670074_INSPECTIONS_20171231

NUH I H UAHULINA
Department at Environmental Qual

Type of Visit: (AICompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: L_L_f_LJ County: V 1'ls �✓ Region:
Farm Name:, S � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: [ {
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: l U 2 SV
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►►specify Pop.
Da' Cow
Wean to FeederEINon-Layer
Da' Calf
eeder to Finish
Farrow to Wean
Design C•arrent
I) . P,ouit , Ca aci P.a
La ers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
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)?
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 10 No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes IsfNo
❑ Yes x No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

F:.cifi Dumber: - 1 IT Date of -inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
k
No❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes XNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ANo ❑ 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
VI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 5dNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VjNo
❑ 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 5�No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 'J No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Wo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

F.pcili Number: - I Lf jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes kNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ;VNA ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Oq No
❑ NA
❑ NE
❑ Yes [� No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes L� No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
urawIngSIMI faculty 1o;,neaer;expLain 511uan0ns (use:aumnonaApages;as;necessary,).; - ^: - < '
Mcta , gc. -tD Lk% -#fit. conr-aA pkr� F6-k # to'4C- -__6
ekAJA Av ZO n {vl �12-2 'Fl yms
C _ Ivy 9 1, � • 66
�� ti
-'
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�Sl I31
Reviewer/Inspector Name: (] S'1 In �AA QU
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qta - Ti U 1
Date: TiffiS
2/4/2015

Type of Visit: q rRoutine
pliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y� / J J(,� Arrival Time:❑ Departure Time: E! = County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: vim{' � is Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: L lV
Certification Number:
Longitude:
Design Current Design C*urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
owsign Current
Dai Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,oultr., Ca acity Pao
La ers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters CO]Yes XNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of inspection: R 1 ((,o
Waste Collection & Treatment
4. 11 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
E
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
_
Identifier: 1 LAGO60L.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
t% No ❑ NA
❑ No ❑ NA
Structure 6
❑ Yes [!No ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 do ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[.2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 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?
0 Yes
o
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
KNo
❑ 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
E�No
D NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VN o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements Dot er:
21. Does record keeping need improvement? If yes, check the appropriate box below. 2Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Z Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
L4� Zo23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z� o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes WNo ❑ 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 d o ❑ 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes O/No ❑ NA ❑ NE
❑ Yes C�/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
10
NA
NE
❑
❑
LJ '�
[3 NA
❑ NE
E, go
❑ NA
❑ NE
6"N'o
❑ 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).
�u"cz_� NtffSGo 2A 5 'DL€.
'I�C f'+ i A63 a4E 6. S .
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
TO N&A Lj� �ssq_.s,
(;�C-T Swn&E ?("A
Date:
6 "7

r
Type of Visit: Q Com nce Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
C}
Date of Visit: Arrival Time.: Departure Time: 2 County: Ons 44' Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Vi'rs in `ek j e ft`i,1-5 Integrator:
Certified Operator: Certification Number: G z So
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design Current Desigp
Capacity Pop. Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish b ot?p
DairyHeifer
Farrow to Wean
Design Current Cow
Ca aci Rio , Non -Da'
Beef Stocker
Farrow to Feeder
Farrow to Finish
D . P�oultr,
La ers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
111
Other
Other
Turke s
Turkex 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)?
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑Yes [jNo ❑NA ❑NE
Page I of 3
21412014 Condnued

Facility Number: I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 2-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Struptr}r"I1 e� � tr�ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: oo� Sa•�l �oon �•�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 7 Z
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 E] N ❑ 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 [► ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes [q-No ❑ NA ❑ NE
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 E3No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wi?nd Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0 � +u Z H� " S & o ,pr- A � � A
13. Soil Type(s): A 4 4 aq �
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 [D"-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [5"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes OrNo ❑ NA ❑ NE
Reauired 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:
oes record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections , ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F51No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - jDate of Inspection: -2-411
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C31�o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
[:]No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
E Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: _ -Z0 ) L(
V ( o
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[4]"No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
B No ❑ NA
❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0-No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes ED"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [TNo
❑ Yes 2:No
Yes No
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or"any additional recommendations or any other comments.
Use drawings of facillity to better explain situations (use a,�d/dittional` ages as necessary).
Z + V`5t (�n Gorr--e L+ �1-(�f (►u i�or Oe c- n^ A-li�e�ol LQ��?C~l�
Z �• 5 r u j 7 G 0- 0. �-- ' n No t j, "_j p o" -L
Reviewer/Inspector Name:
10C'
Phone: 710 - IN - 777
Reviewer/Inspector Signature:
Page 3 of 3
Date: ?A I ) i�-
2/4/2014

Type of Visit: ® Co Hance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
isit: Routine Reason for Vutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: 10 a Departure Time: � County: 04& b�j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �EJV S Integrator:
Certification Number:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Nletf Poultry Capacity P,op.
Layer
Cattle
Dairy Cow
Design
C•apaeity
Current
Pap.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,oult , Ca aci P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
IN
I
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
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VNy"
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faciliq Number: - Date of Ins ection:
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
Identifier: 47-� _(61r,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
2q -
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes 6�0_
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
Ef No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ��Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes WNo
❑ NA ❑ NE
❑ Weather Code
F,Kludge Survey
❑NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ s Z /No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CJ No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes E�No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes di"T,
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
.DA
Z r) Smil u, UAc-0 MO 5�UV r--E 9A-izD R 6 ova
SL_006-e T a ,
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: 1 10 W(—V?
Date:
2/4,2011

Type of Visit: &7outine
iance Inspection- O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: y 3 Arrival Time: t p Departure Time: County: aNstkatj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: vaXL&sk�'1ou'jy..c Integrator:
Phone:
Certified Operator: Certification Number: I (o zz()
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
We# Eoultey Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish q(p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
it Ca aci Plo
Layers
Dairy Heifer
Dry Cow
Non-DaH
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ N [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 61 - Date of Inspection: tf 4 113
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 i Structure 3 Structure 4
11��3Cr
Structure 5
Structure 6
Identifier: (n^ LtgC��
Spillway?:
Designed Freeboard (in):
n
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
E!f 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes gNo
❑ Yes VN
N
❑ Yes
❑ Yes E 'N
❑ Yes L"J 1Ve
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ 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? ❑ YesgNo ❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili N mber: JfA - Date of tns ection: -q 4+
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes D/No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes Ell'o ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
Fj 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 o ❑ 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 EjZo NA NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? Yes [:PiCo 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
o
NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
Rio
NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
6/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. n
Use drawings of facility to better explain situations (use additional pages as necessary).
WcATC. 5;Lvo6E 5wZV - `i (;A� 3iCr L-A Gs�l3 c -To Do St 1 6 I�
s� l-e UE L' Zs 14-z"
Reviewer/Inspector Name:
61 i f f rA R Ate/ Phone: h R 4
Reviewer/Inspector Signature:
Page 3 of 3
Date: 13
2412 r

Type of Visit: gCo�p'tpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l Arrival Time: ® Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Vj_kat.,," AN arS
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine C►apacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry C►apacity, Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
IJ . P,ouIt Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
FITurke
Turkeys
Puuets
Other
Dischar¢es and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑
❑Yes �`No
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facill Number: - Date of Inspection: 3 j
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: 0L tr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N 7D 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 environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/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
N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F2( ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo ❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 21412011 Continued

I I
Facift Number: 17- Date of Inspection: 1 �'✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dD o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ NA
pwo
❑ NE
El Yes
❑ NA
❑ NE
❑ Yes
E2/No ❑ NA
❑ NE
❑ Yes
C a No ❑ NA
❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ❑ NA
el
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesVo
N❑ NA
34. Does the facility require a follow-up visit by the same agency? ❑Yes ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).0
Reviewer/Inspector Name: " Aj ti hj . J Phone
Reviewer/Inspector Signature: Date: J1I`t
Page 3 of 3 2/4,2011

Division of Water QnaUty�
Facility Number , �07 Dmsivn of Soil and Water Conseryatton
.. % IDOtheC�A ene
- g y.,.�
Type of Visit Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assis=Access
Reason for Visit Routine Q Complaint �2Q^Follow up Q Referral Q Emergency Q Other El Denied
Date of Visit: 3 �b Arrival Time: b.Y Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: V.S� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o ❑ ' 0 « Longitude:
Design Curreni: v." Design 7, Current ti ,� DestgW" "" Current
Swine
Capacity .Population Wet Poultry Capacity°'Population CattleM Capac1 Population
_,•
u
A
❑ airyHeifer
Dry Poultr3
❑ D Cow
- z
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
11
❑Beef Brood Cowl
their,
❑ Other
Numher2of�St�uctures
❑ Wean to Finish
❑ an to Feeder
Feeder to Finish
� O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑
Lb ❑Dai Cow
❑ Non -Layer Dairy Calf
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turke 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes�No ❑ NA ❑ NE
[:]Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ElNA
ElNE
❑ Yes
❑ Yes
❑ NA
VN
El NE
El Yes
❑ NA
❑ NE
I2/28/04 Continued

Facility Number:
Date of Inspections
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
Identifier: t LAG-o J Zi
❑ Yes C4o ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZI 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes iNo ❑ 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 environmentaltheat, 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 JNo ❑ 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 Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
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 JJ/ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 ❑ NA
El NE
15, Does the receiving crop and/or land application site need improvement?
El Yes
Zo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EX/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
Commenti (refer to. question #) `Explain any YES answers and/or any recommendations or. any ather,'comments.,
Use'arawings of:faciliiyto, etter,explain situations {use additional Pages .as nec"s,a .y) ,
Reviewerlinspector Name �:..�x ` Phone: �o
Reviewer/Inspector Signature Date: 3 l p
Page 2 of 3 1 12128104 Continued

f
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WIIP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 o ❑ NA ❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E2 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0' Io
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
b No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P4o
❑ NA
❑ NE
Other Issues
2& Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29. Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q Igo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El YesEl
VNo
NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments' and/or Drawin s " -
0
Page 3 of 3 12128104

q
Type of Visit ('Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Q4outine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (P t0 Arrival Time: ibdb Departure Time: County: OhMa .nti 1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: V 1 Y t.QXA C t7.ii Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = Longitude: E_-] ° =' =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle i Fi—Ja c i tTA Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ to Feeder
L4Vqt,
Iq OW
❑ Dairy Heifer
Dry Poultry El Dry Cow
❑Farrow ❑ Non -Dairy
La ers
❑ Beef Stocker
El Farrow to Finish
El Non-LayNetsers
El Pullets
El Beef Feeder
❑ Beef Brood Co
El Gilts
❑ Boars
❑ Turke s
_JMNumber
Other
❑ Other
of Structures:
❑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?
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 SrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes El ElNE
ElYes ZNo ❑ NA ❑ NE
12128104 Continued

Facility Number: (Q -- Date of Inspection lv tp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA C-co LACra4r J Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c13 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
2/No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
&No
❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require El Yes
�/
[3 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
LI No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E2 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
,
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QrNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
D�No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E7 ❑ NA
El NE
18. Is there'a lack of properly operating waste application equipment?
❑ Yes
7No ❑ NA
❑ NE
Comments {refer to ,questron'#) �'E%plarn any„Y
'1W oi. lC OJEE D ko
YAJ W AL S,
-tb f Sar1. Gti40-C- J . GoV EA -
O LtT
`
t,j N STUw ��
� � p >J �I�AC�,
�r,G ruts 5 e(r",e* 4�►,je
lA (-tit..
ReviewerlInspector NameU
Phone: b
r16 3
Reviewer/Inspector Signature:
�
Date: _
9 110
Page 2 of 3
12/28/04 Continued

Facility Number: (o� — Date of Inspection (o r► u7
e uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U4o. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fd No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<o
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
G- o
❑ 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
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�
E4
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,.,�
L�J 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?
ElYes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
,Eln4
[2'No
❑ NA
❑ NE
A{I4ltlonAi�CflmmentS AnOrDraWing5,` ' h
Page 3 of 3 12128104

(9-1
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: yi Arrival Time: C7U Departure Time: County: 6A) SLA irJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V =i AL&Z L1L4i Q
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 0 A Longitude: = ° = i = [I
Design C►urrent
Design Current Design Current
Swine
Gapa H Population
Wet Poultry Capacity Population C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
q%'jG
7Iaa6
EjDairyfeifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
ElLa ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Oti
10 Turkey Poults
❑ Other
10 Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — � Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes uk ❑ 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: L_I4Cvv+J 1 Ar'cmo Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I Z.0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E4o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltheat, notify DWQ
7. Do any of the structures need maintenance or improvement? El 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 dNo ❑ 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. ❑ CN Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ZN ElNA [INE
15. Does the receiving crop and/or land application site need improvement? ElYes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes El No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Zo
❑ NA
❑ NE
CoW1._IrSU+,_ Wb,(Z_AL. aN W f3t_.L_
Reviewer/Inspector Name �� t'AQiJ�c.Ca._ Phone: (9lb)
Reviewerllnspector Signature: Date: a C X-�
A -- 7 _'r 2 1 1 7/7R/Rll i-nnti—d

Facility Number: — Date of Inspection l
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 ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 1 Yes ❑ No ❑ NA ❑ NE
❑ Waste Ap21tocking
ion ❑ Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E2"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LJWN
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L''J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,/
b No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,/
N
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
El NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VN
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Page 3 of 3 12/28104

Type of Visit QrCoo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G j7 0 Arrival Time: a Q Departure Time: I County: QAJS,QW — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: VTA6=Ar_rA Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ' = Longitude: = o = 4 0
it
Design Current
Design
Current
Design Current
Swine
Capty Population
�.�.
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
I0 Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer 1
❑ Dairy Calf
® Feeder to Finish
q $ %
;66
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑❑Beef
Turkeys
❑ Beef Feeder
Brood Co
❑ Boars
Other
❑ Other
❑ Turkey Poults
ILI Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes i3 No ❑ NA ❑ NE
❑ Yes D o ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: (,'� — '� y Date of inspection
y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6-erQA! I I�A Cranbjd L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): N a 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [__1 Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0Yes E] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RfNo
❑ 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
[2� o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Commentst(refer tquest ors#) ply any YES answers=riorany�recommendations or anyotlter comma .
IJse�.drawtng f�faciltty to:Vb r.ezplan s 'tuations: (use<addttosial�pages:as necessary}:
7.} Ca>J?..r�1dE �i w°n-K dN nrlc� A4 i[�I . coNTru �� ,ICE 2m hl&VF m EX
Reviewer/Inspector Name o A/ LL, Phone: (?,0
Reviewer/Inspector Signature: Date: 667 n
rageZ vJ j A�Z�U.v� w.4*riueu

Facility Number: G7 — 7 Date of Inspection G s y d
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 t</J No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Des; n ❑ Ma s ❑Other
g P
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[J 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
❑ 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
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,—,/
L] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3/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
ZN o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
ElNA
[3NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drhwings
Page 3 of 3 12128104

Facility Number 6
t6 Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit (r7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z (1 Arrival Time: © Departure Time: County:y"'j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ VQrt-&-r8LA Jj�k)JCZAJS
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = . = Longitude: = ° = g = N
Design ''Current. Design' Current Design"C.urrent�F9
S"114-1wine Capacity• Population Wef Poultry--. Capacity Population Cattle Capacity Populahoriy
❑ Wean to Finish ❑ Layer
® Feeder to nish 1JX
r;�❑ ElNon-Layer
❑ Farrow to Wean ; Dry;Poultry
r; ❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
L Boars I
Other
❑ Other
1 ❑ Non -Layers
❑ Pullets
—7..❑ Turkeys
❑ Turke Poutts
�� " ❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Dairy -Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
-
Discharge originated at: ❑ Structure ❑ Application Field Efother
pRA.DJ a. Was the conveyance man-made? %rl fr,
Number ofStructures,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
E Yes ❑ No ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
`-, SyI
❑ Yes ?Nq
❑ NA ❑ NE
El Yes ❑ NA [INE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 6Date of inspection i
Waste Collection & Treatment ,_,/
4. Is siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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: %A 6 od,U 1 U46a6,N Z
Spillway?:
Designed Freeboard (in): 7.0 ?-a
Observed Freeboard (in): 17r7 22—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? D Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑"N^o ❑ 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 CJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
L' I Igo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UNC ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[21� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ld Zo ❑ 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):
r, a4vlftf 6 G"Ot ep UP
Rwb fP_CUW - 24b GAQ,0-'JX .DV P A• F,c:;:c_o O�7Yfi�. &0Ck C p
of-(- A1J?7 W-C LC 761lh P
O DT JU LAL a/rO 1,A6c ,Ji A bWY e✓NEN Lb,,Ie.
7� C�,►Ar.���F � xr�� o� GR,4s3rA/0v4T
�,� �wa�It- P�n?�s-1,o�JEs
r✓�t N Af rtrv�i( 4rVn P.►f,�/ ,A.rP -.vb�+c,� P.fEa
ykVME/AW, t� &E 4,11ronlCn
C40rjbs CALLA tIN
. C010RFC7' EAVES-,
Reviewer inspector Name
4 Phone: d 16 --7.JFI
Reviewer/inspector Signature:
Date: Z
Page 2 of 3 / 12128104 Continued

Facility Number: Date of Inspection tr 7
Required Records & Documents
r9. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to haXUP
components of the CAWMP readily available? If yes, check
the appropriate box. ❑ Checklists ❑ Design ❑ maps
p ❑ Other
❑ Yes EE No ❑ NA ❑ NE
E(Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections [I
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DINo
❑ NA
❑ NE
Other Issues !!
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
❑ 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
El"N' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�,/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��,,//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
E3' o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
01No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
=acilityumber 6 0 Division of Soil and Water Conservation
V
- - 0 Other Agency
R --
Type of Visit 6 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1(r D{s Arrival Time: Departure Time: County: dNStOh/ Region:
Farm Name: -Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: -� Title: Phone No:
J& Onsite Representative: U (LG1dXA ICES __ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 4 =, Longitude: ❑ ° u
Design Current Design Current Design Current'
y Swine Capacity Population WetrPoultry . Capacity .Population. Cattle. CapacityPopulatto�.a,
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
yV4 to
1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Nan -La er
j
Dry Poultry
Other
❑ Other -- E
❑ 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
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures. �G
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E)No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 9Wo
❑ NA El NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: L7 —
t
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: (A40Mj 1 G4 6ovAl Z
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): z0 Z�(}
Observed Freeboard (in): 1 oZ�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2(No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes eNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. 'Do any of the structures need maintenance or improvement? D Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes !,a 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 ETNo ❑ 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 B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (3 04 4 (r) S G a M A Ti-W C 4)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LSNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [:RlNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E.No [I NA ❑ NE
17. Does the facility lack adequate acreage for land application? ElYesTo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain. situations. (use additional pages as necessary);
�.} W aX ors OZ1e W wzt. L1Jz0Ex-r } 3vr NM -Co To C#AJTr0j(jf
?8 9SrAet .1 rPi CaA5s
LaVC.�
►3(cC) Ia. 070AT6 wuP *ott­ `Z,606 AC. CAG& ,
T
Reviewer/Inspector Name T S ��rA�N�cu.
Phone: NIA ) -759 LkS'
Reviewer/Inspector Signature:
Date: 6
Page 2 of-3 12128104 Continued

P' Facility Number: — Date of Inspection
Required 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 1:14es ❑ No ❑ NA ❑ NE
the appropriate box. "P ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d 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
[] N
❑ NA
ElNE
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
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes:�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CJ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[� o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q'No
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
❑,Ko/
❑ 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?
ElC Yes
�
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CI 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?
ElYes
L'I No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

I
Type of Visit 0 lRoutine
mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3/ Q5 Arrival Time: 6 Departure Time: County: 8r4S Lk J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ' `Title:
OnsiteRepresentative: gzoj7ai zny.6N14'V)2 _
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = g 0 s, Longitude: = ° = j =
W�]Dgurrent Design Current. Design e�ity >pulatron Wet Poultry . Ca acr Po ulation , _ Cat#le .... .,_; Ca aci Po ulation-
❑ Wean to Finish ❑ Layer ❑ Da' Cow
❑ Wean to Feeder
❑ Non -La er
I
I❑Dai
Calf
Feeder to Finish
b
❑ Dairy Heife3
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ La ers ❑ Beef Stocker
❑Non -Layers ❑ Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other F--Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PGilts
Boars
Other.
VD —Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
LI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
El No
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
El
lN
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
VNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 1p') Date of Inspection 8`S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EYINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G-V.� 1 LfA C-7mti% Z
Spillway?:
Designed Freeboard (in):yo
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ZNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 enviroo ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? v� Yes �o ❑ NA ❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit? ❑ Yes L( 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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M 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 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes b No ❑ 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 Z No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N' o
El NA
❑ NE
ElLQ Yes
,L�✓1,
3Vo
❑ NA
❑ NE
Po UPOKR_ vJAsT( To sHoW ACRP_AC.,6 4F zo^Se P0rv%Pz4&, GE`C CaiP y'
6F lA CO Z DESZ.&O PIJD ofars�i (L. SFN® CPP`r To Wn1 V.b
,;zo k.&e r �,O PY of AtjNuAL (_6 T 51,t/D(t6 SJ2,Ay A 00 C�gt.{La2,ra n) v�ST14 A p
�. Co arrsN v oR-rc cs- �✓ �s TA B l.�rN 3NG Gam+ S< c6v6 2- �,✓ t k Woo
Giorr 12 �N Ndtk Aa'r. VVv P 2-LS6Ii Z11/ -FXi5L ®'
t►aJAr6 ^/ Foy G24p LIZALDS
Reviewer/Inspector Name PTO;}, ' 1 � ` ` - Phone: fzo) %�(o Zo�j
«..
Reviewer/Inspector Signature: Date: T J`'
12128104 Continued

Facility Number: — Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA2—iP readily available? If yes, check
the appropirate box. �WUp [] Checklists n g ❑Maps ❑Other
❑ Yes O No ❑ NA ❑ NE
E Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑�Noo ❑ NA
❑ NE
El Waste Application ❑ Wee y Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
E7 Annual Certification
El Rainfall El 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
N ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
VN ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L2No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No E iVA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1a No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EfNo
❑ 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
IQ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
��
12<0
❑ 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
RJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9f Routine O Complaint O Follow up O Emergency Notification Q Other 0 Denied Access
Facility Number Date of Visit:
Permitted j` Certified © Coud�itionaDy CertifiedRegistered
Farm Name: ... �4f.iGQ..l.-(.."�J`!,�....t.........
Owner Name:... _Wh!.���rL1��.W.i. �1�. $ .. _..............
Mading Address:...._ ... - - - -.......... ................_._
Time:
10 Not Operational O Below Threshold
Date Last Operate -o1r Above eshold: •........................
County: ..NS1�� .� »........._._...............
PhoneNo: _� ....._..._ �... ............- - �..._......._........
Facility Contact. ......_..._.. ....._ _...... _. Title: _.. .. _..... ... ._..._.... Phone No: _ ----..
Onsite Representative:.. V��/.,�� Integrator:.... r� OIC�
Certified Operator; ................... ......................... .... . . .. . . .... . .... . ............. . . . ............... Operator Certification Number: .-.... -.................. ......... ......
Location of Farm:
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 'C Longitude • ' 64
Desrgn ,= Cuirent Desrga Cirrr ent Desrgn Cut feat
r M -
-.-- . ... . -. 4 �_i _
Swrne PnWtryT Ca Po Cattle, Ca 'P6 iiEatrorr.:M`
_Po olat<on ; '_ cr utatzori, ap
Ca a
Wean to Feeder
❑ Layer ❑Dairy
GrF eeder to Finish
❑ Non -Layer Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other A_: { ,
;
_
Farrow to Finish
�: TOW DeSlgllll Capac>tty a
Gilts
n i K �A t '
❑ Boars
r€ To,a� SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes )2%
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J•No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. ...... .........
Freeboard (inches): 2�
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Rio
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? Oyes ❑ 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 ❑ Yes R(No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes 21 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive Ponding ❑ iPAN ❑ &�4
ydr Overload ❑ Frozen Ground ❑ Cop/p�eerr�and/or Zinc
12. Crop type '4 dZW0/ / / r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ER'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes r No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNo
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes INO
Air Quality representative immediately.
Comments (refer to questtoa #) Ezpiam any YES answe r and/gr any ns ar any other COMMents. �
s :.: . �.
[3se diwings gf facility to better explam sitnatioas (are addraanal pages as necessary) 0. ❑ Field Copy ❑ Final Notes t
Z5>A g��s�f �y2 ASS �o�,ER�
19
�� G(%5 �z�z•,.� lfv��,5 .��.o ��� <ry ,�yF�f�as ��i_�`
Reviewer/Inspector Name 14
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes XNo
❑ Yes PNo
❑ Yes 10 No
❑ Yes No
❑ Yes No
❑ Yes VNo
❑ Yes y No
❑ Yes VNo
❑ Yes j;KNo
9 Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes
❑ Yes 'ONo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
Additiobmments-an or vnngs 'Eiis
t„ a
erg
AV E
�GO�l�S /v im '4wv INR'e f- y
l�
12112103

Type of Visit Qtompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Z Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Z ZO D3 Time; f 6
Facility Number
rO Not O erational. 0 Below Threshold
O Permitted ©Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: DV 14 — tA Ne n k Iry r r— -2- County: 6 -1 s idW
Owner Name: -D y i C' -, ey n k Phone No:
Mailing Address:
Facility Contact, Title:
Onsite Representative: U r�' '^' h k-'^ _S
Certified Operator:
Location of Farm:
Phone No:
Integrator: rjph ✓a W
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 ° " Longitude 0 0 6
Design
Swine Ca aci
❑ Wean to Feeder
Current
P,o ulation P,aul_try
❑ Layer
Design Current Design
Ca achy P,o uiation Cattle Ca aci
❑ Da'
Current
P,o ulation
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area
Holding Ponds !Solid Traps 0 ❑ No Liquid Waste Management System
❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lacoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i%lo�,,
Freeboard (inches): 7-(9 3D
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PrNo
❑ Yes ,?!fNo
❑ Yes �No
Structure 6
05103101 Continued

r
• Facility Number: —"7q Date of Inspection Z d D
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes P(No
❑ Yes XNo
❑ Yes XNo
❑ Yes '�dNo
❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ yes jzfNo
11. Is there evidence of over application? ❑ Excessive Ponding y❑ PAN [I Hydraulic Overload El Yes ZNo
12. Crop type _ U e rrn +�dr, i t `� , B c sv► L A Cer, t-e 1 /'1� a1-] t/ J&,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes JzNo
c) This facility is pended for a wettable acre determination? ❑ Yes 9-No
B. Does the receiving crop need improvement? ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes RNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONo
18.
Does the facility fail to have all components of the Certified Animat Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
"No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Z No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
'�a'No
ONo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Jallo
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
[:]Yes
0 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Z No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments -(refer to quest,on`#� ExplAin 44- ES answers aed/or.any recomarendahans or;an otl erebmments.
L w.3c1rawin s of facility -to to better eg liun situations use adiiit:ona[. a es as:necessa ` `' '
g �" i? P g rY) ❑ Field Copy ❑ Final Notes
, t -
y -
J
1►, f dj` r wti r.r i liek" e,irJk►0"?c-0 • 7-� e �t�tO j� qo+-v �: 1Djs G►�tO� G rdy�
ce r e j ►-, q o o� Sh g�0e • _l,c let� �J� a► inAr s w "t L a cAjc Q.,re Gi I
i S (..�� 1l j✓LLZY7 +Gll� �� 1/I `t ��1,c r�GOr(�S Ae'er n 04`1(1i
L'y/1TG abowl l��od�
Reviewerlinspector Name �^ �a6ta�r r i5#:
Reviewer/Inspector Signature: Date: 2 2 o O 3
05103101 Continued

w
Facility Number: Date of Inspection Z O d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 �ffNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes -,VrNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes /0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 'IffNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'B%O
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ .No
"Additional Comments and/or Drawings:
05103101

r -� • - _ � )j1vl51vi1 of Water Quality � � � ¢ ,
` - O 1)1vlACi of Soil and Water COnservati6n _
16
OtherAgencY
u :'
-
�
Type of Visit O Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 67 74 Bate of Visit: 3/26/2002 Time: 16:00
O Not Operational O Below Threshold
® Permitted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold_ _ __
Farm Name: I?ulftnd Ankins.Farm.#2............................ County: QasJQYX ----------------------------------- WJR0......
Owner Name: >s?atlans�__-.------------_ Jeulda�----------._.------------ Phone No: QaQZ9:43-------------- - - --- ------
Mailing Address: J,43.1?ell.UX-.Q rjk.Roash.................................... .......... ftweLyille...N.C....................................................... 5�1...:..........
Facilit Contact• .....Title : ............................................... Phone No: ......................................
Onsite Representative: Y�T�ULiR�TeAltli4�--------------------__------------- Integrator: Nu[p1l,XjFamiiltjF2 jns..____-------------
Certified Operator: D .0 afxdj ............................. jplxwm ............................................. Operator Certification Number: it2S1.............................
Location of Farm:
South of Ellis Airport. On West side of SR 1210 (Loop Rd.) approx. 0.4 miles from South end of SR 1210.
ti
® Swine ❑Poultry ❑Cattle ❑Horse Latitude 34 • 48 50 Longitude 77 • 38 s 51
De
Swine -= - C.An
t
�n - =Poultry.
❑ Wean to Feeder
® Feeder to Finish
4896
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
..
-_= g Current...._... ` Desi -
.n . .
'Design Current
-Ca-acity Po ulatioo-=_-Cattle _
Ca acit Population
❑ Dairy
❑ Non -Dairy
Total Design` -Capacity_ _
4,896
- - Total SSLW _
660,960
Number of I,agoans 2 19 Subsurface Drains Present ❑ Lagoon Area 119 Spray Field Area
HoldinggPonds / Solid>Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........SmaU...... ............ J_v4e.........
Freeboard (inches): 23 33
AP IAA in r

uIiv Jiut
r
Facility Number: 67-74 Date of Inspection 3/26/2002
c.unrinueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
a.
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Analication
10. Are there any buffers that need maintenance/improvement?
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Coastal Bermuda (Graze) Matua Graze
❑ Yes N No
❑ Yes N No
❑ Yes ® No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any, applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N Yes ❑ No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments rgfer to uest<on Ez lain any YES answe s and/or_any recommendations or an other comments
'
Use drawin s of fac�Egi� to better ex lain situat ons x use additional a es as necessay
g —h p ..., ( - p g'� ❑ Field Copy ❑ Final Notes
.�
and 8. The pumps on the lagoon leak to cool themselves says Ms. Jenkins. Waste has run down the side of the lagoon and some waste
+
is puddled at toe of lagoon wall. This appears to be a problem as the grass in this area of the lagoon appears to be dead, I believe from
he animal waste leak. Need to contain the waste that leaks from these pumps and route it back into the lagoon with no damage to the
lagoon.
9, and 18. Need to have lagoon design information for the new (small) lagoon.
I5. The matua needs improvement in several large areas in the front field. The bermuda needs improvement in an area behind the old
lagoon. The rye appears to be at a point of growth that it will not be properly removed by grazing in the two small fields and thus it need
o be cut and baled.
Reviewer/Inspector Name Stonewal :1Vlath�se, .n a .___ ^_W
Reviewer/Inspector Signature: Date: a2—

0510101
Facility Number: 67-74 Date of Inspection 3/26/2Q02
Continued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
:A itiona -omments.an ,or -'Drawings - -
19. Need to be sure to use a waste analysis dated within 60 days of the application events on the IRR-2's. Need to go back and
recalculate the matua records in accordance with this when you get back the analysis which you are currently awaiting.

'� !tDivision of Water Quatity
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I)ate of Visit: ®"fine:��Printed on: 7/21/2000
rO Not Operational Q Below Threshold
Permitted [3 Certified © Conditionally Certified [3 Registered Date Last Operated or A ove Threshold:
.........................
Farm Name:.....!'..................................................... County:.... b..O.....
............................. ... ................... .
Owner Name:
................................................................. Phone No:
FacilityContact:.............................................................................. Title:................................................................ Phone No:....................................
:Mailing Address: .............................................................................................. **-"*............... :..........
....... . .. .. ....
A
.......................................
%
Onsite Representative:....... \fie �. >% ........ Integrator:.
Certified Operator: .........................JJ.........................._......._.......................................__.......... Operator Certification Number: ............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 �i Longitude • 6 66
Design Current
Swine Capacity Population
❑ Wean to Feeder
%Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer IM Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag,lnn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed. did it reach Water of the State" (If yes, notify DWQ)
❑ Yes
❑ No
c. li' discharge is observed, what is the estimated flow in plhnin?
d- Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any pan of the operation?
[:]Yes
VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
t'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
krNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: . .................................... .................................... ............. .........
Freehoard (inches):}
5/00
Continued
on back

, Facility Number: — Date of Inspection 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
kNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
VrNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)o No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
O�No
Waste Application
10. Are there any buffers that need main tenance/improvement?
❑ Yes
XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
1b
❑ Yes
gNo
12. Crop tyre YCA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
,Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'!
❑ Yes
9No
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
j(No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
%No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
j�rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ElYes ,XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes i�rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes WNo
0: �q'viioiatioris:oi' deficiencies •were pgfed during this:visit.' • Y:ou V l•i•eeeive tW rui-ther
correso6yideR&. ab6u- f this visit:
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
Reviewer/Inspector Signature:
76) 3°I :!(_3y
Date: �7D2
X_-1DC
5100

FaciUty Number: — Date of Inspection y'F
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below WYes ❑ 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 &j No
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes e6 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
j No
31_ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes AfNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes IWO
,&I

- Division of.Water'Quality =
Q Division, of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 'Time: OQ Printed on: 10/26/2000
Q Not operational Q Below Threshold
.Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..............
Farm Name:.....+J..l^.:.]•!��"...................... County:.i1S!...... ..............................
Owner Name: ...................................................
Facility Contact: ........................................................
Mailing Address : ............................
Onsite Representative: ... 0ek.S.............
Certified Operator: ................................................
Location of Farm:
Phone No:........
..................... Title: ........................................ I....................... Phone No:.................................. .................
.................................................................................................................................................
........ Integrator:.....1-............. .. `.\%................................................
............................................................ Operator Certification Number:...............................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �` 14 Longitude • 6 «
Design Current
Swine Capacity Population
❑ Wean to Feeder
Ef Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I T ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps I JE1 No Liquid Waste :klanagement System
Discharges & Stream Impacts
I. 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_ II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........ ............................
Freeboard (inches):
5/00
Continued
on back

1
LFacility Number: 4r7 —T_)Lj I Date of Inspection I 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 NNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes hjrNo
(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 14No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid IeveI
elevation markings? ❑ Yes N No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N'No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
0 No
12.
Crop type 01 c�-z,�, �'' a SY .�1 gs.��� c��►-SFe
r
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
lilNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
JN No
b) Does the facility need a wettable acre determination?
❑ Yes
'QrNo
c) This facility is pended for a wettable acre determination?
❑ Yes
EfNo
15.
Does the receiving crop need improvement?
❑ Yes
D?rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
)4 No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
9Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N1 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
NrNo
(ie/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JkNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
:: �'�10 yiolafigns:oi deficieucies were noted d>x'irig fhis'AsIC • Y:oo Will-i-ebNW ii6 further •' • : -
rorrespondence. abouf this visit. • . •
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 a§-ecessairy)
IS
l S OQd l L- - 576
-�►- ��,� c�1 � �� Caw-.�c�� �� �iz.�t� �..�� � �. ��s�� �� ��
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

Facility Number:b1 —9q I Date of Inspection `j U 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 at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�fNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P 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 kyNo
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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional omments and/orDrawings:
�- �-e `tip'' ty��! �� ►•��s '�-�2s c.a,
dvt' � �- d `
0
J
5/00

Lagoon Dike Inspection Report
Name of Farm / Facility Dulev Jenkins Murphy 2276 . A
Location of Farm / Facility SR 1210
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:IV
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
( Check One, Describe if Yes)
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors Patrick Gragan
et Paz h
6' Freeboard, Feet 17"
3.5 Top Width, Feet I2
2 to I Downstream Slope, xH:ly 3 to 1
Yes X No
Yes _X No
Yes X No
Excellent - Qrass
Did Dike Overtop? _ Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X Na
Engineering Study Needed? Yes X No
rs
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _ X No
Other Comments Pumping -in procus.

Lagoon Dike Inspection Report
Name of Farm I Facility _DuIev Jenkins Murphy -2276_ - B
Location of Farm / Facility �SR 1210 - -
Owner's Name, Address
and Telephone Number
Date of Inspection 9 / 29/ 99 Names of Inspectors Patripk Groan
Ianq Paith
Structural Height, Feet 3-5' Freeboard, Feet 16"
Lagoon Surface Area, Acres
Upstream Slope, aH:1V
Embankment Sliding?
(Cheek One, Describe if Yes }
Seepage?
(Cheek One, Describe if Yes)
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
1.5 Top Width, Feet 12
2 to 1 Downstream Slope, zH:1v 33 tq
Yes _ X No
Yes X No
Yes _ X No
Excell= - grass, - - -- - - - -
Yes X - No If Yes, Depth of
Overtopping, Feet
Follow-up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
i�
Is Dam Jurisdictional to the Dam Safety Law of 1967? - Yes X-- No
Other Comments min in r ce

Lagoon Dike Inspection Report
`A
Name of Farm / Facility �ltv Jenkins Murphy 2276 A
Location of Farm / Facility SR 1210
Owner's Name, Address
and Telephone Number
Date of Inspection 9 / 29/ 99 Names of Inspectors brick Grogan
Janet Pkh
Structural Height, Feet 6' Freeboard, Feet 17"
Lagoon Surface Area, Acres 3.5 Top Width, Feet I2
Upstream Slope, xH:1V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
2 to 1 _ Downstream Slope, xH:lv 3^ tQ i
Yes X No
Yes _X No
Yes X _ No
Excellent - eraas
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? ` Yes �X No
r
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes^ No
Other Comments Pum in m, r c

Lagoon Dike Inspection Report
Name of Farm / Facility Dulty Jenkins MuEphy 2276 B
Location of Farm / Facility SR 1210
Owner's Name, Address
and Telephone Number
Date of inspection 9 / 29/ 99 Names of Inspectors Patrick Grogan
Janet with
Structural Height, Feet 3-5' Freeboard, Feet _lb„
Lagoon Surface Area, Acres
Upstream Slope, aH:IV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
1.5 Top Width, Feet 12
2 to 1 Downstream Slope, aH:Iv 3 to 1
Yes X No
Yes X No
Yes X No
_ Excellent grass
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments P raping in Mcess. -

r,.
DtAision of Soil and Water Conservation - OperatiomReview
D Division of Soil and Water. Conservation-.Conipliance inspection
19-Division of Water Quality --Compliance Inspection .
© OtherAgency - Operation Review
MRoutine Q Complaint Q Follow -top -of DWQ inspection Q hollow -up of DS1'4C review Q Other
IFacility Number
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered
�
Farm Name: ... a ... ��............................................
Date of Inspection
'lime of Inspection 1(j 30 j 24 hr. (hh:mm)
Not Operational] Date Last Operated:
..........................
County: ...............5A...C_................................ .......................
OwnerName: ................... Phone No:................:......................................................................
Facility Contact: ............ Title: Phone No:
MailingAddress: ................................... .....................................;.........................
......-........
....
...............................................................
e
Onsite Representativeclh ........".. J��..h .. 4 ..i'........... lnte„rator:....... t.''i�J...-.y....................I............................
Certified Operator: .... I ............................................................................... ............... Operator Certification Number:..........................................
,oc f n of r `
.............. ..............t..........-........-.. .�5.....�t .. ..................................................... g VGh.
�........... r ...-. f.� ........................................................
Latitude �' �� �« Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish Ll 'XqZ ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number,of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. Il discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/inin",
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Structure I Structure 2 Structure :i Structure 4 Structure 5
❑ Yes j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [XNo
❑ Yes LYNo
❑ Yes [N�No
Structure 6
Freeboard (inches): --
--..1............ ................. I--...............
1/6/99 . Continued on back

• Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes '-(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? y ❑ Yes V14-0
(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? j;Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes MNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
WNo
Lot
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
tNo
11. is there evidence of over application? ❑ Ponding ❑ Nitrogen
El Yes
[�fNo
12. Crop type................................. ...................................... ............................... .......................................................... ............................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
MNo
14. Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
.NJ No
15. Does the receiving crop need improvement'?
DfYes
❑ No
16. Is there a lack of adequate waste application equipment'?
❑ Yes
Q�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[(No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
UfNo
19. Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes
nNo
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
P: No:violations or. def9ciendes :were noted: during this visit. I'tiu will:rereive no further. ::: :
eorresporidence:abotit:this visit.:::::•:•:•.•:•:•:•:•.•:•:•.•.•:•:•::•:•:•::•:•:•:•.•:•:....:•:•
Comments'(refer- to .question #): Explain any YES answers and/of any recommendations:'
any otlier comments.
x
Use,drawings of facility twbetter explain situations. (use additional pages as: necessary) ;r :_1 7
J90
1.0
`tvtri g��� �tiy�-, �a r� �-•�-c.�, . ►�`r�� �.a-�r �� � �i�1� >`-�-e
4�
^I•- l�ti 2ct-Y2
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5 l( t % 11/6n-9

❑ Division of Soil and Water Conservation [] Other Agency.
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O FoHow-up of DSWC review O Other
Date of Inspection �
Facility Number
Time of Inspection [Z= 24 hr. (hh:mm)
© Registered © Certified [3 Applied for Permit XPermitted JE3 Not Operational Date Last Operated:
Farm Name: .... A.......... ..... County: ......... 0}l:c?'.......................................Z
Owner Name:...D..L!..............�?.?c......
....y...........................s��............... .. Phone No:
Facility Contact: ... -l�J.%..l].................. Title: ....................... Phone No:
Mailing Address:...... 3. # �`. ........}` ....... .................' �f.%��:................................. z
Onsite Representative:........''. r ...... r . // "K�......... g...
v ..f'. t. r 1.. ......... h 1G1...... Integrator: �/
Certified Operator.......... ..... .......... _1A:.f!1:.k1__ r.........I......... Operator Certification Number .........................................
Location of Farm:
Latitude C=]• ' " Longitude =• ` "
x Design .. Current =�
Design Current, Destgn =,Current
a«. ,.. Capacity :Population
,A .Poultry
_ . ;`Capacity.. Population Cattle Capacrty ' PopulatYon
❑ Wean to Feeder
❑ Layer
El Dairy
Feeder to Finish
ZJWJ,
❑ Non -Layer
I
❑ Non -Dairy
❑ Farrow to Wean
❑Other
.::. R ..
❑ Farrow to Feeder
❑ Farrow to Finish
E�
x Total Design Capad
❑Gilts:.
h
w
T 1S
Ufa SLW
❑ Boars .,
Nuitnber of Lagoas I HaEdtttg Ponds
❑ Subsurface Drains Present 110
Lagoon Area ❑ Spray Field Area
r
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes @, No
❑ Yes 0 No
❑ Yes cQ No
❑ Yes JR No
❑ Yes ® No
❑ Yes No
❑ Yes No
fl Yes ❑ No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes i1 No

acilit Number:
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes No
Structures (Lagoons.11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure ? Structure 3 Structure 4 'Structure 5 Structure 6
Identifier: Q
Freeboard(ft): ........1............... ......... 1a...J................. ................................... .................................... ... ........................... .... ....................................
10. Is seepage observed from any of the structures? ❑ Yes )9:1 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancetimprovement?
(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?
WastLARRIication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
........ ..I5. Crop h1 .....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No. vialations'-or. deficie'neies.rvere noted -during this:visit..Y.ou:Weill receive.nci•furtlier'
correspondence about -this: visit:
❑ Yes M No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes KI No
❑ Yes ® No
❑ Yes 21 No
[I Yes ® No
❑ Yes H] No
❑ Yes ZI No
Yes 0 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
TJ. L-'�A 1' ,,v �J �+ ti Si,T 9�Ft.� 7�s 3 � IE�g��tr.e� v ,�/2•�o`/t To v S���G,
_� '"7 �AQ� �rZs�S 0" !fir t f, L lkea �
ev f tn► cif tSF F Rat 11 h
Z. ,1►i��� To �.�-t..,(� c,�,-r/`G»� ��/� A-rs.� Sri ,��,,,� �_p �j ,�i.✓�cj-s
Bt rr fZ ,y4 [ r i"i f;%! J-17A "AIIA 'Le,6 ew 0—, 1, r 7125/97
f Reviewer/Inspector Name
Reviewer/inspector Signature:
Date:

U
•
Site Requires Immediate Attention: 4/a
Facility No. •
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: 7 .1995
Time:
Farm Name/Owner:
57y
Mailing Address: 6�3 �L G� rz%1�_ -
County:.—
Integrator. Phone:
On Site Representative: -u /¢'n�/�1�,�T� Phone:
Physical Address/Location:
10
Type of Operation: Swiine _� Poultry Cattle
Design Capacity: _ 4 gqlv Number of Animals on Site: 'Y"$�7� ��✓!�/ y
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -5(k ' �1 Longitude: ° '79 4 --Z" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hourstorm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: �Ft. & Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? - es No
100 Feet from Wells? es 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 e state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate was a management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: I g)" - LAW 6 T1 � - )CR12,o'1 40OX5
Inspector Name
ature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WQ Pax:919-715-6048 Jul 25 '95 7.25 P.02/17
Site Requires Immediate Attention NO
E
•
•
Mailing Address:
Facility Number: 7—
SITE VISITATION RFCORD
DATE: 7k 4e -e 2 , 1995
Owner:. _VV 47,vot/ e 41 Ns _ ^ Farm Name:
County: _ 4 n1IS Ca w _ w.
Agent Visiting Site: CS Phone: '� •�- `f SS' �7 L >
Operator: rTe Phone: `—/0 - 37fl —2Z_,7
4
On Site Representative: _ - Phone: —
Physical Address: r f z,� �'�;�. U//�.viL :� _ I C / // S fi ff v�v' oiAl
t—n[.2r7bx er A,-T,•a zit '61, .41C I// 1 4 CPOZ— ale. f-S d"RT- IrN Sear f,
(C f
5,
265-f'fv,, T ef t jff-'C"s2
Type of Operation: Swine rJ Poultry Cattle , 3 '117/cLs- r 6-4.-.% eN J�c�
Design Capacity: _ 4 F 916 Number of Animals on Site:
Latitude: Longitude: �a "
Type of Inspection: GroundAerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot +,9 inches) or No Actual Freeboard: z Feet ^t 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 og�&has there erosion of the dam?: Yes o�
Is adequate land available for land application? .'Yes bto is the cover crop adequate? er No
Additional Comments: t�/f� s_ 7 _sue ti �!�-r%% a•f ��r/:z
,fr,?�• _76 /6,,a�ol
Fax to [phone]
Signat6rc of