310181_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

3f-
Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2 u Arrival Time: Departure Time County:
Farm Name: A4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: K ry-G. 1I i-0I-VJ�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Region: wrklJ
Integrator:
Certification Number: /(n
Certification Number:
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?
Page I of 3 ` \
Longitude:
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CJ ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
21412015 Continued

Facili Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? Efoyes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Q/ /Yes ❑ No ❑ NA ❑ NE
Wth a propriate 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 elNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �j/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
E7fNo
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
e No
❑ NA
❑ NE
❑ Yes
21VO
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
[ No- ❑ NA ❑ NE
o ❑ NA ❑ NE
a,uiumenm trerer rtu quesuun,xl: Explain any 'E� answers?aoaior any auamonat recommennattonsior any otbercomments::z: :
Use,,drawings,of facility 16jbetter explain situations use
additionaf,pages as necessary"rt
r
Reviewer/Inspector Name: -/ t✓` Phone: ql9 _ J%S
Reviewer/Inspector Signature: Date: Z/
Page 3 of 3 21412015

Facility Number: - / JDate of inspection:
Wa§te Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZreNo
❑ 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):
t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 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 [2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21 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
00'Ro
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ZN
❑ 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
E301No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Io
❑ 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 0<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

for Visit: 'O Routine O
O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 6 Arrival Time: Departure Time: ®Q County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e n n C (� r o wn
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number: ?�7�
Certification Number:
Longitude:
Swine
an to Finish
Wean to Feeder
Design Current
Capacity Pop.
91j
Wet Poultry
I 11-ayer
Non-La er
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P,oultr,
Layers
Design
C•_a acibr
C+urgent
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q[her
Other
Turkeys
TurkeyPouets
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 [3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,,D,
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: ') I - S-f Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ 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 Ej 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 0-rlro ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 101bs. ❑ 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
[/] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
rNo
NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,__,��
E]_PK
❑ NA
❑ NE
20. Does the faci � fai ave all components of the CAWMP readily available? If yes, check
[—]Yes
❑ NA
❑ NE
the approp aag
Y
❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other,
21. Does recordd improvement? If yes, check a appropriate box below.
es
❑ 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 Inspection1
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J i�i6
❑ 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

1
Facili Number. 31- Date of Inspection: 117r d'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑<o ❑ 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 IQ"'O ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes G3 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes No ❑ NA ❑ NE
❑ Yes
[�_No
❑ Yes
❑,Ko
❑ Yes
fo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments. I Use drawings of facilityto better explain situations (use additional pages.as necessary). •_ �- ••- --.. .y , ;,; '••1,-
ru �� Inn kS 990 d� sew f rP �-�l2 5 ourr Po'-e //WI)
�1,�► • Pone
2i/2�.
!!!!!� ^ C(eFe-j-
s (G-z� ` 5"
(L fr nq W-A.
�G�rFo,-e and a'tl�
60 J.P. V, . ,00c_t
(A� dG Ltl� �% ,n tern- C(S . OTC-
AMar �, 4Z ( 4 Z ��(�ZIr)eS
,,_9 rf-, sl-4z (-- needs {' X�
rr') G` 1 /
10 eta -'5
.n re- CO r.c(5
A-e k-C CLof y k,,5 Pro tiN h �y LC/� IflSf FrP.-.iC�P�c�S.
201� Sor �S�S�oZ Zn — 2�-3o•-t�k
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: -1117)oy
Date: 1 (i b
21412015

(Type of Visit: 0 Com ce Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit: " Arrival Time: +Q� Departure Time: D County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title:
krntia fk 8 rot Integrator:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
I ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
an [o Feeder
�j i
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D P,oultr,
Layers
Design
C•.a aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharves and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Didthedischarge 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 Io ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE Y
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes g3'Io'❑ NA ❑ NE
❑ Yes Quo ❑ NA ❑ NE
Page 1 of 3
L i
21412015 Continued

Facility Number: b - Date of inspection: 71
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): ri. T-
Observed Freeboard (in): i 0
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
Structure 5
Jo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E<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 ErNo ❑ 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 O/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 CA W MP?
❑ Yes E3<
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Fj'No
❑ 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 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6-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 I3-1VO ❑ 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 1 of 3
►�i
21412015 Continued

[Facility Number: jDate of Inspection: a i / T'
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
I M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check dyes
Ej No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
EI'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
[]' Imo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[a'&A ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [%1No ❑ NA ❑ NE
❑ Yes [Z'No ❑ NA ❑ NE
❑ Yes O No
[-]Yes [ rNo
❑ Yes 3`­N9
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
(Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better exalain situations (use additional oases as necessarv).
SI a 9C 5"�'�7 Spy S levc(s 9-r-fh.4y, -ILV\ so-
d - { �, r- F (k-t' n.-)
s'p,% C4 t"o/'f F, Ocu-I J' o..e-1_/ Q /1/c /,J, -AN0\
I4
i'r!/20
pnclt���* ov
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phone: �f7 (J 716 ��,,
Date: / 11-2- z' / T
21412015

Type of Visit: f2ecompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: _241toutine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit:
Arrival Time: ,�3p j Departure Time: County: � �o
Region:
Farm Name:
/
1QjV
r di�y,\h r ,iyt Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: &nQri'V l EiYV✓\
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: tyl. 422
Certification Number:
Certification Number:
Longitude:
Design Current
et Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.Finish
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
Da' Heifer
Wean
o Feeder
Finish
FpFaimw
D . + P,oul[ .
La ers
Design
C_a aci +
Current
P,o .
D Cow
Non-Daio
Beef Stocker
Non -La ers
Beef Feeder
I
Pullets
IBeef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees 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 PNo ❑ NA ❑ NE
❑ Yes fNo
[—]Yes 1/ "No
❑ Yes LIo
[:]Yes �No
❑ Yes [2'FIo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: Date of Inspection:
Waste Colltction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes , 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes -:j No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [allo
❑ 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 �3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 8 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 JZ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ONo
❑ 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 L? No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes .[�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [allo
❑ 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.
0 Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard J: 6Vaste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 1' No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes P No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: jDate of Inspection:
24. Did the' -facility fail to calibrate waste application equipment as required by the permit? [:]Yes f�J`No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,[�J`No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 12"No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑"No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E3No ❑ 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 j�{do ❑ 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 E2'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 allo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes allo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
-
Use drawings of facility to better explain situations (use additional pages as.necessary).
/
l��' Y�'
ev0VV16 .
61,71
,7/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (�
Date: 102
21412014

—� Division of Water Quality
Facility Number ©- ®Division of Soil and Water Conservation
Other Agency
Type of Visit: Compliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: t Region: W !
Farm Name: ft & Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: 1ker4_ nAr W, IS -COWS
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:-
Certification Number: on Ii'1j
6
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean [o Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . $oulh,
Layers
Design
Ca aci
Current
P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 2f No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Efl-No
❑ Yes K] No
❑ NA ❑ NE
❑ NA ❑ NE
DNA ONE
❑NA ❑NE
❑ NA ❑ NE
Pagel of 21412011 Continued

1
Facility umber: Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes PrNo ❑ 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 ;a -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes oNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes EJNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes VFNo
❑ 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 JE�FNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes VNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes eNo
❑ NA
❑ NE
❑ Excessive Pending ❑ 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 R-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Fr No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes PrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �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 1KNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes PNo
❑ NA
❑ NE
Page 2 of
21412011 Continued

Facili Number: - Date of Inspection,
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes FfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes offNo ❑ 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 C2�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes y � 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 ZNo ❑ 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 XNo ❑ 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 ElNA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes JeNo ❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
[—]Yes RNo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [4 No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Uie drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �p (\ n4A;1;3
Phone: t}[!I GdIJ{J
Reviewer/InspectorSignature: \�{�{p�/�,.� �,__V�
Date:
Page 3 of 3
21412011

Type of Visit:
Compliance Inspection
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit:
�61goutine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: /U Arrival Time: / Departure Time: County: .hwu 7t/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Title:
Phone:
OnsiteRepresentative:
KEIVI1%-70
&OU-:JW
Integrators::(
Certified Operator:
Certification Number: � � �'( 0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Curren[
Cattle Capacity Pop.
DairyCow
Wean to Feeder
SS
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r. P,oult .
Layers
Design
Ga aci
Current
P,o
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
BoarsI
Pullets
I
JBeefBroodCow
Other
Other
Turke s
T ey 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 )ANo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑ No
❑ Yes
❑ No
❑ Yes
0 No
❑ Yes
`P No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

>sacili' umber. - / 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 E] No
No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [3NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload E]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): 1`C (L
13. Soil Type(s): A to g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 17y,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jT No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes" No E] NA ❑ NE
acres determination? ,,___,,,GGG
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 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.
❑v WUP El Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
'❑ Waste Application E] Weekly Freeboard E] Waste Analysis 0 Soil Analysis ❑)�to T' ers Q Weather Code
°❑ Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections ❑i Monthly and 1" Rainfall Inspectioyns� .❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I X I No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes 7i� No ❑ NA ❑ NE
Page 2 of 3 �C 21412011 Continued

!''acili umber: 71 - / Date of Inspection: U ���...,,,{{{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
NA
❑ NE
❑ Yes
No
` [❑,
N/ I NA
❑ NE
❑ Yes 'KNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes -;�No
❑ Yes )o
❑ Yes 4No
❑ Yes )SINo
❑ Yes ONo
❑ NA ❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
CA(_11? a //GA/ Nkr_ PoiL4
w.4.
G-)CI-10 o .q(o
(Zcruc,'kBa TU Ge-1 R
?�,AWVIMC GF/7S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6crG�C> (3 RATER
Phone: 9162�14-4n t
Date:
2/4/2011

Type of Visit: gCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1U II Arrival Time: Departure Time:® County: IA/
Farm Name: i�_oNN<_ Tt 1> (Loon( FA a ft^ Owner Email: l /
Owner Name: L6111VGT14 9. �Gtowni Phone: g1O-OW'369
Mailing Address:
Physical Address:
611_, NC Des e
—I
Facility Contact: Titt/le:
Onsite Representative: F�/jt/ 1-} &0Lq-) X� In�ntt�(e(grrraltor:
Certified Operator: I."N� j /j �, R.Cyy.� C' wiication
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Number: .111`410
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
$s
-E5
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oulhs+
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Op No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Pagel of 21412011 Continued

Facility Number: JDate of inspection:
Waste Collection & Treatment
yyy[[[
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f Jtl No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
7❑'C No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C4cm0
Spillway?:
nn
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.)
rr
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`1
*No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
iii777'''"'
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 I ❑ NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ � S C
13. Soil Type(s): AA
14. Do the receiving crops differ from those designated in the CAWMP?
(es
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VLNo
❑ NA
❑ NE
Required Records & Documents
77�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign 0 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 0 Waste Analysis Q Soil Analysis
❑ }b�as[e Transfers
❑Weather Code
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rainfall Inspectioonss{
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
����....I----x����ffffl No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: "jDate of Inspection {{
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
ii%"""
❑ 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 PDA 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
A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
A ❑ NE
R�N
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes I J� 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 lyl 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)
TTT
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? ElYes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes t
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments -,vi. M
Use drawings of facility to better explain situations (use additional pages as necessary).
C4u(304T-/0iY bLAc- DO 1 `a
w-A-
cjl a9/11 I.
T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: I1V '1/6 -13 97
Date: I) 13/ I/
Page 3 of 3 214,12011

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
IReason for Visit $-Routine O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access I
Date of Visit: q%' � Arrival Time: U5.1� Departure Time: County: I/V Region:
�/
Farm Name: I—IGNNE7Fi QQn0'—,�/ ' AA`ZM Owner Email:
Owner Name: KENVE%H 12- (�tUkY�/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: K4—:1V1\(E7'44 �v7U'e� Integrator:
Certified Operator: .1C>;N,r �-� Q • \'LZC�L�-�N Ope�1CCerti6cation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =U =' = Longitude: [�o
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Cl Yes xNo ❑ NA ❑ NE
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
0
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Fadlity Number:? Date of Inspection( y C�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ElNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: (_"C0'V
Spillway?:
Designed Freeboard (in): /-7 • S
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.)
❑ Yes
hll No
7r
❑ NA
❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
ElNA
ElNE
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?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes No
❑ Yes /K` No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
§6No
❑ NA
❑ NE
❑ Yes
No
/A\
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) pE(L S< f-�
13.
Soil type(s) 8%A V5
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
li`i' No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,ty No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to'questiou #);' Explain any YES answers'and/or'anyrecommendations or any ;other comments ? "
Use drawings of facility to better explain situations4use.additiomal pagesas'necessarg)c w
, v
viewe/Ispector Name
[Eviewer1lospector
p / - '' Phone: / G 9G
Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: —) t) Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0 No
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
XNo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists 0 Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
✓✓✓✓ ` � No
El NA
[I NE
El Waste Application 0 Weekly Freeboard 0 Waste Analysis [3 Soil Analysis El Waste Transfers❑AAnual Certification
❑ Rainfall 0 Stocking 0 Crop Yield Q 120 Minute Inspections +❑ Monthly and 1"
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;kNo
❑ 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?
❑ Yes
ANo
ElNA
[3NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
) No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(XNo
❑ 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
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
��yyii
Iy No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
.
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
DdNo
❑ NA
❑ NE
Additional Comments and/or Drawings: - `" <n
�' c•q_�ca�v p U G �� C3�i
wA
Page 3 of 3 12128104

%3
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Qq Arrival Time: ® Departure Time: County: �I.tT Region:
Farm Name: �Ke-NNE1H (�I�L(Zou_-LI/ FAV-m Owner Email: (� ?fin
Owner Name: V'Er�tNey+ ?, pp,�Lg.!t 'y (� Phone:/ nn-Dsq-3(�U
Mailing Address: JL4S "NoC CJtWLA&V JZ8 �L15� I IL.t /V; c CORPS?
Physical Address:
Facility Contact: Title:
Onsite Representative: KCNNETH�j (���LOL_ � 1
Certified Operator: `�ew�To 9. '6(LOt+AN
Back-up Operator:
Location of Farm:
Phone No:
Integrator: �f
Operator Certification Number:
Back-up Certification Number:
Latitude: (70
[7, [7" Longitude: n° n n
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish 10 Layer I
❑ Dairy Cow
® Wean to Feeder
❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
El Gilts [I Non -Layers
❑Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Coid
❑ Turkeys
Other ❑ Turke Points
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts j..�
1. Is any discharge observed from any part of the operation? El Yes l7(1 No [I NA ❑ NE
Discharge originated at ❑ Structure El Application Field El Other
/ \
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
[INA
[INE
other than from a discharge?
//
12128104 Continued

Facility Number: 1 — g 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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C ACOON
Spillway?:
Designed Freeboard (in): �Q.S
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? El Yes I1;I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes TANo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) TA
No
Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ 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 XNo ❑ 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
PNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
kNo ❑ NA ❑ NE
XNo ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answ,erstarid/or any recommeu'`da one or �yYgthel nun, eME_
Use drawings of facility to better explain situations (use additional pages as nec`essaryt) a -,F-
STIR-L���NC ON CIE[-DS.
Reviewer/inspector Name I H I1'IANpA 1 NC S ` Phone: 910 -� 96 4
Reviewer/Inspector Signature: t3.✓n4'� Date: M/Q q
12128104 Continued

Facility Number: j — 1 1 Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[]Yes
No
�(,,,ttr
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,,,�
{,a7 No
❑ NA
❑ NE
the appropriate box. ElWUp El Checklists ❑ Design El Maps ❑ Other
v
21.
Does record keeping need improvement? If yes, check the appropriate box below.
EC] ❑ Yes No
ElNA
[INE
ElWaste Application 0 Weekly Freeboard ElWaste Analysis 0 Soil Analysis ❑ W1aste Transfers
❑^ual 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 Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�[No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No )VV' 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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
1,.)•A.
319 l oR v .(-Iq
falVos G.99
12128104

Division of Water Quality
Facility Number17"-0 Division of Soil and Water Conservation /
- — 0 OtherAgency
Type of Visit )& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )K Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1%V Region:
Farm Name:
Owner Name: \CENN E T 14 &GL o
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1(EK/Y67-11 �L-'W
Certified Operator: K ENNT- EH 1 � • 'L�2R-S�AMCA—W
Back-up Operator:
Location of Farm:
Latitude: F7
0
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: J h Le
Back-up Certification Number:
Design Current "Design Current
Swine Capacity Population' -- Wet Poultry- Capacity Population
❑ Wean to Finish
❑ La er
® Wean to Feeder
9,5C)
. ❑ Non -Layer
❑ Feeder to Finish
Dry Poultry -
❑ Farrow to Wean
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =o =, = «
Design
Cattle -.: Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
Feeder
LNumber of Structure
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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes IStLjNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 — f �' Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: La iovY
Spillway?:
Designed Freeboard (in): q .5
Observed Freeboard (in): a c0
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f 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
XNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
q No
'
El NA
El 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
4 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question tl): 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):'
R-050 wareQ t_rAK A(LOIwNp F.Nt� 0 F t_AS-r 1- 0"SE w4S?C 1N �l i •
fok —3uwKg FARMFit (aC-AArCt rc� C4F_CK wt4TE2 LtNE$
Reviewertinspector Name I HMANUH Q4 /Afc 1 Phone: "10- irl(0--f 5�)f
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

A
Facility Number: —f8-1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes );fNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ,j�'No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ClYes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
13zjo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Flo
_ \
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
No
[I 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?
❑ YesIo
El 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
[INA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
\
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
A'IVo
ElNA
[INE
Page 3 of 3 12128104

A. C) Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Co liance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit:
/d� //Q/dG
Arrival Time:
Departure Time: County: p4lhobnj Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: kkA1416± �/ 1y gkoyt l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
'Design 'Current=. '':I
vine Capacity Population Wet Poultry C
] Wean to Finish (❑ La er
Wean to Feeder 2 ❑Non -La er
] Feeder to Finish
] Farrow to Wean Dry Poultry
�] Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0 " Longitude:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Cattle
v�v�a
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?
Page 1 of 3
❑ Yes E�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
[J No
❑ NA
❑ NE
❑ Yes E No ❑ NA ❑ NE
12128104 Continued

`%
it
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 / Structure 2 Structure 3 Structure 4
Identifier: %�W
Spillway?: c
Designed Freeboard (in):
Observed Freeboard (in): 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 EX/0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes BNo ❑ 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 21 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 NJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,..,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes M N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) 'L ,S G o
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2 No ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes O/No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J;Ko
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question J): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Zod jjwP Mvrr (3E R.E.DotX ,tl,J 30 DA'S AI.IV CW� SEnJ'p l0 ubvu
2Y v aS, flvOG6 WCAcs6t> Al�O� OsN6 QuT ta!'Y Nai fENT s t),w&fi, fENn Ta Dr�/Q
�l� StOGrcZNG 3o CA
Z0116t/TOXy �ifom mv-r664R-i 6�E6EPS Ta 45 NJ ICEC�YLD.1,
/APP1ZcAT'tail (�r5xv15 wAsrf AN1atlJ r t10 )b AP® atJT Mi/Sr A1AV6 1/6XACE
IQAn V_T_1_J AAA4, Car' 067SZ0LE &IrrrT 0,67;lsnl CO& And SCi✓n T6 AaV .
Reviewer/Inspector Name cJu/�+�t/ /(, Phone: 97 1 /76 — /,SY45
Reviewer/Inspector Signature: Date: /v
noon 7 of i

ffTT��.II
Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have /all components of the CAWMP readily available? If yes, check
the appropriate box. 52 WUP ❑ Checklists ❑ Design ❑ Mans
p ❑Other
❑ Yes E No ❑ NA ❑ NE
Z Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA ❑ NE
❑ Waste Applicatro ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Locking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
�'�NE]
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
L1 No
❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
—❑
2� Yes
❑ No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
CKes
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No❑
E
N!A/❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E1- A ❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
nNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
❑ 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
Lr-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
01Qo
❑ 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
CC
,R'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or
Qv6 5T.ZJA/ 413bGT PLA6 &VbW W d od M49-k6K. NX
Page 3 of 3 12128104

Type of Visit d Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l0 1 S a5 Arrival Time: Departure Time: County: Ly0
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
iCE N N ET i 6 l� Rpu✓ 1-'
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: = o = ,
Swine
❑ Wean to Finish:
Design
Ca act
Current 1,
Yo ulation
.:v.:..P r
Destgn
INVe[:Piipltry Capaaty
't. xra,.i,,m�ra.
❑ La er
Current
P pulahono
il
Cattle` '
--
—ElDatry Cow
Design Current
Capacity Po fion
P
-
Wean to Feeder
3SS 2,
❑ Non -La ei I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
- :. ❑ DairyHeifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑Beef Feeder
❑ Beef Brood Co
-^,.,R, r ---�
-
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑
Layers
❑ Farrow to Finish
❑
Non -Layers
❑ Gilts
❑Pullets
❑ Boars
.-❑
Turkeys
Other _
t
:::� .c•f ,
...
-
❑
Turke Poults
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Er -No
❑ NA
❑ NE
❑ Yes
2<0
❑ NA
❑ NE
12128104 Continued

Facility Number: SI - g 1 Date of Inspection to 1 oS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo
❑ 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): Ici, f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�/
L1 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
ENo
❑ 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 Ef',,/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Lam] 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>o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes LI No ❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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) CG ) S G a
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3'No
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
—
I 4es
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
r❑� o
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,t_,
IEdT� -
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI No
❑ NA
❑ NE
!S,) WtJTjdU6 To 06,60 CotVI"C, fJVTE/LAJJ
LIPOAjf wVP Gr+-at✓60t M, Oo31J6, 4f)"! MAy J�1GREAsE; �Al� ALSO T�ipt—
AoRES AY-e b'J-f"E&cl-,'r a Two /'q(,£,j,
20 v P DP m Ctt.6 f 'l3E t o -Foft-nti,(
IReviewer/Inspector Name I _ o MIJ�p ttfd G(,, .* = °�'`'" ' � Phone: (4/0) ri - 7;L6S I
Reviewer/Inspector Signature: "I1I�^'� Date: 10 /$ or
12128104 Continued

Facility Number: — I $) Date of Inspection
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 I components of the CAWMP readily available? If yes, check L/l Yes ❑ No El NA ❑ NE
the appropirate box. VTUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Q"re's
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Week Freeboard [I Waste Analysis ❑ Soil Analysis El Waste Transfers
El Annual
Certification
El Rainfall [I Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
�
NNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,3
El -No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
—❑'�IA
ETNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ICJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�/
J,J_, tNoo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
Elio
❑ 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
EINo
❑ 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
El2 Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[Na
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

Type of Visit 6 Copipliance Inspection O Operation Review O lagoon Evaluation
'Reason for Visit (6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number g� Date of Visit: !0 o Time: 1000
O Not Operational O Below Threshold
Mfermitted GCertifled 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: j CE N N ETI-i Is" J County:
Owner Name:
Marling Address:
Facility Contact:
Title:
Phone No:
Phone No:
Onsite Representative: �«!J t-rlli g It 0 W ►J Y-- Integrator. CA tLR o
Certified Operator. _ Operator Certification Number -
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• = =I -
Discharees &Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes QNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ✓
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o,
❑ Yes VVV///
❑ Yes No
Structure 6
12112103 Continued

Facility Number: 3 ( — (8 1 Date of Inspection [yy7
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes d No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes D44
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWty
7. Do any of the structures need maintenance/improvement? ❑ Yes ��io
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes E3 4o
elevation markings?
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
M—N
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
� No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type ?'4—&4tVWH C 14) 5&b,
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
C2rJNo
14.
a) Does the facility lack adequate acreage for land application?
[I Yes
ON�No
b) Does the facility need a wettable acre determination? .
❑ Yes
61//
c) This facility is pended for a wettable acre determination?
❑Yes
QNo
15.
Does the receiving crop need improvement?
[jYes
❑ N9
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
1211�0
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
81�0
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[ 40
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
0 No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
L,,=li 'f11E NCW WUf tjCFb 14 EET Ant VP0AT6,V /nOP 5"Nol,v,16 ArWAAG& LIS60
A q Axlt,"Y' SY-9 rn,
Is.) (0"Tr.WVb TO Do WC6O Go1JTtro— anj "vr' Ga.ASS,
23) VJRSCE ANAL kSij GooD F6(u b° OACj '2-*�R. ANr) AfTEYI SAn+PIE DATE. PEASE
kF rrP WLTCASrauS Z" -r wsE wSj.I DOW S .
pr,�/EtL N++S 1J)60 CoC AN9 PEtLr✓li( 3E SurtE jo sT1+RT uSSN6 AL+ tJrl✓ Fo%�5
Fa.6 ^^ 6cT: (Sr r;04 ti'ffi D,
Reviewer/Inspector Name —
Reviewer/Inspector Signature:
Date:
WIZ/Us "nunuea

Facility Number: 31,- g Date of Inspection ( u
Reamred Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
YNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
23. Does record keeping need improvement? If yes, check the appropriate box below.
[ Yes
❑ No
❑ Waste Application ❑ Freeboard [Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
N
27. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
QNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
f i6'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EQ
Ld'1vo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a min gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted daring this visit. You will receive no further correspondence abort this visit
` Commentsa`nd/or,Drawmg <: x11- s
l2/IZ/03

"P,
x f,,esc «q'_, � t
� Drvismn of Water Quality
- ..
"`
-, s '
,= Dmston of Soil and Water Conservation
4l
r
fiY r
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
/� Date of Visit: / D Time: Q Printed on: 7/21/2000
�� f '
O Not Operational Q Below Threshold
Permitted Jd CCeertti/fied ❑ Conditionally Certified`❑ Registered Date Last Operated or Above Threshold: .........................
Farm Name: ......ga !: w..... .. County:.... ......................... ......................
Owner Name: ....fr.J..[.Y..>��...1..f
........ 6Q.O............................................. Phone No:......................................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ................................... . . ......... .... ................................................. .......................................................... ..........................
Onsite Representative:../7.Fj y/y ................. ..... .M-1v----------....................... Integrator. -_----- ,`
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
❑ Poultry ❑ Cattle ❑ Horse
.... _ Design Cu
to Feeder
rto Finish
v to Wean
v to Feedei
v to Finish
Gilts
Boars
Latitude �' 0' 0" Longitude �� 0` =11
went Design Current Design . Current
ition Poultry Capacity tion Po ulaCattle Ca as Po ulation
❑ Layer ❑Dairy
❑ Non -Layer I I I[] Non -Dairy
❑ Other
Total Design Capacity
o of Lagoons u su ts ace rauesent g-nn rea
ol__gP nds/Solid Ttaps No Liquid Waste Management System
JUSprayField rea ;
r
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any pan of the operation? -
❑ Yes
PrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
9No
Waste Collection & Treatment
-
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[]Yes
PrNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
IdentiFier: .................................... ...................... _............ ................................... .................................... ......... ..... _._... .........
...... ................ _..........
Freeboard (inches): 28
5100
Continued
on back

r �
Facility Number-_ — 9 _ Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
-
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? _
❑Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
V1No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
V(No
12. Crop type F
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
ENO
b) Does the facility need a wettabie acre determination?
❑ Yes
WNU
c) This facility is pended for a wettable acre determination?
❑ Yes
V(No
15. Does the receiving crop need improvement?
❑ Yes
�d]No
16. Is there a lack of adequate waste application equipment?
❑ Yes
10'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes g(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 fi�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes'ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes �dNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IA No
24. Does facility require a follow-up visit by same agency? ❑ Yes /No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes. No
Id•yiQCa itjns;e dg£ciencies •iygre 00 04 ditril�g ihjs:v�sit;-You wild-Secgiye �.0 futthgr • ; •:
corrasnoridence abotiti this visit. ::' :::::... :' :' :' :'.' ..' .....' ... .
T K6 �Rsi F �%� �5Z5 %a GAD d�P �/�PZC�T2o,
�va0 Fa b
�N A)f_X- �
Name
Signature_ it i- ����_ Date: / 02 5100

Facility No Date of Inspection / p
Odor Issues //
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes m No
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 P(No
❑ Yes �No
❑ Yes �No
❑ Yes/E'No
Additional Comments an or rawings: -
i9Rz.
2,�9 lj M�i✓ fpg
7o eECGeps �Ei iF� J�uc� /�S
im�RovF%'��
Pj uz�bz�✓�5 0 �E7� f2 4Fm ©t /46
o.JS
G�/D 3���3%D 2Zlo �k- %5q x. �0�3
C
5100

Division of Soil and Water Conservation Operation Review
0 Division of Soil and Water Conservation Compliance Inspection
,,� Division -of Water Quality „Compliance Inspection
C3 Other Agency-OperationReview,
40 Routine 0 Complaint 0 Follow-up
of DWQ inspection 0 Follow-up of DSWC review 0 Other 1
Facility Number
Date of Inspection
[Time of Inspection
�: �-00
I-- 24 hr. (hh:mm)
10 Permitted 0 Certified Q Conditionally Certified
K�Il/1C7 /q
FarmName: ................................................:.......�.........................,,C.Yl.�...........
OwnerName: ......... l.S.1/ixi,.Z.. ........... ... / t
0 Registered
J(,//0 Not O erational
/%� . 7 County:
......
...... Phone No:.......................................................................................
Date Last Operated: ..........................
l/.... a.
.... ....%��...............................:.....
Facility Contact: .... keWelt). ...........62O.
...
Title: ........... C%:v ..... ......_......... . Phone No: ..... -............................................
MailingAddress: ..................................................................................................................... ................................................................................. ... ....... ...............
,
Onsite Representative:Hl..i,'".,�.......................... Integrator........,... /�//-s
�//�� ........................ ....... ... .... ........
Certified Operator: ..... .,�ew/'%Y'/ti-........ , ]„!� %.:................................ Operator Certification Number:,,,,,,...........................
Location of Farm:
Latitude =• =' =1 Longitude =• =' ="
-_ `Design Current = .`- Design: Current Design Current -
Capacity Population" Poultry "' =Ca Capacity .Population :. Cattle Capacity Population. ---
Wean to Feeder 355'y ". ❑ Layer ❑ Dairy _
. ❑ Feeder to Finish _ ` ❑ Non -Layer �- ❑Non -Dairy -
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other ...
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars — - Total SSLW
INamber of Lagoons.. . - /� -� - ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-,,Holding g Ponds / Solid Traps -- ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 9
Identifier �I/
Freeboard(inches): ................................. .......................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 4 No
❑ Yes ❑ No
❑ Yes ❑ No
_/Ow -
❑ Yes ❑ No
❑ Yes ANo
❑ Yes ;<No
[]Yes .KNo
Structure 6
❑ Yes KNo
Continued on back

Facility Number: ?J — Date of Inspection
" � 6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
P(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑-Yes
Klo
.\
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
I�No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
kNo
12.
Crop type g# . S I
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
C(No
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15.
Does the receiving crop need improvement?
❑ Yes
o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ANo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.) ❑ Yes�No
No
19. Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes hdNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes W No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,tX No y�
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,IN
\o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yeso
0'iVdwibl'Wiotis;ocdeficiencieswereho(:ea.duringthis:visit'... uwill•receivetie:further
coriesp6tideitce:A6o f
eviewer/Inspector Signature: t��l _ -Y71A//1/, Date:

Facility Number: 7, — 191
Date of Inspection
' Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes /,kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes kINo
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 XNo
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 IKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes r0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,(No
Additional Comments and/or rawings:,
. Ce/ -'Z7 A,)i/l . A9 ZerrIM�rl
let
�% 3/23/99

O Division of Soil and Water Conservation Operation Renews-�,
a Q Division of Soil and Water Conservation Compliance Inspection
r . ® Division of Water Quality , Co004ance Inspection _
;. 0 Other Agency Operation Review,
10 Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other 1
Facility Number ) 61 ate of Inspection
F11)
'imc of Inspection 2n 24 hr.
IN Permitted 17 Certified 13 Conditionta•-lty Certified 13 Registered [3 Not O erational Date Last Operated: .................__.....
Farm Name: ..........��4kthl f •s...:WtU�_A"t..........t&-t........................................................... County:.... ,l�rl�n...............................................................
OwnerName: ........................14.t11a�1!s.............11vs................................................... Phone No:.......................................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..........................................................................................................................................................................................................
Onsite Representative:......... !tilT4^.......(.s?'r................................................ Integrator:.........h4 .......................................................
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude =•=' =< Longitude =• =' ="
Design Current
Swine, � ``-Ca achy Population
can to
Feeder
3 2
❑ Feeder to Finish
❑ Farrow to Wean
-
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design. Current - - Design Current , .,a
''Canaritd- Pnmllation. Cattle Canacity Ponulation
❑ Other
Total Design Capacity. S S2
Total"SSLW
(Number of Lagoons ❑Subsurface Drains 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? ❑ Yes I? No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes P 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 [gNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [P No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1'
Freeboard (inches): ............ .2.-#....... ...... ...............................................................................................................................................
..................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes [9 No
seepage, etc.)
3/23/99 Continued on back

�Facdi[ Number:
y 31 IPA UaLL• of Inspection 11 2
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - ❑ Yes RNo
(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 ADDlication
10.
11.
12.
Are there any buffers that need maintenance/improvement?
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
Crop type �YYNAA Msly {
❑ Yes ® No
Yes )(No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
qNo
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?
j$ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
(RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J!d No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps; etc.)
Ayes ip No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
R1 Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
0' iVd•yiol'afiotis:oi deficiencies were itofed ditreng this:visit; .. I will i•e.... do f. .
:: cocres ondeitct abouC this :visit:::::: .
,.
Comments (refer'to question #)' Explain`any YES,answers'and/or any.. recommendations or any other comments
Usedrawings of facility to better explain situahons� (use additional pages as necessaiy)
i 9. �esmn [cv�r (s be ret o.det) wulUY.
1 \�•.�JI�
�A4 �i `S �.RKOcCJ �asPo) o n 75076 NJ L.t -
.
Reviewer/Inspector Name 1....--
Reviewer/Inspector Signature:
Date:
3/23199

" FacilRy Number: 31— t41 Date of Inspection Q 2 Q q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
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
M No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
(�?No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
DO No
3/23/99

k 0 Division of Soil and Water Conservation Other Agency f y
r Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 1 q
Facility Number 3 I
Time of Inspection :Oo 24 hr. (hh:mm)
E3 Registered F Certified`' Pi Applied for Permit E3 Permitted 13 Not Operational Date Last Operated: ..........................
Farm Name: ............. K.!MK�C1r...... .tawh..... V'.................................................. County:......Ww?)....................................................................
Owner Name: ........ _ ................It a y. A.. .... ..... t.ri.a±1Y............................................... Phone No: ..... C'un.a.i w4.............................................
Facility Contact:
Title:
Phone No:
Mailing Address: .....�_`i3....... a..6Wxti........( Alr.........................................................oF..aSt.....ii!.A..... ................................... ... 72AS1%.......
Onsite Representative: .............. ............................................... Integrator: .........Ck.qlfC..........................................................
Certified Operator:......... V..&AVI'L4...... g:: �iaSLt... ............... ...................... Operator Certification Numben-1.11-1-.6 ......................
Location of Farm:
Latitude ©•®`®" Longitude Zl '0` 10 "
Design "-, Design.".».Current
`. ,., ..
Design Current;-
.e'Current
= Swine "' -:Capacity=Population
..,y.
Poultry Capacity Populahon _ Cattle ,
Capacity Papulat_ion
® Wean to Feeder
iZ
.t ❑Layer
`�..
❑Dairy
❑ Feeder to Finish
°.. ❑ Non -Layer
I
I
I
JE1 Non -Dairy
°
❑ Farrow to Wean
-
-
---
a;
❑ Farrow to Feeder
-. 0 �Other:•..�'
r '`
❑ Farrow to Finish
_
I
Total Design Capacity :y
❑ Gilts
❑soars
Total SSLW.
l06 5 60
��.
d
Numbet�of Lagotrosr% Holdi 'Ponds:F
�
Subsurface Drains Present
❑Lagoon Area
Spray Field Area
.°<
❑ No Liquid Waste Management System
, ._
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® 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 gallmin? �j IIE
T
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes I$ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes to No
maintenance/improvement?
6`. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®y No
7. Did the facility fail to have a certified operator in responsible charge? ElYes In No
7/25/97

- Fa yNumber: 31 —jg(
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11oldinp Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
❑ Yes P No
❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
Freeboard (ft)......... L:..............................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need 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, o`"
r runoff entering waters of the State, notify DWQ)
s�15. Crop type ....................W.4 ................. 5aj6N,........................................................................................................
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 requite 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.violitionsor deficiencies -were noted dtiring this:visit Nou:wilt receive no lirihei-:
corresppi►dettiai about this:visit: " ; :: ; � : • " ::::::: • : • : ; :::::: • :: ; :::: ; •
❑ Yes ® No
❑ Yes ® No
®Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ®No
❑ Yes IS) No
❑ Yes ® No
❑ Yes ® No
❑ Yes 19 No
❑ Yes [5)No
® Yes ❑ No
❑ Yes [2 No
❑ Yes [0 No
❑ Yes ® No
2 LO-A irtve- et-" �a rtvtr!oF-Irt. b�w1 teota 0. dqw.. vale.
Z.It-,,- cadet PA'A) "'"Uw �jo �tlielte� 0, q S11Ymj rf(OVA. 4rt trr-kgJabOV\ & rt
UpaOhW -,oA • uLS a 6t, t-v KcvA,
µr_ brow. �lo. s ie 4r) 0 yr v)
7/25/97
3gr
Reviewer/Inspector Name � •, "�" -��-
Reviewer/Inspector Signature: Date: 11 Im11i

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other .
Date of Inspection I1 9
Facility Number 31 IT ��
Time of Inspection IL.'1� 24 he (hh:mm)
Registered IItM Certified E3 Applied for Permit El Permitted E3 Not Operational Date Last Operated: ........__,__.__ .,,,
FarmName: ... ..t�+M+.. YA.... 'Ai 4r.. ................................................................................... County: ...... .Qtgkt&......................................... .......................
Owner Name:......V'.A.r'V Lk...I:OW}.............................................................................. Phone No: ... a0.3P4. 35?:..............................................
Facility Contact:.. :nr..t.....grxaJ...................................... Title:....... �.........nn.............................. Phone No:.%9[.rd) US. xe=*
..........................................
Mailing Address: ..14.3......... Nc.....�rQa r....... .................................... ...................................... ..Z;H.5.3 .......
Onsite Representative: ...... 1iA.ta`n'.:......._&m.)lw.......................................................... Integrator: ........ f"..ritl� C .........................................................
Certified Operator :......1.4uv'.� 1 l ..z................................................................. Operator Certification Number:..... 1711.1(......................
Location of Farm:
Latitude g • ©` �" Longitude �• =` ®" T'wn-
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
No
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ifdischarge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in -aVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
3
❑ Yes W No
❑ Yes (a No
❑ Yes ® No
❑ Yes M No
NIx
❑ Yes No
❑ Yes No
❑ Yes No
C9 Yes ❑ No
s1L M.
❑ Yes R No
[]Yes ® No
Continued on back

Facility Number
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lapoons.tlolding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
91 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier; ................................... ................................................................................................................................................................................
Freeboard (rt) ............. I tg.............................................................................................................................................................. ...
................................
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
• [M Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WNW, or runoff entering waters of the State, notifyDWQ)
n_
15. Crop type ...... s............................. 6d.j._.q.L.1......................... .......................................................................
`5R1�"LftS.........................4M.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
® Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
09 No
19. Is there a lack of available waste application equipment?
❑ Yes
[)I No
20. Does facility require a follow-up visit by same agency?
[j] Yes
❑ No
21. Did Reviewer/Inspector fail to discuss reviewlnspection with on -site representative?
❑ Yes
10 No
22. Does record keeping need improvement?
00 Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
($ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
tU Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0 No -violations or deficienc(es.werenoted during this.visit. I You.wil} i-eceive no further
correspondence about this:visit:::
3• e«.��y� a%+a. +-O Y&WrJ w4�tr W01 Vo Vr (pnVtVk e;M wo-STD- a dIt GA rt-eh.&ktA oc-'kj(cF{�ass;s
)ZAV"Ur WkkkS of Ia�om, AI1ouQ be VkOtOtdf,' Bo-f( aA&-S Sl.ov1b� reaeJed, Erosion O-reaS
0 1 V\Yxkr d t VIL L40A slwJ W �e ff-secded.
Ito- byl�iw x ord 4ccvz Tler.kt) ih fj4% desi rV.\W 4r corn-
27- Uil6tOW 0&4c �.kP4- wt-r� (aLoor Jes's s �(J (oe in rer� i Fed ado t Sp� rcforjS should
W V'_FV 61 rUix r\044 d iAd Avmbeir, (M-Z " SkOO r) 6c Vj �o P _'V M e\i'4rlce-
7 pW„W �,*s aP�1:e� Nis le croih trot (isk� CA plan. Con+ Dislr;ri SO:I tJ0.{(r
4r assis}r We 7/25/97
Reviewer/InspectorName ;R ` M _, ,.� , a.p. , `;' • f,- '""��
6
Reviewer/Inspector Signature: „�� Z__ X)2 Dale: ((1q14-1

•
Site R_ equires Immediate Attention: ND
Facility No. 31�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL_ FEEDLOT OPERATION . SITE.VISTTATION RECORD
DATE: jU / 11995
Time: mv
Farm N,
Mailing
County:
Integrator: (I- ER01t4
On Site Representative: }
Physical Addy. ss/I ocation:
Phone: �1
Phone: d (�"3d 2'�
Type of Operation: . Swine jL Poultry _ Cattle
Design Capacity: _ .3SS2 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
ZaO 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) Yes r No Actual Freeboard: Z Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes Owas any erosion observed? Yes r No
Is adequate land available for s ray? Yes ornNo Is the cover crop adequate? Yes or No
Crop(s) being utilized: E Coe
Does the facility meet SCS minimum set ack criteria? 200 Feet from Dwellinges
s r No
100 Feet from Wells? No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain. adequate waste management records (volumes of manure, land applied,
spray irrigated on specific ac,reeage with cover crop)),?/Yes or No
Additional Comments: ' �f' /v 1-1-,9d5e_
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention: V
• DIVISION OF ENVIRONMENTAL MANAGEMENTFacility No
?
ANIMAL FEEDLOT OPERATI,O I SITE VISITATION RECORD
DATE: � 1995
Time: /S ay
Farm Name/Owner: Kr-� PKo t,,- N S
Mailing Address:
County:
Integrator. Cra-rr�1/S Phone:
On Site Representative: 12DO Phone:
Physical Address/Location:r91�—
�-
Type of Operation: Swine. Poultry _ Cattle
Design Capacity: q /-Wu AYNumber of Animals on Site: Y Y' d
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 y SJ ' — " Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
• (approximately 1 Foot + 7 inches) Yes or(Py Actual Freeboard'<_Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes orp Was any erosion observed? Yes or( Tc
Is adequate land available for spray? e r No Is the cover crop adequate? eprNo
Crop(s) being utilized: b Ph
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings.�r No
100 Feet from Wells? d�por No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or iC� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage withcover crop)? Yes or No
Additional Comments: Lxxc \ w � nrJ 1 0 a hn 0 � tia i
Inspector Name
tore
cc: Faciliry Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
FacilityNo. 31--4 j 3 S iZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: 1995
Time: 1 i ?jJ
Farm Name/Owner: Lie . __ 47
Mailing Address: _Q� / o� �Q� W 14 t G/ Ale D d-"/f
County:
Integrator t!d rl ul It Phone: 17 3 - w3tf
On Site Representative: _1A-1'AA 1 #��h o�^ Phone: al&
Physical Address/Location: N(" _VC1 vH "14
as l -e-
Type of Operation: Swine Poultry Cattle
Design Capacity: 3 S7_.) J M1/ua-s P. r Number of Animals on Site: S `?
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: + ' ' _ Longitude: -I __S 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) Yes or No Actual Freeboard: _'), 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 r No Is the cover crop adequate? Yes or No i
Crop(s) being utilized:
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 or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No 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 or No
Additional Comments:t/ti
s.}-;;
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.