srtuattons. (use additronal pages as necessary) x ,
❑ Yes ®,No
❑ Yes )0 No
Yes ❑ No
❑ Yes M No
❑ Yes ,K'No
❑ Yes 19 No
❑ Yes ($No
❑ Yes ® No
❑ Yes
® No
❑ Yes
W No
❑ Yes
P1 No
❑ Yes �jNo
❑ Yes )9LNo
Yes ❑ No
)i'. Sy slot. Arzwg or, 4L.4, OU6 walk cif- `, jay} s%ovld be (%tr� w� c.( ai►c� Q
rc see O 4. fiat - be M-ter) .
kt� field #.
cc: Vtvtston of water duality, water Lluattty Sectron, Parrtity Assessment Unit 4/JU/5P!