310813_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua;

Type of Visit: f—) Co¢ipliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: JVT UN Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 9_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
I Laver
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P,oulti
La ers
Farrow to Finish
Gilts
Non -Layer
Boars
I
1pullets
Poults
Other I I IMI IOther
Phone:
Integrator:
Certification Number: 61
Certification Number:
Discharges and Stream Imoacts
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 ofa past discharge from any part ofthe operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[]Yes o ❑NA ❑NE
[] Yes No ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number: V1 I - 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 S cture 3 Structure 4 Structure 5 Structure 6
Identifier: GhI�RI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviroumen i threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1� 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
❑ NA
0 NE
Does the receiving crop and/or land application site need improvement?
El15. YesYNo
Mo
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fNo
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesfNo
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 CyNo ❑ 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 InspectiZo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -'91 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25.,Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes RfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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?
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J
L/,
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes QX01 ❑ NA ❑ NE
❑ Yes[�No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes � ❑ NA
❑ Yesfo ❑ NA
❑ NE
❑ NE
❑ NE
Phon(9)6) � a 3 9-
Date:
1201 S

Type of Visit: Q C mpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: j D County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: yy Title:
V
Onsite Representative: 'E f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: f 9-7�9
Certification Number:
Longitude:
II i
Swine
sh
Wean t!toFinish
Design C«urrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Current
Pop.
Dai Cow
Dai Calf
Wean tder
on -Layer
Feeder
Farrowean
'j,
2�6�
Design
Current
Dai Meifer
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P■ouftrr
La ers
Ca aci
PAa ,
Non -Dairy
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Other
Other
jPullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
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 ofthe 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o [DNA ❑ NE
[:]Yes go ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ N E.
Page I of 3 21412015 Continued

Facilit Number: jDate of Inspection: lo
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 Str cture 3 Structure 4 Structure 5 Structure 6
Identifier: � ��J;_X
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 1 71
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes JN(o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo
❑ 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
1 l . 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
[/7 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[7 o
NA
D 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
o
❑ 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?
2Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: r' - Date of Inspection-
i�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
VNo ❑ 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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
o ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
� o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
734o
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
�] Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesONo
o ❑ NA
❑ NI
34. Does .he facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments question'#)_�Explam any YlvSariswerssandlorranyiadditionalg°gr`ecommendations orany:othercommzents
c _p�:-L-x:?..:L:&$fix:. a..�'.��, kN�in.'e k. t.s:fl.1:,xx.. ;.x. q? :, e.A;,9'a%!..a:.; r$C a+f§kis i:. Fl .ri q(ai,S�kd Yi..x�.
Use=drawings��factbtyto_betterexplam:situations�.(use additional pagesaas necessary),. _; .•_qs rsr;;F�=,_';�t
I s.� CET7�� Qa�T�� 4- PEt�� w� R" G�'��5,
91) gLooc_j� Sv E Poe &r, Pc-�c�n�� i� � p�ESE��T Y
Reviewer/Inspector Name: 6H d U/ 6LE' 1 �0'--6'Arj Phone: b j
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: C) Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
III i.l•
Date of Visit: 73 a Arrival Time: Ss _. Departure Time: S S County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �T f /� , c~ f Title:
../ Onsite Representative: e r � S � cf,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ' 1 ' 7 f /q
Certification Number:
Longitude:
Design Current
Design
Current
n .�N
Design ;Current
Swine
C►apacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.;"
w =.
Wean to Finish
can to Feeder
Layer
Non -La er
DairyCow
DairyCalf
Feeder to Finish
Farrow to Wean
12 3I,p
Design
Current
DairyHeifer
D Cow
arrow to Feeder
Dr, P.oultr,
Ca aeit
P,o
Non -Dairy
Farrow to Finish
Gilts
()0
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes Ij l�o ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili .lumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�JNo ❑ 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: S !) 1.— 6-1%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -L� _L_____
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 E2-1;ro_ ❑ 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 [?I' —No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETN'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] N ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes En"No ❑ NA ❑ NE
18. 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 ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E]'—N o ❑ 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 EyNo ❑ NA ❑ NE
❑ Waste 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 [TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [n'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaellityiNumber: - Date of Ins ection: S
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Ye
[T N
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
Yes
[] No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Ej 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 7 No
❑ Yes No
❑ Yes No
❑ Yes [7�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [ N - ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/]nspector Signature: �� Date: 5 1Ir
Page 3 of 3 21412015

(Type of Visit: UCo pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: DUP(,-.w Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (' Title:
Onsite Representative:, ]�(7 J �� ���` Integrator:
Certification Number: 1'769_ q l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish [Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder 1
Design Current
Dr P.oultr. Ca aci P,o ,
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other Turke Pouets
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)?
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 ❑ NA ❑ NE
❑ Yes []No
[:]Yes []No
❑ Yes ❑ No
❑ Yes &No
❑ Yes E(No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 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
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: /� ' �,}SSii�Al
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� 3� ^
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
2/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > tO% 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
r'X0 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
C _I ''' ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2'�N_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? ❑ YesrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDatcof Inspection: !
24. Did the facility fail to calibrate waste application equipment as required by the permit. Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes FZ/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 property 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)
❑ Yes b�' " � ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[]Yes 40 ❑ NA ❑ NE
❑ Yes 2 No
[:]Yes / No
❑ NA ❑ NE
❑NA ❑NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes
E No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes,
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1-q,) eAL.T6aArZW+J �IbEaev
(pCA�' Sj_uo(rF S�JEY
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonee /j 03 0
Date: 4191
214 2011

Type of Visit: U Hance Inspection U Operation Review CU Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: County: DliELLEKiRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: i F I ?9
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle C+apacity Pop.
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Feeder to Finish
2
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
i 1 5 o ltr Ca aci Rio ,
Non -Dairy
Beef Stocker
Gilts
jon�ayers
ers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: .3 1- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: �% �►,L��IFtL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No[_] ❑ NE
❑ Yes (2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [::]Yes [4No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 5(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 G?(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 ZNo ❑ 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
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application gite need improvement?
❑ Yes
fN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r2 No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
YNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall 0 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
❑ NA
�No
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facie Number: 51- Date of Inspection: a 3
24.`Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EjNo ❑ NA ❑ NE
Other Issues
28. Did facility fail dispose dead 24 hours document
Yes
NA NE
the to properly of animals with and/or
[]
CZ
❑ ❑
and report mortality rates that were higher than normal?
WNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
[3 Yes
[DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑"N"o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E]PV
[3NA [] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� 70
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other- comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
� LL11 --
Reviewer/Inspector Name: G! 1 Phone: � lto b --
Reviewer/Inspector Signature; IVJRN Date:
Page 3 of 3 1/4/2 11

Type of Visit: Q) C pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ',Z, Z Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
-11"
Onsite Representative: j C_(r (` �EE 00r�) Cz Integrator:
Certified Operator:
Back-up Operator:
Locatibn of Farm:
Latitude:
Certification Number: f qj
Certification Number:
Longitude:
Design Current
Swine C*apacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle C*apacity Pop.
La er
DairyCow
Wean to Feeder
Layer
Dai Calf
<
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
DairyHeifer
Design Current D Cow
1)7,9 P,uultr, C•.a act P,o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1, Is any discharge observed from any part of the operation? []Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does 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 Ef o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: 31 - Date of Ins ection: 4 Jig
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1=J 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):
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
threat, notify DWQ
or environm2No
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
YNo
❑ 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 YNo ❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� 1Ve
❑ NA
❑ NE
acres determination?
ec
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes�No
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
u 'V
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
u
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Ins ection: 1 1 L
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PoNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L!1 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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)
❑ Yes CDIT[-] NA ❑ NE
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
❑ Yes
❑ Yes
No
C N
No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ • NE
(Comments (refer to .question ##)rExplain any YES answers and/or any additional recommendations or any other. comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r
d R L Phone: U
Date:
2/4/20 1

(Type of Visit {(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access jj
Date of Visit: `} 1 t Arrival Time: q (>p Departure Time: County: DLJP t=)J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: ` c- spe cpam'j G Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = Longitude: = c= 4
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish (01 r2
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
ElNon-Dairy
® Farrow to Feeder b
❑ Farrow to Finish
❑ Laers
El Beef Stocker
❑ Gilts❑Non-La
Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ furke s
Othe
ElOther
urkey Pouets
❑Other Number 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 JNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
El Yes
o ❑ NA
❑ NE
❑ Yes
L1 No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility 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: LA &0-00 5aW LA Gczd Vu7�� ej
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 5
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes VN[o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) `
6. Are there structures on -site which are not properly addressed and/or managed ElYes E4o, ❑ 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 ❑ [Ireat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes LJ No ❑ NA ❑ NE
maintenancehmprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
F] o
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
L' i 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
o
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to, question ##). Explain: any YES ;answers and/or any,. recommendationvoriany other: comments f „3
Use drawings of facility to better explain situations. (use additional!pages:as necessary)
w
Reviewerllnspector Name
Phone 916
Reviewer/Inspector Signature:
Date:
l Lei t
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection a z IT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design El Mans ❑Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
<
El NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl Yes
7140
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IEI<No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes P40 ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[K No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
EJ 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
E 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
E 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?
El Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Hv
Page 3 of 3 12128104

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q.Outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i uil r v i Arrival Time: 7[id Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact., Title: Phone No:
Onsite Representative: J C(P sta alig&f
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o = 1 = f1
Design
Swine Capacity
Current Design Current
Population Wet Poultty Capacity Pop latlon
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
c'�,
7 1W
Dry Poultry
❑ La ers
❑ Pullets Non-ts ers
❑
El Turkeys
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
Z.*Sb
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
ElBeef Brood Cow
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UJ/No
❑ 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 I of 3
12128104
Continued

Facility Number:
Date of Inspection-F-�
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 l Structure 2 Structure 3 Structure 4
Identifier:(AcfasA S6u) *J - ky-5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
dyes ❑ No
❑ Yes ["No
Structure 5
❑NA [I NE
❑ NA ❑ NE
Structure 6
❑ Yes E�No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
Elth
7. Do any of the structures need maintenance or improvement? Yes L1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes LJ,No El NA ❑ NE
maintenance or improvement?
Waste ADDUCHHon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes l3No ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
El No ❑NA ❑NE
No ❑ NA ❑ NE
o El NA El NE
I No ❑ NA ❑ NE
i i ? i-.
.Comments (refer to question #) 'Exp)ain any YES answers'and/o`r any recomiriendations or any, other�comments ~. ®„� s t s
: `E � t
Use: drawin s of facilit '.to bett"';cz li?Iin situations: use addittonal aes as necessar �` 1tl
g Y P ( p rgt s Y) ;�'
�.� �n }� A��aD Y Sc,r.T,
•
Sc ItrC' , Clew w 1.t tj
CL.e utr_V E�
Reviewer/Inspector Name
Phone:( 7
Reviewer/Inspector Signature:
Date: (5
Page 2 of 3 12128104 Continued

Facility Number: — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
,(❑
L�J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
% No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
2Yes
❑ No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Li No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q 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
EJ 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
EJ N
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

Type of Visit Fcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up �ferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,��7 Departure Time: County: 1 `t Region: —
Form Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �2-Fc S�E.yDsm C'
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = ` 0 & Longitude: 0 o = ` 0 "
Design Current
IM11111,1111
Design Current
Design Current
C+apac�ity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
ai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Daia Calf
® Feeder to Finish 1:3LQ
Dairy Heifer
Farrow to Wean
1 Z4o
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑Non
-La ers
❑ Beef Stocker
El Gilts
❑ Beef Feeder
❑ Boars
❑
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑Other
Number of Structures:
❑ Other
DischaMes & Stream Impacts
t. Is any discharge observed from any part of the operation?
ElYes
,
LJ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
eNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
eNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Vacili6_-Number:'j La Date of Inspection "� J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'l�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 I Structuree�3'' Structure 4 Structure 5 Structure 6
Identifier: CA�� 7V I'V'/ 1-rersrN rFC_mCQ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LdNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[3No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
LNo ❑ NA ❑ NE
maintenance/improvement?
11. 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 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
6No
❑ 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
L��"No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El[ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,2 No
❑ NA
❑ NE
-.S 4oT4.:e.,`3,u .4`.:e ti;'l1:'R.At�ea:5.'>ro. ?'Aa.8�k n4s1c%.19�€�L'-'
'Comments (refer,to question;#) Explain any YFS'la'i'i s and/or any recommendations or�any otyher�com'jmesnts.
u,[seWturawings of Iacility to better�explam srtuat►ons l{use.addstional pages�as necessary} �� �� � � g (y$
, .
777757 -P 7777 Lv AT R_ "V Do7,k/ G Q-cE k. iN a I'
rAS5CS 1-14 9- J FAA l( /!, L.LT`r(-( R_Aa: J {A l-L
.
?,, itA P .�'� NL,- C V
Reviewer/Inspector Name �� - - _ -- - -- _..p �-A/L (.L. - I Phone:
Reviewer/Inspector Signature: Date: G
Page 2 of 3 12128104 Continued

Facility Number:3 y — Date of Inspection 13 '
R ' dR d D t egmR.
19.
re ecor s ocumen s
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
Ef NE"
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
L"J NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[�NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
2 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ETNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
/C' NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
CNE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
0<E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
D�E
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
[Z 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
[3 NE .
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
�zo
❑ NA
❑ NE
12128104

31 M. el
Type of Visit eCrpllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 6 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: � � j
Farm Name:'_
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: $30 Departure Time: County: ZX1122_�� Region:
Owner Email:
Phone:
Facility Contact: Title: Phone No: _
Onsite Representative: �E SPc 00tr46n Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = ° = 1 = "
D101
esign Current
Design Current
Design Current
Swine
C®; paeity Population
Wet Poultry
Capacity Populthan
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
(o
i. u V
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
11
❑ Turkeys
Other1,11111
❑ Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharges & 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 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
WTNI
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

i
F'Mit
Y Number: Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA 6md
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a3 _
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 M 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 iNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LJ 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 AIR12lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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 Zo
o [3 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ONo
17. Does the facility lack adequate acreage for land application? ❑ Yes 7NO
o
18. Is there a lack of properly operating waste application equipment? ❑ Yes
24,) VAS Lof` or CA V=is(Z-K
[I NA El NE
El NA [I NE
❑ NA ❑ NE
Reviewer/Inspector Name �. (7 ''. 5,,;;r ax`,; Phone:
Reviewer/Inspector Signature: Date: f3
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection rr
;Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Y'ZNo
o El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? dyes ❑ No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes CdNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2 o ❑ 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 ❑ 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 o ❑ 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 ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional,Comrnents-and/or Drawings " `' �' �• �' °
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit ;Routlne
r�Vpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 316Arrival Time: F F YS Departure Time: County: DUPE) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: v 6 fT SIPL- b tr
Certified Operator:
Back-up Operator:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 = it Longitude: 0 ° = 1 = "
Design Current
Design Current Design C►urgent
Swine
Capacity Population Wet Poultry
❑ La er
Capacity Popu�lon Cattle Capacity Population
❑ DairyCow
❑ Wean to Finish
❑ Wean to Feeder
❑Non -La yet
❑ Dai Calf
Feeder to Finish 3io7'�• 33 a
❑ DairyHeifer
® Farrow to Wean Dry Poultry
❑ Dry Cow
JR Farrow to Feeder ZdDIlia
❑ Layers
El Non -Dairy
El Farrow to Finish
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
Feeder
❑❑Beef
Pullets
❑ Boars
ElBeef Brood Cow
El Turkeys
Other ❑ Turkey Poults
Number of Structures:
❑ Other 10 Other
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
zo
rNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 3 —gl 3 Date of Inspection L t)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes DNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lA 4vcQJ SbVJ Et -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 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 environmentaltrent, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o El NA NA NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J 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 ADuliCatiOU
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ld No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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 EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KN.o ❑ 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 ❑'I_To El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes allo ❑ 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):
;L5,) 06CD Ta Da SLdi>GE
u'Tk-% 3b DAYS,
&VOALL, ot1EA- A('P PY
To-rAL PA13 f3ur +,!`C{i y Cu� 6 S P 6leS nSoT Coo ouC(Z. Q4LA
R->1t�J
Reviewer/Inspector Name
vJ-,Pd Fi' "e., Phone: q
Reviewer/Inspector Signature:
Date: a e
1 12128104 Continued

Facility Number: 3 Date of Inspection 3 b
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ed 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 Inspection�,No
Weather Code
22. Did the facility fail to install and maintain a rain gauge'? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ es LJ No ElNA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? [Yes VNo
o ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? ElYes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ 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
^LJ( o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
al Comments and/or Drawings:
12128104

`7 )V Division of Water Quality
Facility Number 3 i tS 1 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Qf Cpiiance Inspection 0 Operation Review 0 Structure Evaluatlon 0 Technical Assistance
Reason for Visit ZRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Iff° ,�uP�rN
Date of Visit: Arrival Time: 5,�� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Phone No:
Onsite Representative: _ J£��2� i Sti'E9osN� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Title:
Back-up Certification Number:
Latitude: = o ❑ 4 0 Longitude: ❑ o = , 0
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
❑
Farrow to Wean
Farrow to Feeder
11.4U
( L
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number 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 [/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
12128104 Continued

.acility Number: 3 — 813 pate of Inspection Z3
Waste Collection & Treatment
4. -Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 22 Structure 3 Structure 4
Identifier: A dooN Sad/ uln(oc^v Qfde9 f
Spillway?: q
Designed Freeboard (in):
Observed Freeboard (in): qg `I.3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA El
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Ycs ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P(No ❑ NA ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ N
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ N
❑ 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 Drifl ❑ Application Outside of Area
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
[� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
tNo
ElNA
❑ NE
18. is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name /�% L Phone: k 1 % 3 It
Reviewer/Inspector Signature: Date: 23
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes "4i ❑ NA ElNE
ElYes L1 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Na ❑ 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
'o
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �'/No
la ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑Yes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O"NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
O 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?
El 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
❑ 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
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYesVNo
NA
NE
Additional Comments and/or
12128104

r
ON
Type of Visit PrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency Other ❑ Denied Access
Date of Visit: !I i/p D Arrival Time: 2 ; Departure Time: ti unty: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ! Title:
Onsite Representative:F� UYL�ZII%�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = 6 = is Longitude: = ° 0 ` = "
Design C►urrent
Design Current Design Current
Swine Capacity Population Wet Poultry
Capacity Population Cattle C•apaeity Population
❑ Wean to Finish
La er
El Cow
El Wean to Feeder
LIE[E] Non -Layer I
I
Upgry Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Cowl I
❑ Turke s
Other 10 Turkey Poults
Number of Structures:
❑ Other 10 Other
Discharees & 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 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
�Q Yes ❑ No El NA ❑ NE
/❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ 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 Structur 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
[�NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
/ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA CNE
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑No ❑NA X NE
❑ No ❑ NA XNE
❑ No ❑ NA X,VNE
NE
❑No ❑NA
❑ Yes ❑ No ❑ NA [Z] NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I 1 Phone: U
Reviewer/Inspector Signature: ' Date:
Page 2 of 3 12t281d4 Continued

Facility Number: Date of Inspection !j 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box. ❑ W­UP D Checklists I/ ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
�� -'�' /"�O�-
1014
loca k / Von
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA 'ONE
❑ NA E
❑ NA NE
❑ NA [YNE
❑ NAE
❑ NA �f;NE
❑ Yes
❑ No
❑ NA
JVNE
❑ Yes
❑ No
❑ NA
EIINE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
ElNE
ElYes
U(No
❑ NA
❑ NE
Page 3 of 3 12128104

31
Type of Visit Q(�C,00mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit [:1 Routine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: N'quw Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: DEFF .S.pE.1�onttJG' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: n°
Operator Certification Number:
Back-up Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle in
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La et
❑ Dai Calf
ZI Feeder to Finish
(p a OS
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
Zoo I 1b.3
Layers
Non-Dairy-
Farrowow to Finish❑
Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
LI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
24
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

e
Facility Number: 31 3 Date of Inspection t p
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: SS S u W
Spillway?:
Designed Freeboard (in): C, . 5
Observed Freeboard (in): J.D �. }
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElE3
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 YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA Cl 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 Drifl ❑ Application Outside of Area
12. Crop type(s) ? (-R.nr_& O A CC-) &0 A L� ALA A Rsc'js C>R.C## ARD
13. Soil type(s) W06octs)&r% GOLOS669.0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l-J NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
151fRio
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
';'r � aa,:.-
"Commentsl(refer to gdestion#) .Explain any YES answers andlo'r any recommendations or�any other` comments
Use drawings of facility to better explain situations a(use additionalipageslas#necessary} ��,•
Reviewer/inspector Name Phone6 5-
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 31 —'$ t Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
E/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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E;�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ea"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
/NNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RfNo
❑ 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
LJ 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
El 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
El Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit A Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit P Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: tZ Departure Time: (� County: Region:
Farm Name: ,-4,0 F u7 ���� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator: A44/V _,,.....__—.
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = ; Longitude: = ° ❑ ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I ❑ Layer
I� ❑ Non -La et
Other
❑ Other
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �II
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. Wbat is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge? °
[:]Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

+ Facility Number: — Date of Inspection
Waste Collection & Treatment 6
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I St ucture 2 Structure 3 Structure 4 Structure 5
Identifier:L/►1Iy� _
Spillway?:
Designed Freeboard (in):
pJ� C _
Observed Freeboard (in): �7 2
❑NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,�] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ' ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;Z No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 Drifj ❑ Application Outside of Area
12. Crop type(s) 1'�46L _ / z"a- /_�
13.
Soil type(s) C�OL� _GUG�pi%t•�,-pLJ.__/"vytcZK
14.
--------------------
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes gNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"
❑ Yes ONo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes ''No
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
/. 55
2049 cfl jco�2
� / /-}-�� � s ��sT �c�.�r�_o �.✓ �- �,®�c�-pro
Reviewer/Inspector Name �. ,,,t ; ;;„ Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check OYes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WDp Z Checklists []Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 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
5INo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[?rNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
17No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;?I 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
�7No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
WOOD• ��s� N �i/yi, c / r�o,•,l �c�i�?
7141 �y
11
12128104

(Type of Visit QYCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number bate of Visit: �o o Time: I I d 0
0 Not Operational O Below Threshold
Permitted)dCertified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ...........
di
Farm Name: ..43���r....'F.J�I�. .%.....a?!Ccjp.p................................................... County: .... N..,Q0.......................................
OwnerName: ................... ............................... ........................................................................ Phone No; ......................................... ..............................................
MailingAddress:............................................................................................................................ ....................... ...................... ................................. ..........................
FacilityContact: .............................................. ................................ Title:................................................................ Phone No:...................................................
Onsite Representative:.f..1p i10��d.......................................................... Integrator:......... ............................ ......................
CertifiedOperator: ................................................... .. . ......................................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude 0 4 46
l 'F Design -1
i t Swine!,
a ` i' f C$ ap 41j
❑ Wean to Feeder
JZFeeder to Finish
Z
3 6 t?
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
,I,, D4M
Layer
Non -Layer
Other
:'Ni i�� e } 1 i }',7k P 4€ f3i It3
in Capacity'[,{
DtB�'S.�1LW ill
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? - ❑ Yes Ld<o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ;1Rio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... lC+ rU............ ........................ ......... I ................... ....._...................... I .......... .....................................
Freeboard (inches): 2' Z z
12112103 Continued

Facility Number: -- Date of Inspection}'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 11114o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes FNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes rNo
❑ Excessive Poonnding ❑ PAN1 ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
1
12. Crop type cso,)Ci l!. � 1 ALFA1,t r4 6kLH 'f o 6ejq5s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [�
El yes [W
❑ Yes
❑ Yes X
❑ Yes 7No
❑ Yes UrNo
❑ Yes rNNo
❑ Yes [�No
❑ Yes YN�o
[:]Yes No
❑ Field Copy ❑ Final Notes
toE-r' au F Acus {JodE wT-rO N E(j w Vt' t-j(,L O Dzt1G Air ALfA
►2 S�E��?,� �S -r �I�ocEs5 UC IN:5 _LEiSGI C.ENTE1 P_( OT
W P u q UZLL 6C -rjE0 I�J?J (&eQ4 ' L,N&0arlS, CA9C �_UL N6T
T,5 APV(,Y ro ArJ q L>AO) 00T _1J w LR ALARCAD V UNTIL
T-C&4 S U L'.L5t w rES Y T. T>►J,
SL1 U%C / CALZBO..KTX$J, roc -ZpC, Ce,� w-w,� c" Ylr" Au.1
Reviewer/Inspector Name %
Reviewer/Inspector Signature:
Date:
rJir1m2

Facility Number: gi—g Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 124 Minute Inspections ❑ Annual Certification Form
❑ Yes 9Z
❑ Yes
❑ Yes L 0
❑ Yes 70,
❑ Yes
❑ Yes Z
❑ Yes
❑ Yes
❑ Yes No
Yes ❑ NJO
❑ Yes e
❑ Yes
❑ Yes OZ36
❑ Yes VNo
❑ Yes
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up 9f Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:ffT_ Time:
Not O ationa Below Thresh
Permitted [3 Certified Conditionally Certified 13 Registgred Date Last Operate r Above Threshold: _
Farm Name: Q � # 6 County: Sbi UQLz
Owner Name:�L1Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: E eE EZD-2 r-)G- Integrator: l oLoo 5
Certified Operator:
Location of Farm:
Operator Certification Number:
7j Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 Du Longitude 0' 06 �u
Design Current
Swine rnnnrity Pnnnintinn.
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current,
Poultry Capacitv Population Cattle, Capacitv Population
FLayer f ❑ Dairy
Non -La er ❑ Non -Dairy
10 Other I I
Total Design Capacity
Total SSLW �. .
Number of Lagoons ©FF ID Subsurface Drains Present ❑ La oon AreaIESpray
Holdtng`Ponds 7 Solid Traps . Ow " ❑ No Li uid Waste Management S stem
Field Area
Discharges _& Stream Impacts
1. is any discharge observed from any part of the operation?
OYes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field A Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ❑ No
Waste C911gcfion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes V No
Structure 1 S eture 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier:?.�zSliFie
Freeboard (inches): Li
05103101
Continued

Facility Number: — r3 Date of Inspection)=�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15,
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
0No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
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.
,Comments (refer to question #} Explain any YES answers:andlor••any recommendations or a"_ her.comments '• ,. , :..
FUse tlrawings facility better 'pages as,neeessrfy)
of to explain situations ;,(`use additional [] Field Copy ❑Final Notes
0 IJECI}�t5� F�Ci�7�Vq
f
FROM
u �P
c,'LuR P. Co 1,���a --��sa Cris I,r�T$o C�oGG �a>�Z,�P �s F%�,�
Reviewer/inspector Name ✓ - "Rd
Reviewerlinspector Signature: Date: D
05103101 Continued

Facility Number: 3— Date of Inspection
Qdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments andlofDrawings;
f-- r4 4vr'vor'1
FxYAczrv��r��r� ,
oN ��sCo�cj (�f 1R, lJPa �sJ G- �DA+n c-1 FLvw
FRpr \ FouJzrO� --oro�ox-rc�1
0 U A ti-o
1J 70 �►�G-� D ta.
!hC K :5-
T— D�D tO9
C'5 Ty rr\ r+ p �r-f �t CQr.Pc
-re,��R 0 R G R E4 rz-�� T zb
\DQ Q k6ou-r �
05103101

z
4 CL V-
p Division of Water Qnalit;
u
Q Division of Soil anil'Watei Conservation
0 Other AgencyV.
IType of Visit 11co,�mpliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit jo Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 1 Date of Visit: S 30 O Time:
rO Not Operational 0 Below Threshold
© Permitted Q Certified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
rt
Farm Name: eJ ey'/ 121-1 t1 C]O�Cdd i_ n ci -- - -- -- County: D jfe i;.-
Owner Name: ��d sJPed �" j Phone No:
Mailing Address:
Facility Contact: I Title: Phone No:
Onsite Representative:{-f s]�6�`+�ut , %O l t?►� Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' i� Longitude
Design Current
Swine C:anarity Pannlation
❑ Wean to Feeder
Feeder to Finish
13 69
022
❑ Farrow to Wean
arrow to Feeder
I Z 6 Q
02 1
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 10 Non-nairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present 10 Lu oon Area ID Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, li'discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. li'discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: SrL✓
Freeboard (inches): 34 28
05103101
❑ Yes )Z No
❑ Yes ❑+4lo
'v
❑ Yes ❑ N6
❑ Yes ❑ No
❑ Yes .,WNo
❑ Yes ❑ No
❑ YesNo
Structure 6
Continued
I

Facility Number: ,7 1
S 3A/O 7-
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Agnlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding' ❑ PAN ❑ Hydraulic Overload
12. Crop type es C 1/6
13. Do the receiving crops differ with th sc designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, hail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
❑ Yes 3'No
❑ Yes ETNo
.,i I Yes ❑ No
❑ Yes '7NO
❑ Yes •IJ No
❑ Yes O'No
❑ Yes ❑ No
❑ Yes ❑ No
;'Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes .ONo
❑ Yes No
2rYes ❑ No
Yes ❑ No
ElYes kNo
❑ YeseeNo
❑ Yes ❑ No
❑ Yes RrNo
❑ Yes ❑ No
IIETYes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES gnswers and/orany recnmmendatlons or.anyothenkcnminents�y
Use drawings of facility to better explain situations. (use atldltianal pa"g`esgas necessary)
m�y ❑ Field Copy ❑ Final Notes
�� -r•ti� �'��. r, � .-,ee�fs a wedA()je• ehcrCS
use 8d 4wo S;%S C-lo
Et0WetrQ_✓ 6,45 S4C_ 106n js o., A ca-1t16,ncw ,p AISo, F;e'(A
1.0 n 6 o u+ &,—i w.t� b e-4 wee Pi -jile 4wo sAet I s a s uvoe t (, e td
y W se+ red4ern -rep- arlo liGcf4 ��
f11sd Mf• .speofd �+,� dj�-�e�w, iv,G/� {41C aevi c e f e, 5c—, e or r'111 5 D+`�
o ' e ►'moist be G im; �'tvr� dicYC a 4�'tSO� )Dv11,S Cade/'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S 0�-
05103101 Continued

pa5a 3
Facility Number:
Date of Inspection 5 O
Qdor [ —Ss ucs
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
Oyes ❑ No
❑ Yes 'Jallo
❑ Yes ZNo
❑ Yes ,allo
❑ Yes JZNo
❑ Yes ❑ No
❑ Yes ❑ No
Additional Cbmments and/or Drawings:
li{. �Dyr���tleD, 44e r S�G� ;f 64 oi61r o� rCQC%; soY►-,e len �S
-e
�4ke
Aow�-I ev o" ", &ip A j4jk e N 4 tah
�n )44 off' Itese and raof;v-e of slo ,mac
`The�erore /rJ,._ Slo-v d,'n need 4o es�4b1 A, OM E0 -6
A Se4 I,,,,e41,od Fd✓ ►'for►; etv1I5- ih F,e1d, 4y 1 sv eA
LIF CS ct ir1 SL1 vndev-�/`Outhd W+' -t aof'�`.QyIQ yi� 'e Se"r .� IVe-ed -4D
Cvhsvl+ iv1411 A✓Ivah'f i�M 4eCIIAICAd-<fCCV°g1j'54 e,- eY1�►�ccr-�4�
-p,e d -,-4 1 1 --144/ 4i61, a-f 4t, i s r e .b r;5&,S . Me- S�pe4di'5
je-e6f s -lo iYlGn�� nra�er 17 S �Via" � 4e ld q ► h Ae t,"q,.b ]e
4iG,r'e 1 L{e�-<zr."er �q-� I'oi� (�t1h' *ei► v4vs4 6e do-e 6y a vml,"ridc/
A e e1i rl ► cod t�G�"a 1 r 4 or e k1 Jr >,i ee r'. 4 Lro ) Me'- ,r�c,�d � �� oee,O( s
-10 17a ve- 4ke we-�Itih le al c rej Ae-4 e�^ ; PWM 40 �- kgrSe rn14d re
i r ;4 � r<s evs a h oad;j ona ] sP--q y.9;61d . v,(&kt co—yl e- l r"
o/' 4ke w,ef#abfe / 4 C tvA-V4e'Flam�sJ�tads
�o be w�: e� AGG�rG �tig 4a 4,4e Lt,---HeA QGv-f ind M,
needs 4c kee?lp Jr+s ;reirlAni /teGoevb aewd
we-ssj Mr. s1o&dd'-'1 rTeeofs �d er'�dtc•� o�rrcr� -��C
awo - 04
;�C5 by riff ✓W.4erk aid havC A Ca)-,�Opj Guasfe lamf
e r- !fie oe ed S 4a foe -4 wo S.,4e.S ii r7da/aePi'A0 a nd h ve
q wo 54e f lew, c,v �¢h - 0 r ea411 s 14 c W h; c1i G(ea r1,1
1,1110f -��r C� c 1, s ►=1e . �-�' -� �I
5 � �e5 r'8 fit.; v►s 6�a rQ� � -F It cn h� G1'atf-�e �'r"D-►"� 4+'1 P S �' � e f S -�o
&e q f P1j Vd -Ir 41,c O�4ee- s )4,ek re6ld-f- -Tile C4,`4 hle acres
de4e✓ew;^q�to'h� qh )ejf?rw: r 'Odef,ec�r'ort� /At,lr'�� o jf LCA Fj'?A(
iS 10 be, done W ;1'.' 9� I:IcB yS
of wgs�c is 4o 6�r depw ih aeevvW( tjce wi4t 4 4 e I.,�e�able etcr�,t
Ofe}¢� 't r n��� Gh c.1t+�tO� i^eCDrA�' Q>'e fo r6G % ALG4�d>115Iy . Ism, P7eed �o
ti�Sf837D7 @rtsuic more., se;] 4ypes S-h,wsi for eAc4
.25, -Tke" r.•► Ztas- mere 41n,on ctllot.•ed dy fie L.JAJ)e flan gnpt

M,
• Facility Number. f — 8J3 Date of Inspection OZ
Odor Issues
26. Does the discharge pipe fromt1w1confinement building to the storage pond Zighboring
ge atlor below
liquid level of lagoon or storage po with no agitation?
27. Are there any dead animals not dispose roperly within 24 hours?
28, is there any evidence of wind drift during land ap �ation? (i.e. residue on, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the ' uid surface of the lagoon?
30. Were any major maintenance problems with the ventil ' n fan(s) no ? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to ha appropriate cover?
32, Do the flush tanks lack a submerge ill pipe or a permanent/temporary cover?
niments and/or
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
100E ,set'j ,eper� 5t7ovvJ -ram !.S fens����e
rlc-"04 on 4/1 c4' ahe .1^; r'J'JS t:vr'rePO t ®(es ��✓I�i�e�
�o ✓' �.e sow . f'a rr►-t , r<'VI � • s eel d ; ►� r n �; G� � � kR f-Ike sa r►.. 1� s'
>�a n.o-i �r,�vG 6 eQn ��� ken �ra erl i ti e Field ci -' �Ie tP
tiva n�k s � o ,ne 5 v 6 M-,' -� S�yw�i /�S �a � 1✓ � `� ; G k-1► � Y, o r s� a-1- - �r�
d d J,-,j o F ell 3 40 Grob e-S 6 y Tv rr e) S, z adz
av,d vlOan �Pce�v;�.q ,�sv)�'s , needs �a ���1 y 1;�•,e i�
fe,svlfj 1-tor,/,o.cre o,-~.re #Ieedeof
"ec"O's AS naa be i'� Y''ecor*d e,1A week;
'14-1;mes , of week hqs beer -&-r- sk,'epeol ov- ©,,c
was eeoe--teA nAd Ike 04ke-' L-va-1 h,4, M'eed -10 ,r,ccard levels
ea c k L le-e k Far ear ch iql aoPl.
Nc�Fe= T+�P �in:s�t%�� I�yoQ" ;S reg vrre4 4o tiav� -q4 leaks/ ZI t'or
-Freeboard Q e corof a-.� �o 41, e 1 orgy,,, Ae6i p k, i►r'o . A 1 sd, 4e sew
)he e6- "'ntiS4 4,rve a1eyr� 24.` 1, of�fPC$O d
f`i,�cen � T11e,^e ivaS4e an' la1Isis of"�ed surr,'e-; eri'..}1•�
l.Ji-it1/+1 4Q d� ys or Si,...C' /Vevc,,' bc✓' 2D0 I q"!C{ 9-4n✓q,17
21 -
1$ -� D o 2 yA ean s . feed 4e h, , I LvaJ4e gaol ys � 1
,4AI cd 1,;441'ki 64 d"-3 is a��lt'uc-It'a� �v��-}s A1sa} head 1a
be s-vre )e use- �i ��S�a ar,4ly.�t1 d�-(ed w:-l�t;h 6apd�ys �,<'
emp?(C'tl ¢1/a► S �O ca.(cu1kqG 41-C d'J)��✓D�}�I't A�/ r;ed eta
t �,e T 1�f P. P"fM'11 y Vs; a ve"A' -Pe on a ;1 0J77-fo r
rcp,-4 �� n��►� 2oD )Z evPX14-J whet i s�o�l�I use �-�.e 3/-4�/D2-
re_
evev?
r>��t ieed n KP c"- reyo,--4 -Po,- v-e &o /n4r, Mqy 20O L
lg. 41ppCArs -FLIg4 ;s ,S- dl ek!4e,-�n -/Ae p►reS Q44ke enaf
a F -4 A c Z-)en ho t., s 0 rr " 4 e {) � I S�� �, -,e . S �6 be 4.q e h
/ 1 eS q T Lt � c-i' �' o r1 I?Ped � �
461 OfeYe-11 f -�}�i5-�'vO�^'� �� v..01n.+-vim �.G]:.,.: na�t �Lt C n et• ��; �r,Rl �_..,�O,rP_Yi�arir.
14yc,7&1 - Also, ie^ki iee DCGV✓Y;n� g-1 44e IOVP-Ir1 S-1a4"'0017/ 41e
Baia/ IALyo6n. heed -(o be 4ctkgh 4o peevevO 44e-fe lea/<s,mct �PedaO
re 1,tce c,;r rCSl,if� n;q,, also geed A0 ehsvr c Halve, 41d sed ;--?weW;,WCi y

Facility Number: 31 -$ )3
Date of Inspection 3A 02
Odor Issues
26. Does the discharge pipe from the con ement building to the st age pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond w no agitation?
27. Are there any dead animals not disposed o roperly wit ' 24 hours?
28. Is there any evidence of wind drift during Ian appl' lion? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public prope
29. Is the land application spray system intake t loc ed near the liquid surface of the lagoon?
30. Were any major maintenance proble ith the vents Lion fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Cdinments andlo.rkbr4Lwin s:
$.�o,,-�;.�,,e� T>r,ere qfe �ar-.e .s��,k hales i►-� -��,e s�a��5'�,ld
o,,re, e F ?, , 31a -11� P sow Fa �-.. %2, ,' s m-►7 �e dz
a �•-��►� �t`le .This A�� ►� �'%e ',I�ed -S Jo be r 9fA1',^eA%refed
P'revevi4 s,"h k Jtol es • Al1a ; neM ec
d ra ►, 4f eS t111h Ch Oise q�pP�tr �O be 1, f-)ed
are f ;OxJl Iled -�)'4
pr PoMV�gn4r d,.rc4"1 rge /rort 44eSe ]�*1c s
-f
1 �• 7) e -i'SG LE C rO)p r1 FC'�S i>�iOro i/e3vlel%T >�+nt Slr in� �1��1r� S
1�1 p% n X Z6 And ri1 sa e h -4he Sow �'; 101 s I ~ !.t/. -T1 er e
rJ C 41 y Aq",d !y q� y, i>C A'� y, �'ert+rB 4y Fir} �'S�,er Z LV
ate F1-'7;-. 4C, IA) his beelL 4V ,e sow J 1 q
-6}r lqeive beet'] p1fn�e? Iil ),I Ie 1j O Z)61c 2, and Ae-f .ve �S
GaJ�' nc, il f bd dldet ✓,o) �i�j wl -10 1e `tlt�►1v ���q �� 1"� r'- �redd 'n
) n �! � eo4cd -� �R lie )lira h r ✓G' %�1 ed� ��t S✓�,p G4e . 07✓.;Oa4O(1-'1J1
0 efl1S AP 44 K e y
oiG-,ar�S necessq'�I Gnd e)irvne a j6eW,5-)Ahd a{
I
4�?S&v-e jean q3 �arS, le $v- 6 AJ-Overn6ev JJ 200Z>
need 4o elm-4 al) a reps Ar 1�ces�a r^� b SE C 044-� add z,adz. .
N�}e r �qll c��s Gor-wren �C� Drl tmde - P vy-7 be-, 9 neeo� 4,
�e r_a plel��l b7 7~uly J� Zaps
05103101

Division Wate
,
of r Quality
Q Divrs>tan,of Soil,and Water Conservation
Other'Agency
Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 'ORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date or Visit: f Z I � OD Thne: 1 Z. s- Printed (pit: 10/26/2000
� �
Q Not Operational Q Below Threshold
id Permitted [3 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........................
Farm Name: `Tud s e �rGwQt' ZR Count.!.''1....................................................I......
........................................'......7?....d.... ........................... ............... y
Owner Name:
........�...:��.....��2G�G,!,... ............................................................ Phone No:.......................................................................................
FacilityContact: ......................................................✓........................l'itle:................................................................ Phone No:...................................................
MailingAddress:........................................................................................................ .................................................................................................. ..........................
Onsite Representative: �er...r Integrator ....
S..e .....?.'A . .............................................. .... r-vwn'.. aF' Gard c..............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
;Ed Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 4 «
Design Current
Swine Canncity Pani lation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
I Z,40
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons Z Subsurface Drains Present jnLag ... . Area qffSpray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharecs & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance ntan-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. li' discharge is observed. what is the estimated flow in gal/min'!
d. Does discharge bypass a iagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: S-0LJ �`?' skc -
.......................................................................................................................................................................
Freeboard (inches): 3 Z 33
5100
❑ Yes If No
❑ Yes tff No
❑ Yes ZNo
A
❑ Yes 9No
❑ Yes �dNo
❑ Yes $No
❑ Yes ,9 No
Structure b
Continued on back

Facility Number: 3 j — 3 Date of Inspection Printed on: 10/26/2000
5. Are $here any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
bg No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
jo 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
ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
WNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Iff No
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
% No
12. Crop type -TqL FGSG U e _-Cr,4oI of y-a z C
13. Do the receivingcrops differ with those designated in the Certified Animal Waste Management Plan CA,,,
p g g ( WMP)?
❑Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination'?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
&Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
J9No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes RNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) XYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time o1' design? ❑ Yes *JKNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 19 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5f No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes ;cvrjl No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E•No
o yiblafigiis'or• defciencie-s •*tyre nbted• Ourirtg 4his:visit, • ."i} will-ree0ive Rio �ui�t� t
ctirresponrience.a�out this visit^ • . . . . . .
Use,drawmgs of facility soon #): Exp lain'an YE5 ( <1 t`
p y were and/o'r any'recommendations or any other comments`,
:
omments (refer to question
better ez lain situations. use additional pages as'necessaryj
$. �'��a�•-� ��+�G� I�'ika oh, saw AeLtscv. A+ 4ke �rh�"sly �. A
w^sl. o LA AVv0% s a4 ekkd &f ltat~seJ q Md e n sure �Cw l i`0.r � wa+ems r �
nt34 er)4ar4•P%6 6LLAd?l/1494>oh rH 4Aesa at reef.
�5. 5at••-,e a✓"ec,,�' o� �','efd r)eedl -�o L,�r�e �escve ,seeded ;n e�,*Jy z601,
lei • Keep p Pr ec6 o4r4 record s +,vee kl1`11AYI's
. HAve O'll �'ree�jarl-/Jr fcGpr�s
aa�; jctf fe- gAve ne�es-� WAsfe Use lororej-
b��:rt P11N cr e lei, on -T-9Q Z'1�G�hfJ
Reviewer/Inspector Name0
Reviewer/Inspector Signature: Date: MBT70,0 5I00

Facility Number: f —gr 3 Date of Inspection JIV19061 Printed on: 10/26/2000
Odor Issues
4
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below OYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ' [--]Yes "�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes §9 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Jj3 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )S No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 9 Yes ❑ No
Additional. Comments and/or rarwings:.'
seve--e l so; I gL,rOSs P)elot l: ke ''In I I I�
l�ja-� C wok 5 SOD 1 a r9. pDh sA l—viP% G
5/00

Facility Number Date of Visit: �� Time: 1 16 0
Q Not Operational Q Below Threshold
APermitted 13 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: ................................................... County:.... ...............................................
OwnerName: ................................................... ........................................................................ Phone No:....................................................................................:.
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress:..................................................................................................................... ............................... ........................... ..........................
OnsiteRepresentative:.. .t'`�'`.............................................................................. Integrator:.....�i!U Ui+-....................................................
.................. . .. ............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 " Longitude • 6 64
Desigi:,,� Cur ent
wine .. canneity Population
❑ Wean to Feeder
Feeder to Finish
'3rJ�-
❑ Farrow to Wean
Farrow to Feeder
r_
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current ;
ltry '-Ca'nacitt+, Pouulatiott `.Cattle �"t
Number o! iLagoans ❑ Subsurface Drains Present [Ion LagoArea ❑ Spray Field Area
_ 6
e
Holding Ponds SolidTraps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DViWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
�YNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
gNo
Structure I S cture 2 Structure 3 Structure �4 Structure 5
Structure G
Identifier: ............S.... .............. �.1!'ti................................................................................................................................I.....................
Freeboard (inches): �Q
��
5/00
Continued on Lack

acilityllumber: — g 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 ONO
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 9No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? XYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes `dNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes grNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )Z No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
1Q Yi p iQzjs o 4004e 0.. •lugs pate$• 00609 , ,' .' �, , ,Yoh wi�i,�ee lye,o fir ,
corresnoridei e: ah6u' f this 'visit: .................................... .
irxplain any,V0r atnwe'rs
❑ Yes )dNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes �rNo
[:]Yes ONO
9Yes ❑ No
❑ Yes ONO
❑ Yes JGTNo
❑ Yes 0 No
❑ Yes )�No
❑ Yes ENO
❑ Yes tallo
❑ Yes NNO
r i.. �: - o.v o-.- � � �..� � .-..,i- i�.. -..... ..� ... 1. .F. of _-.Its •'3F+
t
C b \ �:�.r: c--M7,�►'�c_oc�iwv 1�.� 4-,,. LIP— i7oyii,.. 4- t[�►� w,r. �.
Reviewer/Inspector Name ;� h ..
l
Reviewer/Inspector Signature: \_� \— Date:
Z'-14 —0 k 5/00

Facility Number: Date of Inspection O` Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes & "No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes E�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes t'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes RNo
Additional Comments and/or Drawings:
Cgs-
C� G�:�►�'� c�\� �S t� [S`t car e�Si2 U�� \�ies-+�' r
t <-
LRF.
k�t�V�VJ
p�.
P3
A
5100

" 13DP r i
lvlston of Soil and Water Conservation - O eration Review
i
01'Division 4Soil and'Water Conservation - Compliance Inspection H.. I,
RDivision of Water Quality Compliance Inspection Yi r i
OtI1C'r Agency 'Operation Review t- r • .. i t i 3 r i t • '
11DRoutine OComplaint O I'olloiv-u) of l)w ills ection O FOIIow-u ofI)SWC review O Other
Facility Number Date cif Inspection
'Fink: of Inspection :Q 24 hr. (hh:mm)
Permitted 1A Certified [] Conditionally Certified © Registered ta Not O er:ltic)nal Date Last Operated:
Farm Name: s... Z County ..,. �1,,ln.................................................................
� ..�f:. 6ktzl� r.....�........................
1J „+...... �......
Owner Name:.......c}>�``....+1l;kht4kh... I.... S.�ir.� Phone No:...%�1.P.�.
Facility Contact: .k .Title: `�l/ . Phone No: ...................................................
14'Iailillel Address: .....'.4..................................I...................................................... .........KOnf1t} Y.t.1(.4i� N............................... ..-0.`�.9........
Onsite Representative:. .............. .......... �Sps.GlJ.l`):•.�........................................... Integrator: ...... �s..............................................................
Certified Operator: ..................................................................`.............................................. Operator Certification Number:................. .............
Location of Farm:
............................. ......jaie.......::�......1 1......................... .........,......... ,............................................ ......................................... ............... .........................................
.................................................................................................................................................................:.......................................................................................................
Latitude •�'°� Longitude
Swine
Design Current Design Current Design Current
Capacity Population Poultry_ Capacity Population Cattle Capacity Population
❑ Layer I I EE ❑Dairy
Z ❑ Non -Layer I I JE1 Non -Dairy
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
I Zpp
❑ Farrow to Finish
❑ Gilts
❑ Bears
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 5MSubsurfaceDrains Present ❑ Lagoon Area Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges &Stream Impacts;
1. Is any discharge observed From any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-rnadc?
1). If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is olserved, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than From a discharge?
Waste Collection & Treatment
❑ Yes Z No
❑ Yes 91 No
❑ Yes [P] No
❑ Yes' 1A No
❑ Yes No
❑ Yes 99 No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes V? No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: raorq~,i 11niti�It�
Freeboard(inches):...1...................................i.................................. ............................................................................................................
........
116199 Continued on back

.]Facility Number: 3j $ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes [X No
❑ Yes ® No
Yes ❑ No
Yes ❑ No
Yes ❑ No
❑ Yes 21 No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes R No
12. Crop type ...................: SI,I/....... ��Cf~7u,.............,.........,.....,...,.,....................................................,................................................................................ ....
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14. Does the facility lack wettable acreage for land application'? (foo(print)
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
IS. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freehoard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0' I�1o:vio]ations:or. deiicien. cies.were no.ted. durin' Ali . Wt:. _Vou "I.rI. eceive nog further : -
e6rrespotidei*ce.t�bout: this visit.:•:•.•.•:•.•.•.•.•;•.•.•.•.•;•... .. ... ...............
...• • •
Yes ❑ No
Yes ❑ No
❑ Yes No
❑ Yes J2 No
❑ Yes ® No
P2 Yes ❑ No
❑ Yes R No
❑ Yes n No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Com tients,(refer to question #): Explain any YES answers and/or any recommendations or any other. comments
Use draw ri s of facility to better explain situations. (use additiona `g y p 1 pages.as necessary)t,'�
,
oy '%hv %r uQd( O' �'rxii)%%v) �Ixj�QO�� A�^OOtj► r �if� W-4t 0( utj &,y,
YJ t N 1v
�. Low CLvtzl� ;w sl l��PlJs S v�(} =t`I[t mscre��
y, La oov. O wrvjn- i r� sow �r. oa�� S kul 4 6e Very �` � . rutN ) Yuji it a4kv- %koaJ i� ins J
,s ] ��0� Lr-Q�(t.uc[S, Ljj4t,. W:.�,.y,
-f t,��li �e � yP� �vr W� �e�e►-�;�,�i�°n� Un�zS �- �((rwt`r� er�..p �ir Qmvt'r�e��'Y _
3!x; di Qr W06 `i's-lN L. iS Um, -7q"07n O'- �o1!7 ( C`CveGge, 1Inks t
Reviewer/Inspector Name11'Ud, i;
Reviewer/Inspector Signature: Date: ,� �j g
�I ,_.,. 11/6/99

Fafility Number:...... Date of Inspection:
Additional Q , ` ents and/or Drawings.
lS. FcScvt r�u� S �`Q 1IrOVv fir` S0'''` Ovrt�S of
�°1. ccrrtc wa5�c a+�LyS;s slnoult7 b� U�r�a c_,;,[�u1aK 4
rkk,�nGr- WarceS
7voivA Sec--\e,,
4/30/97

❑ Division Soil Water Conservation a ❑ Other Agency
of and
Division of Water Quality
.::: .m..: , .... v.. , = dNVIVW�1 — :`,, 11
msE§4
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection Z Q
Facility Number
Time of Inspection i : 2l3 24 hr. (hh:mm)
© Registered tkertihed [3 Applied for Permit PPermittcd 113 Not Operational 1 Date Last Operated:
Farm Name: .............. V.Q...... +.rS,11..... .�tr}jCounty:...,. �tShiCr......................
tt.............................................
OwnerName: ................................� 1..Val...... ........ ........................................ Phone No: .... Clip) .........................................................................
Facility Contact: ................ !.%...... ................. Title:............... ,. Phone No: .......
MailingAddress:.......?.. ......X.......1.o.......................... ............... ............... I........... ......V-0 -- .��,...t..r.r.......................,....... 3 .........
Onsite Representative: ............. tt rr
�7s'.�t.....���.�.tx�.................................................. Integrator: ...... . . [>.7n:s...................
Certified Operator:.................................................:............................................................. Operator Certification Number...... ....................................
Location of Farm:
:... ......tilnV.....� . ......R....... ...l9.z,A....... l c�...�.........e ........... sat......,.�.-.4,0................................. ..................................
.. .. .. .. .. .. ...... .. T
Latitude Longitude
z"Design ti;" Current '
' :
Design Current :. Design' ty Current x
;Swine ; < Eapactty Population
s
Poultry ` ''
Capacity'Populahon Cagle Capacity Population". ,
❑ Feeder
a
❑ Layer
❑Dairy
o Finish
Ffficeder
'jZ
I[]
Non -Layer
❑Non -Dairy
(� Farrow to Wean
❑ Farrow to Feeder
❑ Other
�-
❑ Farrow to Finish
" TotalDesigns Ca.paq..
❑ Gilts
❑soars
Total SSLW
X.
%Number
of LagtloRSI Holding Ponds Subsurface Drains Present IPLagoon Area PSpry Field Area
[:[No Liquid Waste Management Systemr
s
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaUmin? NIA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes [P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 50 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes i1 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes '�3 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [UNo
7/25/97

Facility Number: 3 1 — T I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier: ............54 (............ ...............t1ti...........
Freeboard (ft): ...............
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. 6w?.......................................................................................
❑ Yes jA No
0 Yes ❑ No
Structure 6
❑ Yes
Ij No
❑ Yes
R No
® Yes
❑ No
❑ Yes
UNo
❑ Yes
® No
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vidiation -o' i d6rciencies.werei-hotied•during this'visit.- You,Will r&ei ive�no,furfhier'
:. c0ert004dei'O about this;visit:
❑ Yes No
❑ Yes No
Eibyes ❑ No
❑ Yes RNo
❑ Yes RNo
❑ Yes ® No
IS Yes ❑ No
❑ Yes JN No
C9 Yes ❑ No
U Yes ❑ No
�- lv�s�l�tLi CA�d iw 5.a�1 �c�goCr1, t'^¢ la�aar� �Wt1151Wjj lie, toWeYrj c0_3FASt
�i�t,� w� �,ruv� ve ( b��Ort �L�xri ccw e�aS Zw.'
S t - '� sou (a�wti s (�, k)
lz. C „or' �, 01 �}ttt wal n /� ` I - r I
to.K "tc..' '0\02 4'Q YYvi"�e �R fd. Di ia. Qko a,t' V41%-_ l' u ooY� 5f'oV � �G wLowed.
I:. %�--(,. wtaN' s `a �Q M-wf_� PO.— �tstvc A-eIr� J
zZ. 5`vw� n toffs !S iL b\f• 9wd season of c Yc'p C G54Ue +-- Se .
�lSt►y 5 `a �Se �CL sell �� spv" cic-c t"s. �Zc4tulrn r-Lo,)% S�J{� 6e r"ait7e� -k Q I Iz."1 C4.w)ij1 r�lact. �r
Reviewer/Inspector Name
Reviewer/Inspector Signature:AA-.f,:
Date:

__ �❑ DSWC Animal Feedlot Operation Review
NY' �y
DWQ Animal Feedlot Operation Site Inspection K
Routine O Com lain[ O Follow-up of MV0 inspection O Follow-up of DMVC review O Other
Facility Number
D Registered D Ccrttified © Applied for Perm} it O Permitted
Farm Name: ... J I A` ....Q...ems.s�.cr..... -r� s?�.�..... ...............•...........
Owner Name:. T.v..
FacilityContact: ............................................................................•. Tille:.............
Bate of Inspection
Time of Inspection 24 hr. (hh:mm)
113 Not Operational I Date Last Operated:
�p
County:.... ?.,.�.,�.t. ............I..................
........ Phone No: 1.R..)..P..)....Z. � " Li g 17
rr................................................
........•.................•................... Phone No: ... 10
Mailing Address:... . .......a.1........`t..Q.Q.I....I............ .......•... .. ..... �2,-Cu`^..Su,a.,�.��
Onsite Representative.:....ae'.�€........?.�.a.-tIntegrator: ........ �..+r�?ll�e�..:' .& ................................................
CertifiedOperator. .................................................. ......... •.,.......................... ........•.............. Operator Certification Number ..........................................
Location of Farm:
p. �,...�.a.,l.� h�? e.a�......�.i.... ....n -..,� .). q.Z .1..,....r,t.la Qm� �. ....�..... .........¢ t .....................................................
..... ............................ ...... .......................... .....................................
Latitude 0 1 &C Longitude 0 < 4�
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Fopulation5'.
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑Non-LayerI ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds 10 Subsurface 1)rains !'resent ❑ Lag�N�n Area Io Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes 1[No
2. Is any discharge observed from any part of the operation`? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [l No
b. if discharW-o is observed, did it reach Surface Water? (II'yes, notify DWQ) ❑ Yes ® No
c. if discharge is observed, what is the estimated flow in galhnin? �11.4-
d. Does discharge byl?ass a lagoon system? (If yes, nr,tifv DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ENO
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes S No
5. Does any part of the waste management system (other than lagoons/holding ponds) require EfYes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Of No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes allo
7/25/97 Continued on back

Facilify Number: 3 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes allo
Structures (Lagoons,tiolding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ®_No
Structure I Structure 2 Structure 3 �trnctUre 4 Structure 5 Structure 6
Identifier:•tom
Freeboard(ft):............................................................. ....... .
t0. Is seepage observed from any of the structures'?
I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... ��-� V.........................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22., Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
................... I............
❑ Yes 19 No
aYes ❑ No
'Yes ❑ No
❑ Yes [ffNo
❑ Yes allo
❑ Yes
& No
❑ Yes
E9 No
® Yes
❑ No
❑ Yes
10 No
® Yes
❑ No
❑ Yes
® No
❑ Yes
19 No
❑ Yes
[B No
❑ Yes
fi� No
❑ Yes
E'JNo
0 No.violations or de'ficieneie's.rvere-n©ted-during this.visit.- Nou.'WHI receive no further :
correspondence about this:visit:::
Comments (refer to question #}: Explain any YES answers a id/qr atty recomi<tiendations 6r'any other cottiinents'.. t
Use.d...rawings of facility to better explains situations (use addltttinal.p ges as necessary)
5 9A/,W j4 -4-L .to 0--L a' -�� 1t)jg'
At-ls0 y r �►-y. S r,,...� A.r ip v r ,v m e4�
It .'t Z. �-1 S t 0 +n w y �i 0 I. L w o..-til- 4
0. I i 4 �i1to o�wf o.,r- d t L, ,
pppp ' �G `L' 1 (f, Iy.yVyQ�, Rom'[-y �p ,Q�A �.,1: t[ .
1 Q Y 1�— aY 4 ✓C�- "Y� ` (L -ks+• -� y 1 / rw{'r �L .
1 cl a j
-44 Lao V-.e-d-- v e,,f .
►Jo�icer o� b �i �.�- w� 11 i�-C S e.,., t �o r Qn•,oi;o e£ �o,�op ��la.� �,
V
7/25/97
Reviewerfinspector Name
Reviewer/Inspector Signature: n _ 1,,`T �„�„� ,� Date: - 31 1 q 7

State of North Carolina IT
Department of Environment,
1LTWA
Health and Natural Resources 4 •
Division of Water Quality a
APOMM%
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary E)P-HNF;Z
A. Preston Howard, Jr., P.B., Director
April 3, 1997
Buck Sholar
Buck Sholar Farm
256 Donald K. Outlaw Rd
Rose Hill NC 28458
SUBJECT: Notice of Violation
Designation of Operator in Charge
Buck Sholar Farm
Facility Number 31-457
Duplin County
Dear Mr. Sholar:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions conceming this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
for Steve W. Tedder, Chief
Water Quality Section
bb/awdesletl
cc: Wilmington Regional Office
Facility File
Enclosure
P.O. Box 29535, N*'%fVC
A%4 FAX [phone]
Raleigh, North Carolina 27626-0535 An Equal Opportunity/Atfirmative Action Employer
Telephone [phone]% recycles/ I M post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural `Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Buck Sholar
Buck Sholar Farm
256 Donald K. Outlaw Rd
Rose Hill NC 28458
SUBJECT: Operator In Charge Designation
Facility: Buck Sholar Farm
Facility ID#: 31-157
Duplin County
Dear Mr. Sholar:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group"which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
�—
,Z_ /.J�,
A. Preston Howard, Jr., P. .,Jiector
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P,O, Box 27687, N����
Raleigh, North Carolina 27611-7687 �� An Equal Opportunity/Afflrmative Action Employer
Voice 919-715-4100 50% recycled/10% post -consumer paper

�I
•
Site Requires Immediate Attention:
Facility No. _3�) - )3-7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �— 3 , 1995
Time: .OS Qh,
Farm Name/Owner: c�_ 2,- F2rnn
Mailing Address: I e r� 5e
County: Qv 1�� in
Integrator: rJ211
On Site Representative:
Physical Address/Location:
r o Z4
Sk 17 - kose lei /1
ti 4- m ", oy) r.
Type of Operation: Swine Poultry
Phone:
Phone: 2 gcff 4,CA6c0
� C>-7 Sr— Y FlZ f'7r&7
/Cal
Cattle r nee
Design Capacity:' Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 54 SZ ' �" Longitude: n Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ep--S))r No Actual Freeboard: 5 Ft. iv Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? es or No Is the cover crop adequate?�esrNo ZV VC
Crop(s) being utilized: rYtiV z
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system,'or other
similar man-made devices? Yes 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)? Yes o No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.