310341_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental W6

--U-17
Type of Visit: la"Com nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
la 00
Date of Visit: j--f Arrival Time: I C Departure Time County: Region:
Farm Name: / ,5 >'4/ taeo , Owner Email:
Owner Name: Phone:
Mailing Address:
t S
Physical Address:
Facility Contact: Title:
Onsite Representative: (Y 4 IA-h !/ 76 tt 3 j 1✓
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cat#le Capacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
I INon-Layer
I
Feeder to Finish
l (Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P■oultry
I Layers
Design
Ca aci
Current
P,o ,
Dry 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? ❑ Yes �No❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ YesVNo❑NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesrNo
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FacilityNNurnber: - Date of Inspection: /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ YesgNo
❑ 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 imnediate public health or environments rest, notify DWR
7. Do any of the structures need maintenance or improvement? / ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by.the permit?/// ❑ Yes2/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 ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication i
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
�No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
(Window
12. Crop Type(s): 13,e r ,(, da,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
yNoO
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
�No
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ NA
❑ NE
the a ro riate box
PP P -
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [:]NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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;o/"
o A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the tirtw-of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Cp r -! 107
P- (4-3 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature: e3 A_5A;-,x &k/
Page 3 of 3
Phone: l ! q '7 11 V 2-06
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ADI outine O Complaint O Follow-up O Referral C) Emergency O Other O Denied Access
Date of Visit: Z Arrival Time: ,'�f Departure Time: County: �h
r
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: GC �n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: �
Certification Number: / 'R 7 /'
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oult .
ILayers
Non -Layers
Design Current
Ca aci P,o ,
D Cow
Non-Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes
Z� No
❑ NA
❑ NE
❑ Yes
/ZNo
❑ NA
❑ NE
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 .Ej No
❑ Yes PNo
[:]Yes VNo
❑ NA ❑ NE
❑ 14A ❑ NE
❑ NA ❑ NE
" Page I of 3
21412014 Continued

FaciliNumber: - Date of Ins ection: 2 2ZI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r�
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 �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2fNo ❑ 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FZfNo ❑ 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes F;;Mo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 Ei No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 21 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1� No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: frS,-3 jDate of Inspection: ?. Z IZ
24. M. the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J " o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,D'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 'C] No . ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fj'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:
0 Yes �No ❑ NA ❑ NE
❑ Yes [�:r No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes )❑! No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [;No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F:Wo ❑ 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).
W9- Dva
eAM_r-
lad k jo
/ r
Reviewer/Inspector Name: ' Phone:
Reviewer/Inspector Signature: Date: 1 ZL
Page 3 of 3 211412 6 14

- Division of Water Quality
Facility Number - U Division of Soil and Water Conservation
© Other Agency
Type of Visit: Wromptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Y"
Farm Name: LAD &cV44� _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone:
Onsite Representative: Integrator: 44
Certified Operator: Certification Number: 6Q9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
Cnrrent
Pop.
Wean to Feeder
Non -La er I
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=Qp7sign Current
D , P,oul Ca aci_ P,o
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes ;a No
[:]Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page ]of 3
21412011 Continued

f
[IracilityNumber: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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 ;D 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 V1 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 7] 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) Ff
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 VI 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 Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes lam-' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes Vj No
❑ Yes VrNo
❑ NA ❑ NE
❑ 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 allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vf No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KT No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili umber: OZ I- Date of inspection: r
24. Did the facility fail to.calibrate waste application equipment as required by the permit? ❑ Yes 171No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes K 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 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 5�'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Vj No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes A No ❑ NA ONE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RfNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VT No ❑ NA ❑ NE
Reviewer/Inspector Name: ` �0-�3 Phone: �3 6V
Reviewer/Inspector Signature: N12� Date:
Page 3 of 3 " �' 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
if
Reason for Visit: XRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: ® Departure Time: County: U/�I
Farm Name: L+ � F'A&tA S Owner Email:
Owner Name: LAk1L41V . VAou.STOTW Phone:
Mailing Address: !!�F 0 IV 1/� t_U A-K g U -6— HA / S U l L.L.E , /V C, D Q L/ 1 a (y
Physical Address:
Facility Contact:
Title:
Onsite Representative: LA(4LW OoLk5-rnyv
Certified Operator: La-sApam )'-,\ "QttiS%-oN
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Iator:
ag.Cation Number:
Certification Number:
Longitude:
Region:
1 e-3Olv'-
Design Current
Swine Capacity Pop.
inish
eeder
Design Current
Wet Poultry @apacity .Pop.
Layer
Design C►urrent
Cattle Capacity Pop.
Da' Cow
Non -La er
Da Calf
Finish 1-J
MOW
Da' Heifer
pFeedertoFinish
Wean
Feeder
Design Current
Dr, P,oul Ga aci P,o ,
D Cow
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Othe
Other I
Turke s
urkey Poults
10ther
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 XNo ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
[:]Yes [:]No
❑ Yes No
❑ Yes /%%%"����"' No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: I I - Date of Inspection: qM
Waste-Collechon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: { AconAf
Spillway?:
Designed Freeboard (in):�' S
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 lop No ❑ 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 1 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 j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etck.)"�
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cropp Window ❑ Evidence
�opf�Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C1�� Y�e�� �CQ—l.ht\J
13. Soil Type(s): N� C—OIAC
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 o❑
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
0 NE
Required Records & Documents 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.
QWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ VP ste Trans ers 0 Weather Code
0 Rainfall ❑ Stocking Q Crop Yield El120 Minute Inspections 0 Monthly and I " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and.maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 1 - Ll El Date of Inspection: (p
24. Did_the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes""" No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes A 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 ;j No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) r7�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes gNo
❑ NA
❑ NE
❑-Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any, other comments ..
Use drawings of facility to better explain situations (use additional pages as necessary). Y
A-
0",a
IPh/ 1.3
9W II
51i311I 1 •�
g" ;) c'! IL"C, 'CZI a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

.Division of Water Quality � �-
FacrLfyNumber J11y O
Division of Soil and Wafer Consen ahon�
Q OtherAgency
Type of Visit ,C[ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i(Routine . Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ttr 11 Arrival Time: Departure Time: �7 County: LIw Region:
Farm Name: (,�� �A�MS+ Owner Email:
Owner Name: LasaL N Phone: 9 10 — 9900—MS(4
x ��r. _ L\�
Mailing Address: J� /Y lJV w A m S E��N sc� Zc-f N c 953W
Physical Address:
Facility Contact: .� Title:
Onsite Representative: u4 suc_r-W ��(J�S I �✓`F Inte rator:
Certified Operator: L N `�"ST Operator
or
Back-up Operator:
Location of Farm:
a Design Current;
Swine Capacity. Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1 Q(4L4 R 1 90CN
Ll Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Y
Other, =
❑ Other
Phone No:
Certification Number: J ?0(0,4—
Back-up Certification Number:
Latitude: = a = 4 Longitude: 0 ° ❑ , = «
Dcsi&v Current,
Wet'Poultry Ca aci elation Cattle_ Capacity
p # tYPo a
p pA. by
❑ Layer
❑ Non -La er
=Dry. Pouitry
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoNd
Number of
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 PkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:-? Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes //❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA60QKj
Spillway?: l
Designed Freeboard (in):
Observed Freeboard (in): 3�
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.) I
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 ANo ❑ NA ❑ NE
8. 'Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PkNo ElNA ❑ 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? II
Waste Aanlication
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 RNo ElNA [INE
❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 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) S r -�P� (H
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 PkNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes X No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ElNA El NE
18. is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
):
Comments:(refer.t0 question #) ` Explain -any YES -answers and/or any recommendations or ai y 6ther comments Use drawings of facility to better explain situations. (use additional pages as necessaryin
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date: W //
Page 2 of 3 12128104 Continued

Facility Number: + — Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A
No ❑NA I --]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes XNo ElNA ❑ NE
0 El0 Design � Maps ❑Other. the appropriate box. WUP Checklists
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ W/aste Transfers ❑ A/ival Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
El NA
El 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
)X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
V 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
[INA
ElNE
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
Page 3 of 3 12128104

Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
foCtompliance
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: L/N Region:
Farm Name: L-tb f--yqjjmS Owner Email:
Owner Name: �LJ !40, , L 411371CW �/ Phone: / — a9R- 3C6y
Mailing Address: Q / a � j UiA�� V` (_],� �-+ T A/IJS U i LLB , / YC 0?3
Physical Address:
Facility Contact: )1 Title:
Onsite Representative: iLA�/ L�OU►S�d�1( _
Certified Operator: J Al u - R3u5sCW
4-1
Back-up Operator:
Phone No:
Integrator•
.0::) 10
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = 6 = « Longitude: = ° = 4
Design Current Design Current Design C►nrrent
Swine Capacity Population Wet Poultry Capacity Population C*attle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
I eqVqe
I�d
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑Non -La Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑Gilts
❑ Boars
I
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
ClYes
�(No
❑ NA
❑ NE
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�(No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility lumber: I - 3y Date of Inspection=t1.`'r •�+
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )ANo [I NA El NE
a. If yes, is waste level into the structural freeboard? El Yes /ll///❑��`��`No ❑ NA ❑ NE
���
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C4Q X/
Spillway?:
Designed Freeboard (in): _ _ i1q. S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PtNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA El 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
*o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ANo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
)kNo
❑NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D .No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ❑Heavy Metals (Cu, Zn, etc.)�No
❑ 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
Q. Crop type(s)
13. Soil type(s)Q�,FQ�C
14. Do the receiving crops differ from those designated in the CAWMP?�
❑ Yes
)kNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0-No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
*o
❑ NA ❑ NE
18. Is there.a lack of properly operating waste application equipment?
❑ Yes
t&No
❑ NA ❑ NE
eats -(refer toquestion #). - Explain any YES answers and/or any;recoinmendahons or;anyyother„�comments
Use draysaiigs. of facility to better explain situations: (use additional pages as necessary)
T
Reviewer/Inspector Name " Phone:
Reviewer/Inspector Signature: Date:
Page 2 of J l f/4 Ulf l Vfi.".

Facility~Number: 1 — 14Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropriate box. 0 W-Up ElChecklists
0 Design 0 Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ElNE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis El Soil Analysis Ely(aste Transfers ;r ual Certification
0 Rainfall ❑ Stocking 6 Crop Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
5�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
4No
❑ 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
KNo
❑ 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 o ❑ NA ❑ NE
Additiional�Comments and/or Drawings:
W • F-f .
11�'a5jaq f .�
CA LAgv_p 31 CVV of d
Page 3 of 3 12128104

Division of Water Quality
I acift. Number 3 { _ ��{ Division of Soil and Water Conservation
Other Agency
Type of Visit "Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 3611outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: is UR Arrival Time:'f-� Departure Time: County: uN Region:
Farm Name: L+7` s F1Un s ` Owner Email:
Owner Name: L q w_Pjy l`� S r� , Phone: 9%6- O�9 a - 26 Sy
Mailing Address: S F� /y • �� 1 LU JQ M S 1n � ENANS U1LC E /i% C �g3 �Cv�iA
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: t_-L L � I-64 CYST Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= c [=, =6. Longitude: = ° =' =
Design Current
Design Current
Design Current
Swine C�apacfty Population ...
. Wet Poultry Capacity Population
Cattle
41
Capacity Population
❑ an to Finish
❑ La er
❑Dai Cow
❑ an to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
;(No
ElNA
❑ NE
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
pj�Aie
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Timber: 31 -3y I Date of Inspection
Waste Collection & Treatment X
4. Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ❑ 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: L-[.F(�Ocw
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
(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 J�[No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ 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) SG
13.
Soil type(s)
14,
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
MNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA [:1 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
JR] 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
Io
❑ NA ❑ NE
•Comments (refer�to quesho�n #)� xplam�any YEnsw„ers and�{pr any recommendations or any other comments.
F�[Js„�e�„��wmgs�of�facrhtylto�be�tter�eap�la n°srtuations.�{use,�addihona�tq,p,,ages as necessary}: - '
-
1C39 0 1 C_ CA9M - otkr(6G-T - C..1CD g! rKS 1C. 9�r-71.uC •
kx-).*4.
l�PLO V 1
XQ16SS %•
Reviewer/inspector Name P^ iNn J AIC Phone:
Reviewer/Inspector Signature:. Date: —
Page 2 of 3 1212&04 Continued

>;,acilitji umber: 3 j — 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 N
o ElNA ❑ NE
0 [] Design � Maps ❑Otherthe appropirate box. WUP ❑ Checklists
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
El Waste Application 0 Weekly Freeboard 0 Waste Analysis El Soil Analysis ❑Xaste TransfersJJ/ ❑ nual Certification
El Rainfall 0 Stocking ❑Xp Yield Q 120 Minute Inspections El Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes ,No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
NA
❑ Yes No
❑ NA
❑ NE
❑ Yes �6No
❑ NA
❑ NE
❑ Yes ❑ No X, NA ❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 3y O Division of Soil and Water Conservation /
�— D Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O& Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,, . r Title:: `
Onsite Representative: LA (A Li4A V PQ,,tS 7-01-
Certified Operator: L ri Ousmly
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Region:
Operator Certification Number: 966
Back-up Certification Number:
Latitude: = o ❑ ' = Longitude: = 0 =
Design Current g Design Current,.. Design Current;�k
Swme Caaci Po ulation Wet Poult
:�,
p ty . p ry• Capacity Populat<on Caftle Capacity Po ulation,E
_ .. P
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
IL29LI&
I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
t, ❑ La er El Dairy Cow
s❑ :; Non -Layer < ❑ DairyCalf
{ El Dairy Heifer
Dry
I Dry Poultry
N D
El
❑
on- airy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Other -,.
` ❑Other _ _- �— _t, Number ofStructures „
❑ La ers
ElNon-Layers
❑ Pullets
ElTurke s
❑ Turkey Points
El Other
Dischar-aes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [I Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
El Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[ TNo
❑ NA
❑ NE
❑ Yes
JVNo
❑ NA
❑ NE
12128104 Continued

1 n
Faiility'Nu`mber: 1 —
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: l.._
Spillway?:
Designed Freeboard (in): .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo
❑ Yes ❑ No
Structure 5
El NA [I NE
❑ NA ❑ NE
Structure 6
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
XNo
❑ 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 ;�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes rVrVN ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes ,Q No ❑ NA LINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ho No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
Cl NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
*No
❑ NA
❑ NE
Comments (refer to question ft 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):
K6Ej> A/V E4E0A1 r�UJS10A! /�! l�c� u�l4LL- r n�r jG�i-VCFETA
J �-
n
Reviewer/inspector Name I Al 12 -- 1 Phone: [phone]�1
Reviewer/Inspector Signature: Date: $ Q
Page 2 of 3 12128104 Continued

Facility Number: 3 — y 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 all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design []maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA [I NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
kfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
OkNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1� No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JZ 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
k,
[INA
❑ 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
JgNo
❑ 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
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JVNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division of Water Quality
Division of Soil and Water Conservation
Q Other Agency
Type of Visit P
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
xRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: E� Departure Time: ; pQ County: PGz
Farm Name: / _-f Owner Email:
Owner Name: Al Phone:
Mailing Address:
Physical Address:
Region: (6.pe
Facility Contact: Title: Phone No: Q
Onsite Representative: _ �i¢�L, �t/ 4'i �d� Integrator:. /'44WA. T -- lw�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: E] o = ' E-1 u Longitude: = o = 1 = N
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
Design ` Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
t
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 y No ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No El NA El NE
ElYes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo
❑ 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?: ND
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes XNo
❑ 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)
notify DWQ
7. Do any of the structures need maintenance or improvement?
threat,
❑ Yes Z No
❑ NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes XNo
El 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
Cl NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ff No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA El
ElExcessive Ponding ElHydraulic 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 Drifl!❑ Application Outside of Area
12. Crop type(s) +yljle�/�A (T i} S��/�i b 4J
13. Soil type(s) &oq
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes�No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes XNo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes /[�No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes / o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[-IYes jNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: ['p Q
12128104 Continued

Facility Number: — Date of Inspection
J /
/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ YesNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
X
ElNA
ElNE
the appropirate box. ❑ WUP ❑ Checklists ElDesign ❑ Maps El Other -
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain
Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� No
[I NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
/
El Yes ❑ No
XZJ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ;z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
/0
❑ Yes ❑ No
ZfNA
❑ NE
Other Issues
((((((
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes;_ No
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes/ l�J No
El NA
[I 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 X
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 �V,o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
%�
`rf VQ T� r 41AA11 G� V_Qo\40
©G coo N A) L G �•✓ �FN� 0:7- 4,4 Li�Goa �✓ ��425 ' "
5,06-4—,
/y e! /YI l
—S-Oro /amp z/. 8
12128104

Viciiity Number 3�
tp Division of Water Quality /
Q Division of Soil and Water Conservation V
O Other Agency
Type of Visit O'dompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (! Arrival Time: Q -3 Departure Time: County: Region: _ �FP
Farm Name: a-- f�r S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = I = « Longitude: = o = 4
Designs <Current_r., Design Current Design Curren t
Swine Capacity Population, . Wet: Poultry .._ Capacity Population Cattle Capacity Population.,
.
❑ Wean to Finish ` ❑ Layer
ElWean to Feeder ❑Non -Layer
Feeder to Finish Q
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
g: ❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of.Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ,❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
PNo
❑ Yes
;-No
❑ NA
❑ NE
❑ Yes
P-No
❑ NA
FINE
12128104 Continued

Facility Number: — Date of Inspection O
. 'Ile ' -.
Wpste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
e93No
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 Z�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 ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;3`No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 ❑l Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes FTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes [R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments;}:,
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name f--v - -- -- — — — — l Phone:
Reviewer/Inspector Signature: Date:
Paee 2 of 12128104 Continued

_.[Facft'ity Number: 3z— Date of Inspectiion
Aepuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes `ErNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 21No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
ONA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
BINA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ;�j No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
C°NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 9No
❑ 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 0 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 [4 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 C'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes JZ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�j
Page 3 of 3 12128104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time; D O Departure Time: County: lr Region:
Farm Name:�Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: lj2v(� If
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
El Wean to Finish
❑ Wean to Feeder
eederto Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o=' 0« Longitude: 0 e 0 S
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ DEy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number. of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
E N
❑ NA
❑ NE
12128104 Continued

Facility Number• — Date of Inspection
•--Wast2'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? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):WEE
Observed Freeboard (in): JL:7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,❑'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 Jallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 12'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 L31No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 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 CropWindow
1❑ Evidence of Wind Drift %❑IAApplication Outside
of Area
12. Crop type(s) �P_�l?iL!/��lC L �r li �P/� Cl (6 ) .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
XYes
F-1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
L20No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
23'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Rio
❑ NA
❑ NE
t ..
efer to questtont#) sFxplam�any YES `answers
co'4. ///M& � � 1Ls �D f !`� (vl�s GL j4f"� l ra1�- a r
0 a7l Act 7. x . s ®�ad,'��
ze
Reviewer/Inspector Name u Phone:
Reviewer/Inspector Signature: __z �_ Date: 3 Z.S^'
I2128104 Continued

Facility Number: Date of Inspection DrS
'eauliitd Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [�To ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? . , ❑ Yes ,0No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ 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
2rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;3"No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2rNo
❑ 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
ONo
❑ 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
21� o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J;31�o
❑ NA ❑ NE
12128104

Type of Visit OCompliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit J26outine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: 6 l Tune: i
O Not Operational O Below Threshold
Permiitted J2(Certiified © Conditionally Certified © Registered Date Last Operated or Above Threshold: w
Farm Name: .... 4-.-.9L-"...�-- ........... County:t!l�Q��� �...................................
Owner Name: - . __.�....._... Phone No: .. ...... W.. ....
:Mailing Address:
Facility Contact:.._.......................................................................... Title:. ...._ _.. _......_............ Phone No:
Onsite Representative: J �l_F ......g.S..... Integrator: �n
Certified Operator: ..... ..... ......................... .........I............................................................. Operator Certification Nexmber:................ _..._ �._� .
Location of Farm:
a' ❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ���
Longitude • ' 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0&0
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) [J Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes '2-Ko
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes eo
Stxvc�ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ............................................... .............. ..... ..................... ......... ...... -...................... ..... --- .... -............ ....... ...................................
Freeboard (inches):
12112103
Continued

Facility Number: 3 f -3Date of Inspection
5� Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes �;Wo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes [1lo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ;3"No
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/itnprovement?
❑ Yes )EIINo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes Lwo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type r
_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 01�0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes Of4o
b) Does the facility need a wettable acre determination?
❑ Yes Of4o
c) This facility is pended for a wettable acre determination?
❑ Yes ,140
15. Does the receiving crop need improvement?
❑ Yes 0'1g0
16. Is there a lack of adequate waste application equipment?
❑ Yes PXo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 0�o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes L214o
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 ILWo
Air Quality representative immediately.
well 7j?c�� ire
Reviewer/Impector Name
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
Date:
12112103
Continued

Facility Number: — Date of inspection f�
Ikequired Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ja*o
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 Q No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q Ko
❑ 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 -2rgo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes '�o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑ 0<0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 2-fio
28. Does facility require a follow-up visit by same agency?
❑ Yes Lallo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes ONo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes [2' O
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes PNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes PVo
35. Does record keeping for NPDES required fomrs need improvement? If yes, check the appropriate box below.
❑ Yes PNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit F Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit? 95 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility_ Number Date of Visit: Time: /
rO Not Operational 0 Below Threshold
Permitted 0 Certified 0 Conditionally Certified [3Registered Date Last Operated qp-t4bove Threshold:
Farm Name: County: Gz/✓
Owner Name: _ L, � �� Phone No:
Mailing Address:
Facility Contact: i Title:
Onsite Representative: ZAa i L(S�f Aj
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
0swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 06 0" Longitude De 04
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
No Liquid Waste
Non -
Area ILI SDrav Field Area
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )?�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [INo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): zz
05103101 Continued

5f
T �
Facility Number: — 74
Date of Inspection I (D{
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6.1 Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures tack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Aunlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there eviden a of over applicatii ? ElExceyive jonding � PAN ❑!ydrauiic Overlo�fi^ �❑ YesgNo
�JlJl�l_A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan tCAWMP)?
_u 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
o
c) This facility is pended for a wettable acre determination?
El$No
o
15.
Does the receiving crop need improvement?
El Yes
16.
Is there a lack of adequate waste application equipment?
El Yes
YNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
%
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑
(ie/ WUP, checklists, design, maps, etc.)
Yes
No
ZINo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
�XNO
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
A No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
24.
Does facility require a follow-up visit by same agency?
El Yes
,
ICJ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer. io�question #): Explain any,YES4nswers anchor=an recommendations o n
r er comme
�< ( y any©Field
Use drawings of facility, to better explainsituations (use additional pages as necessary): 9 Copy Final Notes
. _ 4 _ ❑
:. _
m�G.0
R
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 v' r Continued

r
r
Y
t
li
L
�
P\
-W

Facility Number: — ©ate of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
AdditionalComments�andlor Drawings -.`,
❑ Yes ❑ No
ElYes XNo
❑ Yes XNo
❑ Yes XVNo
El Yes �o
❑ Yes No
❑ Yes ❑ No
05103101

Dlvlision`of Water Quality_'
` Q Division of Soil andWater Conservation.
Other Agency -
. -
Type of VisitCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: T Z� ( Time: �3 1 4 Printed on: 7/21/2000
10 3 r 3 r
Not Operational Q Below Threshold
Permitted © Certified r] Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ra r'"`S County:.. t. r''1
................................................................................................................................................................................................
Owner Name: L °t- 0 a n 14o � jo Phone No: .......................................................................................
............ ...............................................................
FacilityContact: ..... Title: ........................................................ Phone No: ............. -.....................................
Mailing Address:
Onsite Representative: .L"'Li 1-....4D wjl d ti Integrator:�0
..I...... ....................................... �
y.
I
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
AL
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� Os� Longitude �• ��°�
Design Current
fi111C Csnackv, _Ponulation
Wean to Feeder
Feeder to Finish
2
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Desigh .. Current
Poultry Capacity Poleulation Cattle -Capacity.Po ulation
❑ Layer 1 10 Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design. Capacity
Total SSLW
_ `NUM of Lagooius 10 Subsurface Drains Present ❑ La —n Area 10 Spray Field Area
$oldimg;Pofi& / Sol>id-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 gallmin?
d. Dees 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
a. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........... n......................................................................................................................................................
Freeboard (inches): 2 /
5100
❑ Yes F�INo
❑ Yes �Vo
❑ Yes/fNo
IA
❑ Yes )11 No
❑ Yes &No
❑ Yes )zNo
[]Yes 0No
Structure 6
Continued on back

Facility Number: 3 —3 [late of Inspection O Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �+io
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprcvement?
11. Is there evidence of over application? ❑ Excessive Pond}ing`❑ PAN ❑ HydraulicOverload
12. Crop type e� v1'{ei �I�17 -�6rz-ze+S,Ma1� !�/ci!''i i iie►r�-t �f��l� , `S°y�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
[:]Yes J3"No
❑ Yes 'KNo
❑ Yes joNo
❑ Yes No
❑ Yes )dNo
❑ Yes/,O No
❑ Yes �No
El Yes �No
❑ Yes '2�No
❑ Yes ZNo
❑ Yes _)EfNo
❑ Yes�No
❑ YesNo
❑ YesXNo
❑ Yes No
❑ Yess�dNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes;ffNo
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//,11No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? —1i2tes ❑ No
Nd •violaiions:or deficiencies were noted• during �his;visit: Y;oit will-teceiye Rio hifiht�r;
. • coriesaoridence. about: this visit.
omEments-(refer fa question #) Explain any YES answers and/or any recommendations or any other comments
se drawings_ of faci)IityNio better explain situations. (use additional pages as necessary) E r
25. Meed 4o _/rl l avPl+( ►a►, 1�v,'tin�0l..1 TC'✓ swl�tl� "X;n
Ge.,-se at ff l i act to ✓^t o /q+4 A� er�tGf Q� f"i U r %�� 1 %Z � t J
Td SOU J�'1���
re brv�� E+
J y
19.
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
5/00

Facility Number: 3 — Date of Inspection 20 p Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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/)IJ�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 ffNo
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.) ❑ YesX-No
,ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Ye
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
-Additional , Comments and/or Drawmgs::.
J
5/00

Division of Soil and Water=Conservation Operatiion Review r -
Divisinn¢of Soil and Water. Conservation Compliance inspection '
`B Division of Water Quality = Comphance Ins_ pectiOn
u -
a x . 0 Othe7 AW"' y Operation -Review
14a Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other f
Facility Number 3 I ,3 ( Date of Inspection �i zB 40
Time of Inspection 24 hr. (hh:mm)
U Permitted 0 Certified ❑ Conditionally Certified [3 Registered Not Opera Date Last Operated:
Farm Name: ..............
....—. �.�.... O..�'."�.s........................-............................
l 1 County:..........U.r..l. r'+
Owner Name:............Ln.7/-.ef.:)...................(.a.y.��.n................I..................... Phone No:
.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: .....................
OnsiteRepresentative• ......r2.U�-7an...................................... Integrator:... ..!t�.` k .. g.::±^� s.............................
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
tv�o cat....P..YI..c:...��!?!S..Ys.i.4(e...Qf...Y �...�.����.�.�:.1...^.^..:.�cs Nor }Lt.....II...........
.....
44Lj-f ?q.
Latitude �• �6 �64 Longitude �• �4 �44
-,Deli Currenf;: Design
gn gn Current'.'' Design Current
Swine _-.
Ca act ' Po elation Poultry Capacity Po elation, , Cattle.,, , . Ca ace Po- elation
❑ Wean to Feeder ❑ Layer FE]
Dairy
Feeder to Finish 2 r}cj fj Z 3 `f8 ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other ='
❑ Farrow to Finish Total Design, Capacity
❑ Gilts
❑Boars Total°SSLW_
Nuiiiberof. Lagoons f` Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System z
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®'No
b. If discharge is observed, did it reach Water of the State'? (Il' yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated glow in gal/min? >t /q
d. Does discharge bypass a lagoon systern'? (If yes, notify DWQ) ❑ Yes 29 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment '
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,B No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Freeboard(inches):......:3�.'.s.................................................................................................................................................................. .....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — 3j Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Terrylvdq ,..1_e.►'r"LVdA
z8 0
❑ Yes
IM No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
9[ No
❑ Yes
Ej No
C'I� � Snvr;cGHs
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ',W No
❑ Yes fRrNo
❑ Yes [9 No
❑ Yes 10 No
❑ Yes E[No
❑ Yes 29No
❑ Yes 2TNo
❑ Yes 29 No
Yes
❑ No
5""
I*Yes
n�
No O!
❑ Yes
® No
❑ Yes ® No
❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes Ri No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
fo yMhtigris;ok. deficiencies were h6 ed during Ns;visit: - ;Y:ou will -receive Rio; t'urther ;
corres oridence' about this :visit ::::::::: : :
Comments (refer to.question #): Explain any_'YE5 answers and/or any recommendations or any other comments - _
:w
•Use drawings of facihty to -better explain srtuahons (use,additional pages as necessary) g
A6
!q, f{ �et-,J was-�e .�.��-�.PI� anq��s�s ;s r1ee�(ed.ln ,r'eGDr'�s. (rl�_ �'fo(.1S�o►-,
s.►�s 5a m� IG dots 6�►� - rtkf 6u re.svl-}-S hurve 6vct_< e-
o+�al�s"s 6Q plays bet-oee
ctff-e'- -f►,� d � O►7 �l,e olv1�t11rS�S Tkg- Z's reed 4o be v��la�cd
rcgvla�'l'� t17 lea-k141f )C-Te6A,, Gts cr-Iff i-�q seersoti ye"9V1f erk'1
tr7jy 4a �,er� prcwen-� &veP"q 1;C-g4P,piq . I j
Reviewer/Inspector Name a rJ 4�s= !0 34*
Reviewer/Inspector Signature: j Date: ��

Facility Number: 31 —3c7L Date of Inspection � pD
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below P 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 mac] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [H No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? M Yes ❑ No
d -tiona omments.an _ _or rawtngs:vy
3/23/99

s © Division of Soil and`,Water; Gonse>i*vattan'• Operation Review
O.Division of Sail and Water Consecvatton Compliance inspection p
4. Division of Water Quality Compliance Iuspechon _ ' -
" 90ther' Agency Operation Review - - - -
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number j Date of Inspection
Time of Inspection /Z : d 24 hr. (hh:mm}
© Permitted 10 Certified 13 Conditionally Certified © Registered JE3 Not O erational Date Last Operated
Farm Name: : �d1...7.....ri�►f'l .................................................. County: ...... .1).Qp..l in................................................
Owner Name: ..�. Yi. ..... a. � Q.�t............:............................ Phone No:...... A.Q..-'.. . t..4...` �.Jr ........
Facility Contact: ..............................................................................Title:.......Phone No:
ggoe ff (� [L - ...................................................
Mailing Address: ....... all ...... i4....... W.i..IA1.A-m-S........... U...................... �................ Z.��"[......1
OnsiteRepresentative: .............. . ................................................................................... ....... integrator: .......... H V.l'..p laq...............................................
Certified Operator: ............. �jX ql l'......�-�;QU*,�,van........................................... Operator Certification Numb]er:............
Location of Farm: 1
Latitude �° 0 Longitude • ��«
_ Design Current W -: Design. `Current ' Design Current
-.
-Swine = Capacity Po ula4on Poultry Ca achy . Po ulation :Cattle Capacity Population
❑ Wean to Feeder ❑ Layer EE
airy
Feeder to Finish ❑Non -Layer on -Dairy
= ❑ Farrow to Wean ;..
'❑ Farrow to Feeder . ❑ Other
❑ Farrow to Finish = Total Design Capacity
❑ Gilts
❑ Boars -..r -Total-SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon ❑ Spray Field [I 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
❑ Yes ;E�No
❑ Yes A No
❑ Yes XNo
NA
❑ Yes to No
❑ Yes No
❑ Yes No
❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............ M............ ................................... .................... .................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
3123/99 Continued on back

'-' Facility Number: — Dale (if Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes o
(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 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
IL Is there evidence of ocvejAapplicaNg? Excessive Pondin9 ❑ Yes 1ANo
" ❑
PAN
1
12. Crop type C,{a rL �ji Fi S Q rd } t I'd
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 gNo
b) Does the facility need a wettable acre determination? ❑ Yes [gNo
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes dNo
16. Is there a lack of adequate waste application equipment? ❑ Yes qNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
k Io
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
�(No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
'�@ No
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ERNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
XNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
CTo
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
j�No
Nd •yiolaiidris :oe deficiencies were noted• dg �this'visit: Yoit :will r. eoeiye lid further
correspondence: abOU this visit.. • : . . .. •
Comments_(refer to=question #) ,.Explarn any YES answers and/or. any recommendations t►%anynother comments:
Use drawin of facih to-bettee explain situations (it a addit- al`pages as necessary)
1 ty _ _ _
STrin as re$Ui reA by 5oj 1 ancd S ►'5
Wa.�� da.►-c_ ct,,'ta�. >''�I �JJ�i'rlc�. �r n za-� o � o�. cJcz�wcu�,�' . Tr y � rn a...r'n �-► rl
06 aoo� a�ld �►� � n'}�%if uncd .
Reviewer/Inspector Name — x`s
Reviewer/Inspector Signature: Dater
3/23/99

•' 'Facility Number: — Date of inspection �Q
Odor Issues
'>-Troes 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 VNo
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 q o
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 qNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes�No
,R"'Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
3/23199

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review V Other
Date of Inspection
{ Facility Number Time of Inspection i 0. 24 hr. (hh:mm)
0 Registered Of Certified 13 Applied for Permit E3 Permitted 113 Not Operational Date Last Operated:
FarmName: .............
- _D....... 5-.ft.5.............................................................................
County:.........�u�1�
tn..........................................................
OwnerName: ...............................
L.Aj.1La ......
.............................................
Phone No:...Lq.t.aAa.g.LA.
.........................................
Facility Contact:
Title:
Phone No:
Mailing Address: ....... ?�x...... .:..... a . ....................... ....................... ...........
«An^.ani.J.it.411t..(11.''.['''1�.C....................._ .;Uaic
.4
Onsite Representative:...............� M1.�.frr......�iP�11f41............................................. Integral[ir:.......?.` v.'ixt!tt........................................................... l 1
Certified Operator. ................... ................................ .......................... ..:................................ Operator Certification Number,.........................................
Location ofTarm:
Latitude �•,�'�" Longitude =•
Design Current,,',= , ,
Design -,Current
Design . Current
Swme' `r
Capacity Population Poultry
Capacity Population Cattle .
Capacity Population,
.�
❑ Wean to Feeder
-
"-'
❑Layer
❑ Dairy
Feeder to Finish
2 a
❑ Non -Layer
❑ Non -Dairy
`;.
❑ Farrow to Wean
❑Other
vj
❑ Farrow to Feeder
El Farrow to Finish
"Total Design Capacity',''
❑ Gilts
❑ Boars
` Total SSLW
F G z /H ^. Number of Lagoons'olding 1?onds� Subsurface Drains PreseutjElLagoon
Area
pray Field Area
2 �, , .E- -'� q - ` -�a ❑ 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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
N No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
W No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[�DNo
5.. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IF No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97
Continued on back

Facility Number: 3 —
8. Are•there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes No
Structures fla2souns.11oldinu Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):......... 3:.Z...............
10.
Is seepage observed from any of the structures"
❑ Yes
MNo
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?
[91 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
'pNo
Waste
Application
14,
Is there physical evidence of over application?
❑ Yes
M No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15,
Crop type .................... .t .......Uk'..a'I... C,! sx�....... .............. cj.rn.... ..JR,fLA. L ........ 1. Gs tn....................................-..-.......................-..
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWIv1P)?
❑ Yes
55No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
PQ No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
(9 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Cl Yes
gNo
22.
Does record keeping need improvement?
';Q 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
V No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25,
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
No
0 No.violations or deficiencies rvere-noted-during this.visit..Yo't.will receive no further
correspondence ab`vut this: visit:: :
Comments;(refer to question #): Explain any Y"ES answers and/or any �recommendattons or any -other comments x
t
Use drawings of facility to better explain situations.'{use additional pages as necessary} r"
l2. t�stzrCaws: nut t �or� � trt�+Aa4e... �e �-c. ioa� Opt-c.¢�
E
skau6 �do.W • Crr"ct Pp�JIJ h,t.w (k)Lje sywojd bQ. jojAe(eJ
a►- s�l�y we-cc�,
YY-i �4 Li,
1
7/25/97
Reviewer/Inspector Name "ex.
Reviewer/Inspector Signature: Date: III

❑ DSWC Animal Feedlot Operai><oa Rev4 >tew
DWQ An><malFeedlot Qperation S><te Inspection .
'i'-'
Routine 0 Complaint 0 Follow-up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 l Time of Inspection ' 2 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for i hr 15 min)) Spent on Review
M Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:.....x........................__....__.. _- ...� .._... County: -....... _..... 5l.!i
Land Owner Name: ale► ......1�Srk ... Phone No:
Facility Conctact:...__.... ..... ..........
, Title: ..... ....... .... Phone No:
Mailing Address: ..... ........ _....... ._........ ...
Plf�l,5.0 t �Aq .... _.......... _.... _.......3. .
Onsite Representative: .... f yL............. r.jkG� L .......... Integrator:
1. � r' ............ ...._......_,.. ....... � �................................................
Certified Operator: _ . _� ....... _............. L.s 1.4...._......__.. Operator Certification Number:./&�2....
�.. ....,
Location of Farm:
�ka...J,a.t
................... ---................................ ---....... -................---................ ....... ........ ....-----• ............. ........ __... _ ................-- - b
Latitude ©• 4®69 Longitude ©•®'
Tvne of Oaeration and Desinn Capacity
�_ rDesignrrent,l3esrgn' Current f g
Swine .�� x x� Des n ��Currentt
,.. h.Ca act Pe ulation ��.Ppultry,4Ca acrtvPoulateori=� Cattle .Ca "aci Pond`atton
=` ❑ Wean to Feeder ❑ er ❑
® Feeder to Finish ❑ Non -Layer ❑ Nt-Dairy
171 Farrow to Wean
Farrow to Feeder Total Design► Capacity 2
�y
Farrow to Finish `p
SS W
E,
Total L ❑ Other
n£
b » y<
. Number of Lagoons 1 Holding Ponds ❑ Subsurface Drains Present
MW
IN ❑L
on Area � ❑ Field Area �
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. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
M Yes ❑ No
❑ Yes ® No
❑ Yes
® No
❑ Yes
® No
A
❑ Yes
® No
❑ Yes
@ No
❑ Yes
No
® Yes
❑ No
Continued
on back

Face ity Number: .... 3.f*..�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes allo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ISNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes MNo
Structures (Lagoons and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IgNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes JUNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 13 No
12. Do any of the structures need maintenance/improvement? ❑ Yes EjNo
(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 19 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 64 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type s,nrx `
16. Do the receiving crops differ with those designate�in the Animal Waste Management Plan (AWMP). ❑ Yes [.No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes RNo
18. Does the receiving crop need improvement? 9-Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes 19 No
20. Does facility require a follow-up visit by same agency? ❑ Yes RNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E[No
For C"fled_Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes &No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IffNo
24. Does record keeping need improvement? EYes ❑ No
Comrrients (refer to questari �Explarnbany YES answers'andlor;any recommendations or any,other comments h
Use drawings of facility to better ezplatn situations: -.(use addrhonal pages as necessary}
v
44
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Reviewer/Inspector Name
Reviewer/Inspector Signature: C�,1,.... , ,'I- —�J, I,' ._ .,, ,_. Date:
cc: Division of Water Quality, Water Quality Section, Facility AssessMent Unit 4/30/97

i
Site Requires Immediate Attention:
Facility No. V
• DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: $ 3 ,-1995
Time: `fS
Farm Name/Owner: yzx-'-el si� r'
Ni iling Address: `/
County: D yip b N -
Integrator: /'YI h Ph��e: a
On Site Representative: /� ►' c r� - Pl ine Al,� I — 3 o 5
Physical Address/Location: A10SR 17a i !lee K :;;z ►�: le- c Aim 1�(
�m r2N
Type of Operation: Swine ✓ Poultry Cattle
Design .Capacity: q `{ V,Number of Animals on Site: a �' `/.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: U Longitude: Z_° ' Y 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) es o No Actual Freeboard: Ft. D Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or(o
Is adequate land available for spray?(5Pr NOO Is the cover crop adequate?or No
Crop(s) being utilized: ('i igWig/ ! emu L
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e or No
100 Feet from Wells? e r 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 To 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: CjLb9+-- i.5 P&fPO4K
_ 'T(V— Cn R r
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires immediate Attention �f
Facility Number:! 1 JJ
-ti -
• SITE VISITATION RECORD
DATE.
' . J;?-a 1995
Owner. 4".1 _ R-61&J—" _ - Farm Name: Q
County:
Agent Visiting Site. -- _ _ Phone: 9io
Operator: Phone.
On Site Representative: Phone:
Physical Address: _ Dv, X/5-bo t-ann�,� 2 -, !r /Y)�-I-A
ko-4er
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: 2L� tip- Number of Animals on Site: L�
Latitude: _ 0 Longitude: a "
Type of Inspection: Ground Aerial
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 & Actual Freeboard: ,__�Feet i Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section. .
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
0 12 e? -
Fax to-[phone] Signature of Agent