820235_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

7",— n --1 s-'
Type of Visit: a -Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 1I
Date of Visit: �,5=/ Arrival Time: Departure Time: © County: Region: jc �
Farm Name: C'+- ��� Owner Email:
Owner Name: &,/; 7pj�r Phone:
Mailing Address:
Physical Address:
Facility Contact: : 1 i ,:5L (d Title: ©e-t--) n �—.�' Phone:
Onsite Representative: Integrator:
Certified Operator: �� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
jv'VVean to Feeder fi
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Wet Poultry
La er
Design
Capacity
Current
Pop.
GaitleM
DairyCow
Design egrent
apaeity Pap.
Non -La er
Design Current
D , P,onitr. Ca aci l;o
Da' Calf
Da' Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turke s
Turkey Poults
Beef Brood Cow
Other
Other
Other
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes j�rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
g o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

ill Number: - 3j- Date of Inspection:
PLO- _
-�
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): J3 ,fib
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E]No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
El"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E<O ❑ 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): A,/,-�11�'irytc
—
13. Soil Type(s): A 19A e.-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'1lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ej`No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q'1 0 ❑ NA ❑ NE
❑ Yes [3-<o ❑ 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 Q 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 E�J<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Number: JDate of Inspection: J
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E No
25, Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Q o
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 [3�<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o
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
pen -nit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
101
rAr=
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ Yes
[ "N-o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
[:]Yes
MNo
[] NA
❑ NE
❑ Yes �o
❑ Yes C:rNo
❑ Yes [allo
iiia all awes as nece
Pllg ssa _ ` rY)
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: �/O 3c7�r-DfS j
Date:
21412015

Date of Visit: Arrival Time: „�� Departure Time: O' County: Region: � V
Farm Name: �t�f'tLn1% _ Owner Email:
Owner Name: lAJ TDB -- Phone:
Mailing Address:
Physical Address:
Facility Contact:y}'; �� i . ��� ^fog Title: r►. •ram Phone:
Onsite Representative: cJ�ati—, Integrator.
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity l?iip.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
on -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult .
Layers
Design
Ca aei
Current
to
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ti
Turke s
Turkey Poults
Other
Other I
Discharues and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes JZ_No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CF]-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C5�Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 9`
Observed Freeboard (in): 3
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 JKNo
❑ 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 K No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes RLNo
[DNA ❑ 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 „Ej'No
❑ NA . ❑ NF
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z�No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [2�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence off Drift ❑ Application Outside of Approved Area/
Wind
12. Crop Type(s):/Gu. r�+�/ /� %�L�r�✓��T! lr '['Jt !T-�'!
�/� �i�u✓n/�
13. Soil Type(s): / j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes y❑. No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes [�J_No ❑ NA ❑ NE
❑ Yes 'INo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q 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 RNo
❑ 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 _E;� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5�-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E.No
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes 1K No ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes fKNo ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes C.No
[-]Yes [a No
❑ Yes tELNo
❑ NA ❑ NE
❑ NA ❑ NE
NA NE
Comments (refer, to�question # ): Explain any YES answers and/or any, additional recommendations or, any other. comments
Use drawings of facdity�#o;hetter explain
sitnations (use additional: ages as necessary). .,
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: 222 /S/
Date: & — C11 %�&">
21412015

9
IType of Visit: UComplience Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0410 `_ui ne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: $`: 17 Departure Time: ,3 V County: j��a �� Region: - O
Farm Name: 6',Qd Cf � Owner Email:
Owner Name: zlo ll fez -L- //-, �p/�Z_- Phone:
Mailing Address:
Physical Address:
Facility Contact: 3 i i ( 'To rz Title: /9UjJ n Y tr Phone:
Onsite Representative: S.Y. - Integrator:
Certified Operator: _ J-1-,a— Certification Number: IL 73
Back-up Operator: C�a�(W�G Ta_Fz: Certification Number: 1 I � y /"Ir
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry apaci Cty Pop.
Wean to Finish I ILayer I
Cattle
Dairy Cow
Dairy Calf
Design Current
Capacity Pop81
Wean to Feeder
SM
[Non -Layer
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ltr Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Doi
Beef Stocker
Gilts
ers
Beef Feeder
Boars
oults
Other fia7
Beef BroodCowOther
-E
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 12LNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
LqNo
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: - Z3. Date of Inspection:
Waste Collection & Treatment
Iti4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[I -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): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3.,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
,RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation }poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
i[LNo
❑ 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
QNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ED-No ❑ NA
❑ 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 ❑/l Application Outside of Approved Area /
12. Crop TYp�s) 7 � ryrCsr�/ /��� `�/ /' H�u�u I'L ��xi'a x.r /Gp r.-z /4cJ�� C S
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes jj��o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:)Yes E�,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
IS. is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
21 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 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 LRNo
❑ 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection: 7-/Sr`" /b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
k
Y25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 5g-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
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
5�.No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ELNo
❑ 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
RNo
❑ 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
[gNo
❑ 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
JZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VjNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-lqo
❑ NA
❑ NE
Comments (refer to question #) Eiplaia any YES answers.and/ar. any addtdona! recommendations orMy
ther comments r7
Use diawin s of faciii, #0 6etter;e sttvattoas use:additional a es_aecessa - -,
Reviewer/Inspector Name: S
Phone:
Reviewer/Inspector Signature: �
Page 3 of 3
Date:
21412015

.11 Faciii Number 1 K,9-401 �.3
!Type of Visit: Eo=outine
ce Inspection Q Operation Review Q Structure Evaluation p Technical Assistance j
Reason for Visit: O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access I
Date of Visit: / Arrival Time: D `o o Departure Time: , 3 p County:, S' Region: F?-O
Farm Name: Canso e 1 d— 2. Owner Email:
Owner Name: W ► � i s 1.,...E Fb R r_ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ 13 -l7-op r— Title: [ter r ✓ Phone:
Onsite Representative: 6' G.•t_� Integrator: —M ff
Certified Operator: je'Certification Number: /lo %� l
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Current
Wet Poultry Capacity ., Pop.
Caine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
La er
DairyCow
V
tC,
Non -La er
DairyCalf
Design Current
D Poul Ca aci Po ,
DairyHeifer
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Turkeys
Turkey Foults
NJ Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[:]Yes
E�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: gy=-.2L jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G�� —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6,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
FINo
❑ 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
Dg- 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
[D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 2g-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): llf G�—
T
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes �No ❑ NA ❑ NE
❑ Yes Vq 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 allo ❑ 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. 0 Yes allo
❑ 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 C,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F-2-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

• Facility Number-
'21 T1 jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
El NE
[:]Yes
VLNo
❑ NA
❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
Callo
❑ NA
❑ NE
[]Yes
U37 No
❑ NA
❑ NE
❑ Yes
EQ No
❑ NA
ONE
❑ Yes
�No
❑ NA
❑ NE
Comments (refer; to question #): Explain any YES answers and/or any additional recommendations or any other cpmments
Use drawings of facility to better explain situations (use additional pages as necessary).
Revi ewer/] nspector Name:
Phone: �71a'3`'33aQ
Reviewer/Inspector Signature: Date: 6
Page 3 of 3 21412011

Date of Visit: Arrival Time: R : o t7 Departure Time: J jJ! County: Region:
Farm Name: C.yte,D 4 Owner Email:
Owner Name: �,(� , ` ; C..— i+ Tpev Phone:
Mailing Address:
Physical Address:
Facility Contact: pen Title: w t2 L-W­ Phone:
Onsite Representative: ` ; N� 'foe r- Integrator:
Certified Operator: (-1- Tp pr Certification Number:
Back-up Operator: bu r` 1 t � a~' C' �b Certification Number:
Location of Farm: Latitude: Longitude:
Desigu Current
Design Current
Design C►urrent
Swine Capacity Pap.
Wet Poultry Capacity 1'op
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder p`t a
Feeder to Finish
Dairy Calf
airy Heifer
Farrow to Wean
Desir
paci
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P.oul Ca 1?0 ., :
Layers
Non -Dairy__
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
-turkeys
Beef Brood Cow
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man -trade?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 C&No ❑ NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes IZ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fZn 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): �� IIT
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a 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
[S 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
[R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g 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
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes
® No
❑ NA
'❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
®,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PS No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[5 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[allo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
8� No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
[2� 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
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
L�jNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
125,No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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 (M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [, No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA- ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes IS No ❑ NA ❑ NE
[:]Yes K No ❑ NA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
2[ No
❑ NA
❑ NE
❑ Yes
2[ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question:##): Explain any YES answers and/or any additional recommendations -or any other comments
Use. drawings of Neility`to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: &03-�3
Date:
21412011

i
r—� - Division of Water Quality
Facility Number ®- ® � Division of Soil and Water Conservation
� Other Agency
Type of Visit: is Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q) Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: lIQL L L L-� Arrival Time: Departure Time: County: &4fft"T Region:`
Farm Name: C 4 Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address: 3(o 6 JohA ( 4"dd y "l
Facility Contact: $` Title: t)yvlyl- Phone:
Onsite Representative: 6Integrator: ti_9
Certified Operator: 1A l y ff I e— Certification Number:
Back-up Operator
Location of Farm:
Latitude:
Certification Number:
Longitude:
16731
2?k y 5-
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
I
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul# .
Ca aci
P,o
Non -Dairy
Farrow to Finish
I Layers
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 5jNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
\ Page I of 3 21412011 Continued

FaciliNumber: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5 'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): @ 4
Observed Freeboard (in): go
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
in 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
tR 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 ❑LApplication Outsideof
Approved AArll'�7Vre�a
12. Crop Type(s):
�j
' vlI 17 419Q�_�.�A
ge' L1LL10 hat �1[fi�l j st"m$'I�k
/
rrl/AO421.
,/
njj
_
13. Soil Type(s): N&Otk❑;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
bj No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ca 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 tR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ..� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No' '[ NA ❑ NE
Page 2 of 3 21417011 Continued

` Facili6 Number: - Q I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MNo ❑ 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 [N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No la NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �? No ❑ NA ❑ NE
❑ Yes NX No ❑ NA ❑ NE
2 Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes QjNo
❑ Yes C' No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ff): Exptain any YES answers and/or any additional recommendations or anyother comments ;
Use drawings of facility to better explain situations (use additional pages as necessary).
I CerKrdeS -,YAJ_ `iD�of I YY$e- V Jt a, I9j an b6nos /r'\ F '?kva, r �* Go6,t7( (gr 0w*, NO; e-
r�� aw frMola �bcreP .
as'stud e ewma, svry-+� h a 013 , �I�er�e d o s �r� J� n � yam-,
I7
&oai rer orb Re1dj, md. rvell moNalhebt ,cif, . ,1
h a�� i► l a0&4Y90� �!
���ds cyr3--c4n h9h r � ��
Grp n of +yptca viek f�cr
Prod t D
u•rnvd'� f f b"f r'i'
Reviewer/Inspector Name: c Jln.p f & Phone: q10- L133.3WQ
il
Reviewer/Inspector Signature: Date: _JIA Q7 ,Ta o 3
''
Page 3 of 3 21412011

Facility. No. Farm Name Cal(t;L Date
MC
'0
Permit 01C NPDES (Rain breaker PLAT
FBDrons
Annual Cert -Daily,Pipe)
Lagoon Name, S for' spillWay
1
2
3
4
5
6
7.
Design'Freeboard:1.Last: Recorded (in)
� 7"' . .
Observed freeb6ard:'-�:"::-`--. `;:
Sludge Surve"D
Sludge Depth! (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatrfiertt'.Volurne if> 0.45
Date out of co'molianddl POA? 1 , . ''
W"ThA IN. AFM
Elf
11 MWE!
f
11
ML
I Design D
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields i
Alft!
L
Wettable Acres
RAIN GAUGE
Lime Needed;
Lime Applied
WUP
Weekly Freeboard, -C-
Dead box or incinerator
Mortality Records
Cu-I Zn-I
1 in Inspections,, ---
Check Lists
Needs S (S-1<5)
120 min Insp.
Storm Water
Nppriq P i
�
Wp;ithpr rndpiz
N (lb/1 000- G�Q
19 1 Im
r
WR -
Acres I PAN I Window I - Max Rate I Max Amt
Verify PHONE NUMBERSiand affiliations
-9vA tio 1110
Date last WUP FRO
FRO or Farm Records
VvA 100
OD
Date last WUP at farm
Lagoon #
C 8
App. hard war!
Top Dike
Stop PUMP
a
1%
eQ
4% WD -vr!;W0q ollrO.-
Start Pump
C—
(00
ho
OY
C
com
Conversion- Cu-1: 3000=! 108 lb/:alc'; Z: n-I 3000= 213 lb/ac
W
V3)
bT-
I ok
I
All 6-t
4q�*Qv
-50' pc9S

Type of Visit: QCCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Iffi Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �f7 Region: FRO
Farm Name: Co 1(0f Tf 1 q-# -a Owner Email:
Owner Name: y1/) flh �� p0Phone:
Mailing Address:
Physical Address:
r
Facility Contact: Y+'{11 ((jyl �Qt/p Title: 0" 19- Phone:
Onsite Representative: W1,11(on Integrator:
``,?31
Certified Operator: YVr I � 14 � Nee Certification Number: No
Back-up Operator: I Y 1 I I /Ph �', F0 Certification Number: 9q 4 ��
Location of Farm: Latitude: Longitude:
Des g C_ urrent
Design Current
Design Current
Swine
Capac<tty Pop.
Wet Roultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
5a go 4q3q
JLayer
INon-Layer
I
I
-
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . l;aul
Ca aci
en
l:aP.
Dry Cow
Non-Dai
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Qther
Turkey Poults
Other
I
F 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [R-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
z. Is there evidence of a past discharge from any part of the operation? ❑ Yes CR-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E' No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

iFacili Number: - 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ['No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): a�^
Observed Freeboard (in): 3T y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 ] R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes N'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 ❑ Evidence Wind ❑ Outside of Approved Area
}of JDrift
1Window ! - rA�pplication
12. Crop Types): (�fYt7 Mao ao f :�5 krn I` ; L_C�y b f go,IQ HQ1 q tXQ17P - SfrOlt awt� t)ye
med
13. Soil Type(s): M) A , RQlh-P z y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®' No ❑ NA ❑ NE
. acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C!TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
DNA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. S Yes ❑ No ❑ NA ❑ NE
IETWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to instal I and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No CR NA ❑ NE
Page 2 of 3 21412011 Continued

J
Facility N'umber:- Q,1- 2L;�FL- Date of Ins ection:
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
f>_�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
CR No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No
ER'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[::]Yes
[R No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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.
�5'es
❑ No
❑ NA ❑ NE
19 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
[:]Yes No
D Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question!#): -Explain any YES. answers;and/or any -additional recommendations^`or-any other comment
Use drawings of facility to hetter.explain situations. (use additional; pages as necessary).
s'Feldi met 1 f Yn� 4 � 166- o f f/m Die � — �ecr'�, �,
OVI
fS�ye save -eer�'h o� �� a o l ,
yvosa fplk c, n&,N &jd -�rf[d o� ym�+eplo.. bo-seoyi
eve- P I eo o �� 1V va i (,e et7 �� I � �� Q� �-,r
Nc ora f�� 1��l�' art 0 aO0a 01, -its Z/, b,+ 1�rs c , a qoo
,To fsoi I war �9 99 t - Hilch i)nfliaed
�ve11 rna�'�si
4 r>°(rrdr- Or t) a hare,
RP, ( was r-ev If h aW )a,t fa I I -(br rveW 110MM&
Ga;f�411, 11CO-3 abw rtt Ir f tal vco, co f r]
Reviewer/Inspector Name: ��Q,�'hn �1�!` _ Phone: qj(}q93 3m &y)
Reviewer/Inspector Signature: Date: V
Page 3 of 3 /4/2011

• 6 ^x-
Facility No. Q►Sd`�J) Farm Name Cmcw4 Date
Permit ✓ COC ✓ OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe }
:!•.
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
S�iP!�T yi�►T.1L'�
Soil Test Date aD11
pH Fields
Lime Needed *�a090
Lime Applied
Cu-I Zn-
Needs S (S-1<25) C Lj�7
Needs P d�n94►�I
Crop Yield
Wettable Acres
WUP
Weekly Freeboard ✓
1 in Inspections
120 min Insp.
Weather Cnrles
COX J (00 7f
Trsfe%hees
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
J i
Pulffield Soil Cron Acres PAN Window Max Rate I Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO gliglor FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike 90 qwp
Stop Pump4r•0 6Rr
Start Pum �a,�.D
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac
S�(rN,I
1 �r raa�
1 J Li'Ch9=DO
S )10
Ho
a I urn le
flc6j ,)vY -�,
�3Gaa�
��Ip
IrlB��
Irff
7�
l b `�� I

Type of Visit: t�I:Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 2 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: -S,(jm Region: FK
Farm Name: Owner Email:
Owncr Name: Iv I1'�} Q Phone:
Mailing Address:
Physical Address: 3l&8 John Crinad,, U) , &,r,P b0
Facility Contact: Bill p0a Title: Oma2 _ Phone:
Onsite Representative: Noe , Integrator: M
Certified Operator: W11 1 j fim p(j Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Wean to Finish
Wean to Feeder
Layer
!Non er
Dairy Cow
Dairy Calf
-La
Dai Heifer
'
Feeder Finish V
Desi- n , C urrent
g
1) , . P�oult Q Ca achy Pao
Layers
Non -Layers
Pullets
Farrow too Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Its
Boars
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
e,n cofac� f ifi �I l �? +s 11
Dischar a and Stream Impact
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 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 pan of the operation?
❑ Yes
® No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
❑ No
❑ NA ❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

F'acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LR No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 94
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
[DYes
KNo
❑ 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
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): Suf"&o A�1 jj r wiY4-An11vQ�� &41 III
Cap.
+ h��
, yA
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
5] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
TO No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Wi No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
K-I 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_ Z Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking E] Crop Yield JE] 120 Minute Inspections Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? [:]Yes [—]No
❑ NA ❑ NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
PNA ❑ NE
Page 2 of 3 21412011 Continued

atilt Number: 00 Date of lns ection
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W'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
51 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes $2 No ❑ NA ❑ NE
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
RYes ❑ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawin�s'of facility to bet � � - lions oranyotberfcommeu.
Comments (refer to question ter explain situations (use addiiianal iiaee sas neces ary} nienda1* .
3, Cowl ham 0cceSf -+p s`�eGn 1� ",ye- ( �n lam 1 fkf) ,
y, Fle,�., ha re- 4-ref I Pe checkAC -ibr P�M_ o[ Poi of a calm,
a or
3 �; ol�- ,°�� " f �V cro�l s�z� of 7 CIO U C 5_6
a 1► 11ec� cols h,hP� �r Q ry calf oid- Ia ow e kfeeAi�
PleA I o ca �v
S
7, Pl eg e a S ca b h" sAt to [a 0M a ► d ��sa i ►
�ac�e Ie s gad inh `i lie- js b� sd ��,,., Pr' ry ird 4`0
ood I -or k a
ExeP as n o ed a la�we '_ �v I I mopf0 eZ - 0, �etd r, yod ��ccm'3
P�
N"jp 116j C., Fyod✓ e c
, fi 7*f, i�jvd�0J s(MlFa►fi rw �;j ,warr*eL a�
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phonel f"33-3 QQ llffiee)
Date: SpVj 1 y @ D
21412011

.. ._ Cat,l &d (p �L-
Facility No. Farm Name I Ovr Date
04eQ-� -# on
646 (l
Permit COC
Pop,
Type
Design
Current
C
W.
RM -Mo
Q 9lfl�--
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Flow -
Actual
"P�PHjk*roIn !�d ��,�- d
S?ail est Date t enable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-1 Zn-I ✓ �'"� 120 min Insp.
Needs P Weather Codes
CroD Yield uni~ Transfer Sheets I. /
&TWIRM- - • - -
0 mr�r�n�[crrr�r�r�HUIrr.���rr�
. 1
.
M-
M.
Lr M.,
}1
irc vv§�,-
�l
i
MIr
l/
1M
a
IM.r O
�i
s- Ron CLI&C LIO C
Verify PHONE NUMBERS and affiliations
Date last WUP FRO8 J(g10X Da$,Igt WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lblac
fy-eefwd- Cr T6(m fact fo�i 1 le�oo-,
App. Hardware
P�

I�
(49. Zvi i (A if 0
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r Departure Time: County: Sam s4� Region: t�L_
Farm Name: p� 4 j�,� Owner Email:
Owner Name: 1V1 i �` Orn _ _ f'TJPhone:
Mailing Address:
Physical Address:
c
Facility Contact: B1
{{pom Title: &4k ., Phone No:
Onsite Representative: i Integrator: _
Certified Operator: 1 i�Qlyl _— OW- — Operator Certification Number: 107,31
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = S = !{ Longitude: = ° = 1 =
Design
Current
Design Current
Design •urrent
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
rWean
�11
❑Laer
❑ Dai CoFeeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
Gilts
❑Non -La ers
Beef Feeder
❑ Beef
E-1 Boars
❑ Pullets
El Brood Cowl
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
TR No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number:$ — 51
Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
15ZNo ❑ 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): 4 p� L.
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 tbere structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
15JYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4_ Does any part of the waste management system other than the waste structures require
❑ Yes
J�JLNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
tRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IRNo
❑ NA
❑ NE
15. Does the receiving; crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to.questioit#): w - Explain any YES answers and/or any recommendations or'any other comments��,-.-
Use drawmi of facility to better. explain situations. (use additional pages as necessary. s
Reviewer/Inspector Name t Phone: 3,333
g
Reviewer/Inspector Signature: Date: net
Page 2 of 3 12128104 Continued

Facility Number: SA —Q351 Date of Inspection If L{LJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes NNo ❑ 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
J?_� No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
tR NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
`� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
15j;No
r_] 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
f�kNo
❑ 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
9 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
UrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
g No
❑ NA
❑ NE
Additional Comments and/or Drawings: ;.++.a
�' s-
�, � f6e Wa k a) bre-croft o� I ate' a -s e ��S6ri y a�r� �l �h 1 �nsfde 0ct1!
�aje_'9vc4 covo'
S� La W l wg clf0,g( off- DQc aooq , ,Abo, a- )33 Wyalkf 'stead a� 13.-)a Ac.,,
h ` n 1,Pc�e� 1�d P��e. Ob�pil� Craibo,+
o� rw�k chill .tit
_a ond5 . IB 3o0qgl1&s#v e- nod QoW14-
jifQn a,+ `+o � eep h'l �, q 5►
•q,•rm.�l�
C nod► Of
UKteI Lm+- wm aril- -0eIAo,, oat P'e(mA
[ -, L;; ej_ + h is ►v `,7/'fiTo, /0 f�— tyNrt_ne,,W.
trots adds. lclip-,AA &I foduce-cor13,
Page 3 of 3 12128104

Facility No. _Farm Name CQ1 rav� Date 1 Ot7-
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert }
ma.
y, :rCl'aC�F
W * 3r►'I
Ill�iiiL�a��
Lagoon
1
2
3
4
5
6
7
Spillway-
Design freeboard
Observed freeboard in
Sludge Surve Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Il ,,_tT�'f�i7R�tAT.Ti1
Design Width
Soil Test Date
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records
Lime Applied
LOW J
1 in Inspections ►�
Cu-I
Zn-I
120 min Insp.
Needs P
Weather Codes
Croo Yield
t
Transfer Sheets
RAM
• 111
I• 1''
i • 1
��
r� I
•
���
!
• ` 1EM
Un'_i w% wh*\ht-fkr)-e b.P1Bw1)u7L ' I z "
I .
. .
,,
r 1
lifan %r.22—
r t
r
R-AM,jd 6hlb 1-Xn-13.11 '-)
Verify PHONE NUMBER and affiliations 1�iU� t�.,I !
D to last WUP FRO SIN `� Date Ia�st What farmS{�'it App. Hardware SOmi
Lim ��%fib �1'►1 {ihy�
N„�`R�a' r F'ar� Records
Lagoon #
Top Dike M S�
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
col+ Cails Du t�p� a+
202 l�L
No
ioo
1qy
4k
-31
Ida
Or
106
lb4
170

01kr -7r!SI
�f
Type of Visit 9FCompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
,/_1�I Arrival Time: Departure Time: County: f
Farm Name:-iJl�t.+� 4 �. Owner Email:
1, �
Owner Name: i'V 1r i Ark. Popp- Phone:
Mailing Address:
Physical Address:
Region: M
s�
�
Facility Contact: Bill II
I Pope _ _ Title: Phone No:
Onsite Representative: dj f �� 1 Opp Q Integrator: � n
�
Certified Operator: �'l �l 1'4n r�E Operator Certification Number: )&�3/
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` = 11 Longitude: = o =, = u
Design Current
Design Current
Design Current
SRine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer
I
❑ Dairy Cow
Wean to Feeder
131❑
Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish I
❑ Da'y Heifer
❑ Farrow to Wean 1Dry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non-Dai
El Farrow to Finish
❑ Non -La ers
❑ Beef Stocker
❑ Gilts
Feeder
❑ Boars
❑❑Beef
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
IRNo
❑ 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
IN No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D"No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
_ ga — @3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C'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): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
IRNo
❑ 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
N 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
[5[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I;iNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1R] 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 ofAcceptableCrop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)l.1101
J1
&N--W � (RQ-
p , S� Qt , `Q rl; 1' t u { , 5� 6 A
- -
13. Soil type(s) 0840 V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
IR No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
JR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Wo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ER -No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IR-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):
AL
T
Reviewer/Inspector Name 0 �f phone: f i
Reviewer/Inspector Signature: Date: ULV6 S. ao
v 121281041 Continued

Facility Number: ga. -a3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W-No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [RNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ No
UNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El,{
Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
tRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[$No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
kNo
❑ 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
h 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
2 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or.:: Drawings:
15, LAM was- a plifJ. 0/4-I _Tzh/ac Feb aoo61
fi-1 n- � yie&ajo a►d
4, wi t hf'ed_ edlIbrd6 bye
&oad loo&I _C" 49o&L recavds.
Lei- CV,th*,d I R k- 14a. �-'007
Page 3 of 3 12128104

• Facility No. <�a a - Farm Name (Iyon� �4 Date A { d
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
FB Drops
Lagoon
1
2
3
4
5
6
7
Spillway
freeboard
.Design
Observed freeboard in
Sludge Survey Date
Sludge Depth ft& %
2,'}$'
Liquid Trt. Zone ft
,(o
1`181FIRSTI"D
Actual Flow
DesignNOR
'�--
---
..Actual Width
gal iI'V1a �{�w Aft- or'a�IuvQ00r LjJW AffI r'tYAO-V~r'-& yrso�u
3 Soil Test Date i0 1 in In ections
pH Fields Crop Yield QDI>PQtyIQA� w 120 rain Inspections
Lime Needed >�y_ Wettable Acres ✓ Weather Codes
Lime Applied b� -I {/, , WUP Transfer Sheets ►�
Cu Zn So+f Nt�Ji- AO WjX ' Rainfall Weekly
>1 eeboard RAIN GAUGE
Needs P
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
Sup.
I
-
fvv4:
S
d
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #�
Q
Top Dike
ail
Stop Pump
Start Pump
4T Q
A p. Hardware
I I ed J"Ef—

,
Type of Visit 381 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 8 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p1-4TG ] Arrival Time: Departure Time: County: Region: �^
Farm Name: C-Mmk:Wi 403, Owner Email:
11,
Owner Name Wi 1 � Phone:
Mailing Address: 5_130 R0XhArj2 hyyy
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 PO g_
Certified Operator: wi l l i _ PO>r�
Back-up Operator:
Location of Farm:
Latitude:
0
Phone No:
Integrator:
Operator Certification Number: AWA 160,31
Back-up Certification Number:
, = „ Longitude: = o = , =is
- Design CurrentD�eT�stgn�Cu
t
'fic
esigu Current
yDftW',R"
Swme Capacity Population
IW��� Y
Wet PaultryCapactiy,¢Popahon
Cattle Capace ty Population
❑ Wean to Finish
❑ Layer
❑ Non -Layer 1
w
Dry Poultry :� ..
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
Wean to Feeder
1a
❑ Feeder to Finish
❑ Farrow to Wean;
❑ Farrow to Feeder
m u
❑ La ers
❑ Non -La ers
El Pullets.El
ElTurkeys
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
T Beef Brood Co
❑ Farrow to Finish
❑ Gilts
❑ Boars
_ .... ..... ..:,_ . y __
Other + '-
❑ Other
❑ Turkey Poults
❑Other
dumber 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 tR7No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — ;LTTI Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t.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): V
Observed Freeboard (in): 33 q I _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1,2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C+No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 153IVo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IRNo ❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window h❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) My 4r Re U1 e S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ERNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JRNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ErNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CErNo
❑ NA
❑ NE
❑ Yes
J�jNo
❑ NA
❑ NE
Commenefer�tojgnesfZon #) Eirplaxn;any YESAanss♦ers and/or any�recommendahons or any other comments.
� -� � tom-- � ��-=- � � �. -� L'g . �,��:.-� • -
�Usedr wmgs''o"f facihtyto better eaplam s�taati�onys�a: (use asldetto_pyazljpa�gexs�,as�ne�essary):
7
Reviewer/inspector Name^� Phone: ID
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: $j —a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tgNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to 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 IgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No tO NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No $kNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
153 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
C'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
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[:1 Yes
IS] No
❑ NA
❑ NE
-7,10 Lu"vL r Q��1tt- of) b0&Jd c in a , G«s s� o cony i�
(cos)
o, Pe ry 1vo e tan or itabo ti l�VRM � eOr rvr I l be ✓ ed_ n�k� Croy
1PlQnik� iPd�Or QI cmp� a
Was e-K&e -Q01- a00C sl�� yesY'(�j b&'+ 06,da►e 41 ywar
lco�� -OarM
u&b In Lek nattk)-QirMP cVT
Page 3 of 3 12128104

��s d
C9� e�ol 14,5
459 L
C't
�;. -�I,.-lL 10 -1{C
Z •�r��I- 3��M
lobe
r �
P"A�aJo
M - Pt
£ �
11 L 'I s

Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6, Arrival Time: Departure Time: o Countg:
Farm Name: Z Owner Email:
Owner Name: 1� i111�
Mailing Address:
Phone:
Region:
51 '
Physical Address:
Facility Contact: +-3 t ex Title: 0 wa % Phone No:
Onsite Representative: ` r Integrator: z
Certified Operator: &2j Operator Certification)umber-�7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ & = « Longitude: ❑ o = I ❑ u
urrent
Design Current DesigSX_
Design
Current
Swine
Capacity Population Wet Poultry, Capacipulation
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
Lov11E]
Non -Layer I
"
❑ Dairy Calf
Dairy Heifer
❑ Feeder to Finish
ElFarrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Non -Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other'
❑ Other
❑ Turkey Poults
I ❑ Other
Nurn er 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?
Page 1 of 3
❑ Yes rXNo ❑ NA ❑ NE
❑ Yes
❑ No
X NA
❑ NE
❑ Yes
❑ No
[ANA
❑ NE
❑ Yes
❑ No
N] NA
❑ NE
❑ Yes
)& No
❑ NA
❑ NE
❑ Yes
70No
ElNA
❑ NE
12128104 Continued

Facility Nulpber:Z?--,U6 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [% No
❑ Yes 1� No
Structure 5
❑NA [I NE
❑NA ❑NE
Structure 6
Identifier:
Spillway?: t
Designed Freeboard (in): L
Observed Freeboard (in): 3(tL 319
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 o ❑ NA El NE
through a waste management or closure plan? f "
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EJ:No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ANo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 Windows El Evidence of Wind Drift ❑ AppliiJcation Outside of Area
12. Crop type(s) &Y- M 0
13. Soil type(s) N a A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ;F1' 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 F&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):
6,11 - �4 r r
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
12/28/04 Continued

FacilltyNumber:7;)_ Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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
C4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
19NA
❑ 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
PS -No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
(❑
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
CXNA
❑ 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
o
❑ 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
El NA
[I 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
rONo
[INA
[INE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(RNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit )10 Compliance Inspection 0 Operation Review 0 Structure Evaluation chnical Assistance
Reason for Visit bW&wj#we 0 Complaint 0 Follow up 0 Referral 0 Emergenc her ❑ Denied Access
Date or visit: Ul Arrival Time: 0=0�, Departure Time: County:
Farm Name: �7-�nC�t i ���-7 Owner Email:
Owner Name: L �Q0�.� Phone: _
Mailing Address:
Physical Address:
Facility Contact:
�``�� ` [� Title: Phone No:
On site Representative: �,N '� `� I a i Cx Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: = e =' E--] u Longitude: = ° = I = u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
IM Layer
❑ Dai Cow
❑ Wean to Feeder
I ILI Non-Laer
❑ Dairy Calf
❑ Feeder to Finish
6
as-`
Daily Heifer
❑ Dry Cow
❑ Farrow to Wean
Dry PoultryY
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish ❑ La ers
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
10 Beef Brood Cowl
Turkeys
Other
❑ Other
❑ Turkey Pouets
❑ Other
INumber
of Structures:
:9p_gi�w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
1�NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
[,a NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
1�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
X NE
?. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
CXNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
W NE
other than from a discharge?
Page 1 of 3
12128104
Continued

P.
Facility Number:
Date of inspection
Waste Cofflection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �LNo ❑ NA C1 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 5&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 ❑ NANE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA
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
T Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA / " E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA P
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 j2NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �NE
maintenancelimprovement? r
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA MTE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA OFNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA 0 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA �RNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA 09 NE
.Comments (refer to question #): Explain any YES;answers and/or any recommendations or any;other comments.
Use drawings of Gicitity to better explain situations.:, use additional pages as necessa
t S w s fle, , +•w-P__ l t,w,� Swrt . o w �e.Y U0 : V.a.� wt4ej `
�C3LR�Y rr� • Y� d Pk 5 A'� 6n
1 �f lL . OUXW_r 60 w � -� ac.v e s
Ott- 7 tit 1 S a-rci `4i'r&U_-' LaAL - V
Reviewer/Inspector Name j `b f Me IU [ Ok) I Phone: -)I() ' a'> Cr�—�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA tE
E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes ❑ No ❑ NA
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'qNo ❑ 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
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El No
NA
El✓
,-NE
I � NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
WE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )4,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[--]No
❑ NA
MNE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
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
PkNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
NE
P
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
[I NA
NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
ONE
Additional Comments and/or'Drawings:
Sluff-� �wr ue�y 'Dam, `.
r
a/ Is
q j 19
feCen t� LUAk�
44 Z
1 r4;- ►_( Fah
ri }� ►" rc4k� Ck 4-0.4d C.r! CJ&r
ill S. tj: 4�� mr, n„ ,I
Thi s �s �c_ct.'roAe , {�
c3 i>;n� r P �4n s -� ��i n v2V►i~ 4mc ��-r,�.Q.,� �"� S � �R
Cxn4a c4or .(Ce(kted
Page 3 of 3 12128104
ill S. tj: 4�� mr, n„ ,I
Thi s �s �c_ct.'roAe , {�
c3 i>;n� r P �4n s -� ��i n v2V►i~ 4mc ��-r,�.Q.,� �"� S � �R
Cxn4a c4or .(Ce(kted
Page 3 of 3 12128104
Cxn4a c4or .(Ce(kted
Page 3 of 3 12128104

Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11 �J { 11�101C. Arrival Time: ® Departure Time: Co
Region:
Farm Name: �al� V LAL : I 3L +r, Owner Email: �'} �%
Owner Name: ��� �U�. Phone: � � v 03l
Mailing Address:
Physical Address:
Facility Contact: w 1 �l dlr- Lot t Title: n Phone No.q In qqf) Q 3-11
Onsite Representative: WAV11 Integrator: l 1 I U f Dhu 2i((S1JU1�1
Certified Operator: ` Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o El I = Longitude: ❑ U = ; ❑ "
Design Current
xcrent
DesignNII
Design CurrenSwine
Capacity
Population
Wet Poultry
Capacityulation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
can to Feeder
15
er
❑ Dairy Calf
:]Feeder to Finish
" '
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry.:.
* ` z,
❑ Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
ElBeef Feeder
EBoars
❑Pulle tsrs
❑Beef Brood Co
-
-
-- _ -
El Turke s
Other
❑
❑ Turkey Pou Its
❑ Other
Number of Structures:
Other
;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
gNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
No
El;J
��,.,��yy
NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
JN" A
❑ 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
APNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&![No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:'*6 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )qNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
J�bNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: -:%k i Z,
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
El Yes ,1-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 1�)No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4�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 &o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 16No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
©tFij Jim"' 1`GlllS
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes RNo
❑ 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 NJZ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes')�No
❑ NA
❑ NE
r=, _
Comments (refer to question #): Explain any YES answers and/or any recommendations ar any otli,"0mments
Use drawings gf facility to better explain situations. (use additional pages as necessary):r n
Reviewer/Inspector Name } 1 T j\f 4 Phone: i /0 YJ D
Reviewer/Inspector Signature: c cgf-tz;�jDate:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MUNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
$DNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
t;NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
391 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?
❑ YesVo
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
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
�jNo
IP
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings_',
� x(Al // ma�e
Ve
Page 3 of 3 12128104

Facility No. Time In _ -�tJ Time Out Date
Farm Name Integrator
Owner`1, I�QQ_ Site Rep
Operator No.
Back-up No. _
COC Circle: ke in e ral or NPDES
f )
Design
Current
Desi n
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design Observed 1z:M
Sludge Survey '✓ Calibration/GPM 1
Crop Yield Waste Transfersy UAL
Rain Gauge 'if,"
Rain Breaker
Soil Test PP T—�
Weekly Freeboard Daily Rainfall '�—
Spray/Freeboard Drop
Weather Codes 1I20 min Inspections
Waste Analysis: r J
pay t.! Date Nitrogen (N)
d ,9 o
M
Wettable Acres
1-in Inspections ✓
Date Nitrogen (N}
Pull/Field Soil Crop Pan Window
p
S I-
3 �-

Sa H P-3r
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "f' 3 "� Arrival Time: Departure Time: County: Region: FRO
Farm Name: _ Cenc_art coc,( -waa Owner Email:
Owner Name: G✓: I aM P - Phone: q10 - 9910— 03'7 dew - -- --
Mailing Address: _SI 30, IPdse�ia ro iE-Le_� �.dj� _ G/'.� �e� /16.7
Physical Address:
Facility Contact: _. �T�jI �`a Poop _ Title:
Phone No:
Onsite Representative: W1/ r, , l�oo� Integrator: /tie
Certified Operator: W 1I.'12 M _ %ems Operator Certification Number: /G r/3J
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = =,; Longitude: = ° = , a u
1C.
Design; Current
' �3 y� GDesign Current
Wet Poultry
Capacity Population
CattleCapacity Population
,.
❑ Layer
❑ DairyCow
❑ Non -La et
❑ DairyCalf
❑ DairyHeifej
Dry Poultry
�, .:
❑ D Cow
V
'"'
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Non -La ers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
O lie .�.
❑ Turke s
El Turkey Points
,
❑ Other
❑ Other
xu +'�
Number ofa$tructures:
u Trent
SR�ne � . Ca ac tv, Po elation
,a p� _ ��r�p
❑ Wean to Finish
'Wean to Feeder
o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
E-]Gilts Boars
Discharl=es &Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
[a'IGo
❑ 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)
El 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)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
['Flo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
❑'�10
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: a, —.23 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 01Ko ❑ 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?: h „ d
Designed Freeboard (in): ? `/ 2 h
Observed Freeboard (in): 412
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
QNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2�4o
❑ 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
Q 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 El Yes
,�!'
L_I Flo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
CNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Ea No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind �rti ❑ Applicat� Outside of Area
3or/ 3 � .yy l�o
12, Crop type(s) BPr/� &,c[o- C.,,n i( r, ''A : T_ Corn "ea7L Bcw•e
S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D,Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
[;KE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Cj<E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�10
❑ NA
❑ NE
Mr. '
�+ O� S JCs:�„„! f'r[eboa.� iS �N iuY �v�fi /agae�+sCon�c�-Sd-�PSo� 1f/.PtJ
TdI Ile hi uJ 6v�f L%ls.`�n3 +t� S4aw Me 1ita,..7. rul���/� rGv6r i1 7.s •�U,e 1)�i
Reviewer/Inspector Name . /1v:? Phone: ylt7 -. 1s511 G�13D
Reviewer/Inspector Signature: Date: Li-/ -p
12128104 Continued

Facility Number. g,2 —.236- Date of Inspection
Reguired Records & Documents ��,/�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QO o ❑ NA ❑ NE
the appropriate box. ❑ i [ICAI eektists ❑ De� [I Ws ❑ PA<r
21. Does record keeping need improvement? If yes, check >yhe� appropriate box 5elow. ❑ Yes �lo El NA ❑ NE
❑ ❑ d ❑`- -il Analysis ❑ Waste Transfers
❑ Raasfat ❑-I h*kiag ❑ Crop Yield ❑ l ❑ s ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E'1Clo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
9'f4E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
2 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
Q-NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-1r4o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[9-NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O-VO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
9-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
P-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
D-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerilnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DoNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Adifitiooal'Coipmeiii5�and/or Drawings:
12178104

„fir .. ;;,, ._ ::� .. '�"c:r ... .•. _ .. _ _
+rwr�:w i:.--^. ..-•:YL» u-x++...._ ♦ .ri-vi_4._�. r3, f-.`�.-.X.... — s_a:� -
Type of Visit ® Compliance Inspection O Operation i"eview 0 Lagoon Evaluation
Reason for Visit *Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 t 1?rtc of Visit: � / d Time:
ro—N-It O erational Q Below Threshold
Permitted ® Certified 13 Conditionall- Certified 0 Registered Date Last Operated or Above Threshold-
s
Farm !dame: —Coin c p"A � I ¢� Count.: FMR
Owner Name: r� 1 i ', 1^.+ Phone No
Mailing Address:
Facility Contact: i.--? + a w. ea 4vr• Title: 'OL, J..+. s x Phone No:
Onsite Representative: 1.+ i a w-. ecn,o C Integrator: �n µ e16
Certified Operator: Lei ec,ee- „ Operator Certification Number: Ufa 73 1
Location of Farm:
IX Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0= Longitude �' �•
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca achy Population
® Wean to Feeder d 40 10 Laver ❑ Da
❑ Feeder to Finish ❑Non -Laver ❑Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 __:)! 1
Holding Ponds / Solid Traps 0
Subsurface
uid Waste
Discharges & Stream Impacts
1. Is anv 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 ves, notify DWQ)
c. if discharge is observed, what is the estimated flow in eat/min?
d_ Does discharge bypass a lagoon system? (If yes, notifi, DWQ)
2. Is there evidence of past discharge from any part of the operation?
JU Sprat Field Area 1
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: a
❑ Yes ® No
❑ Yes ( No
❑ Yes [ No
N I PE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
Structure 6
Freeboard (inches): 37 32
05103101 Conttinued

Facility Number: a a, -- a3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes R No
Waste Application
10. Are there any buffers that need maintenance/improvement? - ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN f❑' 1Hydraulic Overload El Yes No
12. Croptype ��r+v�w C. Si+,a<< Grn:.., OS.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes QU No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes (59 No
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
15. Does the receiving crop need improvement? ❑ Yes W No
16. Is there a lack of adequate waste application equipment? ❑ Yes C& No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V] 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
V3 No
19_
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
W No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes W No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [$No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
wiYa1 .dr s-Z k 2tl 43. H.
Comment referyto gnesbon t#} lE,irphun any YES.ansrreirs and/ orean��3recommendations.or any ather_oomments s ,
µ, ` cilr to better ex lam situations. use'addttionai a es $5 neeessa ` Field
ty P f P g *:k °g di y)- Copy ❑Final Notes
Use drawings of fa
i4 �ci e �. 1 ay, � it a �• � W ►'''` �
rYtr. Pope- in - e r1. J F_rA 40 K61 C«.�
ptc_S 4d1teLri CA %1oi
Reviewer/Inspector Name [
Reviewer/Inspector Signature: Date: / 7
05103101 Continued

Site Requires Immediate Attention: /YQ
Facility No. TZ -z5Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A- use- Z , 1995
Time:
Farm Name/Owner: _ Co 1J c O v d ! V V s f , # 1 _. / W; 1 1 r 4, __ f O p-c--
Mailing Address:- ?,-+ & x 3Z 1- A A C /: N-& Al _ NC -ZT ii9
County: _ Sam O so N
Integrator: Murph±; F M" f a.•+c _ Phone:
On Site Representative: l ll /'o c Phone:_ C41a2 ffZ - 7 857
Physical Address/Location: 17ee4 a Rol .
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 2 jeep Number of Animals on Site: _ z, (2c2a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) �r No A Freeboard:_�4 Ft. 4 Inches
Was any seepage observed from the lagoon(s)? Yes o.PJWWas any erosion observed? Yes orp
Is adequate land available for spray? (!P or No Is the cover crop adequate? <!& or No
Crop(s) being utilized: Row Cr & 'c t 42-S-41
Does the facility meet SCS minimum setback criteria. 200 Feet from Dwellings')or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ord
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (or No
Additional Comments: Aa-­ : s
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

racuuyNumver a _
Division of Environmental Management 8a '
Animal Feedlot Operations Site Visitation Renard Spa -,2.r
Date: /10
Tirnc: : 4p
General Informatlog:
Farm Name: C& nukc r, �:a —Coo
Owner Name: 13;ff - tod oe -- — _ _ %01
On Site Representative: r 1 a n . el `so►t Sntegrasor._--.
Mailing Address: k, 1
Physical
Latitude: I 1 Longitude: 1 1
Operation Description= (based on design cbaracterisft)
Type of Swine No. of Anbnab Type of Poultry No. of An&nals Type of Cattle No. -of Animals
Q Saw O Layer Cl Dairy
earsrry _ D Non -Layer 0 Beef
O Feeder
OrherTi9e of UWAtock Number of Animals:
Namber of Lagoons: -2— (include in the Drawings and Observations she freeboard of each lagoon)
Facility Inspection
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
0 Man.made O Not Man-nawk
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( liar the crops which rued impropeowm)
Crop tYpee.. oy s -- -- Acreage: .
Setback Criteria '
Is a dwelling located within 200 feet of waste. application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Lime Stream?
Is ani,inal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
A01- Jain 170%
Yes C] No
Yes CIN
Yes 0 Nq!
Yes ❑ Nc{ c ,
Yes 0
Yes D
Ne
No[
Yes ❑
-yes 0 7r�
Yes 0 Nc�
Yes O Nc�'

Maintena "
Dorn the facility maintenance need improvemeat7 Yes O No
Is gene evidence of past discharge from any part of the operation? Yes
Does record keeping aced improvement? Yes D N�
Did the facility fail to have a co of the Animal Waste Management Plan on site?
ty copy ag Yes O No C)
Explain any Yes answam;
Signature: Date:
Faaity Assesm&m Unit Use AmrJrnw= jfNeeded
Drawirtgs or ObservatioM
[•a [/�i •: �J :'•'sue• '
• �*{�. �. ter.
AOI — January 174M
• _ •►� [y �•- •-« •rr• tea. _ `!• ijrr�YR1�Me"y�•'�!w'���•+�•� �e•--

Site Requires Immediate Attention: ND
Facility No. FZ - z 3 S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A,S use '? , 1995
Time: / 1 - Z 0
Farm Name/Owner: Cp c I d u vSe ' a % W. Il GA002e,
Mailing Address:— - Sg( 3z r - AA 7 C 1 N _ho N l� G Z 8 3 7_8
County: Sa so "
:Integrator: nlut�gk, ; av _ Phone:
On Site Representative: 301 Pope Phone: C 9/ o�) 69 z - 7 65 7
Physical Address/Location: r"7e- Capps r 94.
Type of Operation: Swine Poultry Cattle
Design Capacity: Z.&11 0 Number of Animals on Site: _ z�& 4ko
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) �or No Actual Freeboard: Z Ft. Co Inches
Was any seepage observed from the la oon(s)? Yes or6P Was any erosion observed? Yes o<9P
Is adequate land available for spray? or No Is the cover crop adequate? � ar No
Crop(s) being utilized: /Q w Coes R e_ C s�wl
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? &;)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<P
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 06;�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(!qj) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? � r No
Additional Comments:
_ 9 � Rr-v d
Inspector Name
R ' R
e'�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.