090009_INSPECTIONS_20171231

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090009 Facility Status:
Active permit: AWS090009
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Bladen Region:
Fayetteville
Date of Visit:
09/23/2015 Entry Time: 03:00 pm
Exit Time: 4:00 pm Incident #
Farm Name:
Cypress Creek Nursery Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910.296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
Sr 5274 Old Fayetteville Rd
Ingold NC 28441
Facility Status:
Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Farm:
latitude: 34' 47' 03" Longitude:
78' 31' 5B"
Take US 701 S. fromGarland 2 blocks S. from caution light turn right onto SR 1200 W. toward Bladen Co. at intersection wl NC
210 turn right onto NC 210 for 0.1 mile turn left onto SR 1002 for 5.5 miles to farm entrance on right.
Question Areas:
Dischrge & Stream Impacts Waste Cal, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Robert T Young Operator Certification Number: 18461
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone : [phone]
On -site representative Mike Ammons Phone : [phone]
Primary Inspector: Robert Marble
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Phone:
Date:
page: 1

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number. 090009
Inspection Date: 09/23/15 lnppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 8,000
Total Design Capacity: 8,000
Total SSLW: 240,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
#1
19.50
Lagoon
1
20,00
38.00
page: 2

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 09/23/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Ne
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (LeJ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
MLI
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
[]
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu. Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 09/23/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Ne
Crop Type 1
Fescue (Pasture)
Crop Type 2
Soybean, Wheat
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Cape Fear loam
Soil Type 2
Leon sand, A to 3%
slopes
Soil Type 3
Rains fine sandy loam
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ E ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ ■ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yes No No Ne
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ N ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ E ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
n
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090009 Owner -Facility: Murphy -Brown LLC Facility Number: 090009
Inspection Date: 09/23/15 tnpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25" Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
■ ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes No No No
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWO of emergency situations as required by Permit?
❑
0 ❑
❑
(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
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 090009 Facility Status: Active Permit: AWS090009
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for visit: Routine County: Bladen Region:
pate of Visit: 08/20/2014 Entry Time: 10:30 am Exit Time: 11:30 am Incident #
Farm Name: Cypress Creek Nursery Farm
Owner Email:
Owner: Murphy -Brown LLC Phone:
Mailing Address: PO Box 487 Warsaw NC 25398
Physical Address: Sr 5274 Old Fayetteville Rd Ingold NC 28441
Facility Status: ECompliant ❑ Not Compliant Integrator: Murphy -Brown LLC
❑ Denied Access
Fayetteville
910-296-1800
Location of Farm: Latitude: 34' 47' 03" Longitude: 78' 31' 56"
Take US 701 S. fromGarland 2 blocks S. from caution light turn right onto SR 1200 W. toward Bladen Co. at intersection wl NC
210 turn right onto NC 210 for 0.1 mile turn left onto SR 1002 for 5.5 miles to farm entrance on right.
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Teddy E Wade
Secondary OIC(s):
Operator Certification Number: 22588
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone : [phone]
On -site representative Mike Ammons Phone: [phone]
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures Observed
Disignated
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon #1 19.50
Lagoon 1 20.00
page: 2

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dischar es & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did 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)
❑
N ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le] large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
N ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
E ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN a 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manuretsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number:
090009
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste ARplication
Yes No Na No
Crop Type 1
Fescue (Pasture)
Crop Type 2
Soybean, Wheat
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Cape Fear loam
Soil Type 2
Leon sand, 0 to 3% slopes
Soil Type 3
Rains fine sandy loam
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ N ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ E ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ 0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yes
No No Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20, Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23, If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
N ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other issues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Application Field ❑
Lagoon / Storage Pond ❑
Other ❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ 0 ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑0 ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ E ❑ ❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 090009 Facility Status: Active Permit: AWS090009 Denied Access
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Bladen Region: Fayetteville
Date of Visit: 10117/2013 Entry Time: 12:15 pm Exit Time: 1:00 pm Incident #
Farm Name: Cypress Creek Nursery Farm Owner Email:
Owner: Murphy -Brown LLC. Phone: [phone]
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 5274 Old Fayetteville Rd Ingold NC 28441
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34' 47' 03" Longitude: 78° 31' 56"
Take US 701 S. fromGa€Iand 2 blocks S. from caution light turn right onto SR 1200 W. toward Bladen Co. at intersection w! NC
210 turn right onto NC 210 for 0.1 mile turn left onto SR 1002 for 5.5 miles to farm entrance on right.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other issues
Certified Operator: William Victor Sutton Operator Certification Number: 26076
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone: [phone]
On -site representative Mike Ammons Phone: [phone]
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 10/17/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder
Total Design Capacity:
Total SSLw:
waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon #1 19.50
Lagoon 1 20.00
page: 2

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 10/17/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na Me
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
Elm
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ m
❑
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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
MEJO
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le.l large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
T Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑M
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Me
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090009 Owner - Facility : Murphy -Brown LLC Facility Number: 090009
Inspection Date: 10/17/13 Inssection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Fescue (Pasture)
Crop Type 2
Soybean, Wheat
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Cape Fear loam
Soil Type 2
Leon sand, 0 to 3% slopes
Soil Type 3
Rains fine sandy loam
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ 0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
1101111
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ E ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ 0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090009 Owner -Facility: Murphy -Brown LLC Facility Number: 090009
Inspection Date: 10/17/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■ ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑0
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
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 s1ructure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
D
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Type of Visit: 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: T -t-J Arrival Time: (� Departure Time: /k County: "`JL._' �' A Region: r'TK'v
Farm Name: c4��Q7� u`�C-� G+�� Owner Email. -
Owner Name: A J,tnA!4 "�c �J !it , tic Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 n#$11) r7s _Title: Phone:
Onsite Representative: n
Certified Operator:
Back-up Operator: q0 L-44-Or
Location of Farm:
Latitude:
Integrator: AAWD&,"1'Jk'%1
Certification Number: jj��S�Bf
Certification Number:
Longitude:
- � '
::. Design Crent esi -� Dgu Current
'urPop.
Dnt
esign Curre
Swine Capacity Wet Poultry Ca parity Pop. Cattle
Capacity Pop.
Wean to sh
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
=.:_ Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D . P,iul Ca aci P,o Non -Dairy
Farrow to Finish
Gilts
La ers
Beef Stocker
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No [DNA ❑ NE
[:]Yes
O No
071NA
❑ NE
❑ Yes
[] No
1p NA
❑ NE
❑ Yes
❑ No
�&NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

4
A
type or visit: %& t-ompuance tnspeenon v uperarlun Keview lJ Ntructure Lvamation V tecumcai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:] County:+�,iv Region:
Farm Name: C4 I(QSS V` �L� Owner Email:
Owner Name: ,t,,p4_."p 0 Phone:
Mailing Address:
Physical Address:
Facility Contact: n y.t p K7 S _ Title:
Onsite Representative:
Certified Operator: C�
1.
Back-up Operator: VoC44-5?V
C/
Phone
Integrator:
Certification Number: dr�j�IJ
Certification Number: f -(
Location of Farm: Latitude: Longitude:
Design Current` Design Current
Design Current
Swine ". Capacity Pop. WetP ultry Capacity Pop.
Cattle Capacity Pop.
Dairy Cow
Wean to Finish La er
•
X Wean to Feeder
0xv
La er
aia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
ice. r Design Current
D Cow
Farrow to Feeder
y
D , oultr ;Ca acity Po
Non -Dairy
Farrow W inish
La ers
Beef Stocker
Mts'e
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Dischar8es 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 g] 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)?
l
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [iPNA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge? -
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
In No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�9 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
11
Observed Freeboard (in): ^
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
0 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
IM No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
$2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[N No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 0 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 WWind Drift �❑JA,pp_lica�tion Outside of Approved Area
12. Crop Type(s):QSCt���
13. Soil Type(s): '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ra No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
M No
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rO No
Lpa
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r� No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[P 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 [�bNo
❑ 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 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes mn 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aZ%i�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
.
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
© No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Windows ❑ Evidence of Wind Drift ❑ApplicatioOutside of Approved Area
/_
""'� � 4vcL1---
-j©yi l
12. Crop Type(s): SCc�R-_ t oap S ,
13. Soil Type(s): I 1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
15. Does 'the �receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
© No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q, No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑v No
❑ NA
❑ NE
the appropriate box.
r
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑,No
❑ NA
ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F
© No
0 NA
0 NE
Page 2 of 3
i
21412011 Condnaed

[Facility Number: jDate of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE ZM __7
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 necessarv).
CW-e�S j 1ou e4_ � S/16117-1
5' 4e L%'Slt 0 n llt'W64� s--,7 �-i z
Reviewer/Inspector Name: '00Phone: �o-�i33�33pa
1"_W4C7_
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Facili Number: -C1 jDate of Ins ection: S'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below. T`
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
r
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA FINE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�Z 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
pq mit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
0 Yes
®No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rq-a No
❑ NA
❑ NE
ad ms orComments (refer to question #): Explain aYS answers-ard/or any lany other comments
IlUse.drawings
of facility totetter: explain sitiiatipns.(use additional pages as, necessary.).:
�P Gd+-ram S r� cir Pal S/�6 i s
I/ I S1 6 j'1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: 0 Compliance 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: QS�(�p.� County: Region:
Farm Name: C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: +'' ` 11^'s©►'►S Title: Phone:
Onsite Representative: Integrator: / `! ,*iitk�
Certified Operator: Certification Number:
DLim
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 184lkl
Longitude:
;Design Current Design Current
Swine Cpaci�yWet Poultry Capactt� Popp
Design Current
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer I
-.0-2
Des n Ca
,. D rrent
g
Poult , Ca aPo
Layers
lf
er to Finish
Dai H eifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La erg
Beef Feeder
Boars
Pullets
Beef Brood Cow
:.
- '-
Other
Turkeys
Turkey Poults
-
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part.of &e 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 [P No ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
CP NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
1$No
T❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
TT❑'' No M40 NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-L--
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R No [DNA ❑ 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 P9 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ 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
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Vl No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[N No
❑ 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
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 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 73 7 jDate of inspection: 20
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EQ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
S i 4- ove'`+rce'� 5—` i7f C
(4(OF
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[]Yes V3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�i] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: f-933r33xo
Date: 1/9 (
21412011

J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5/] p I Arrival Time: Departure Time: County: &APJ J[I
Farm Name: ([�t�r ,O SS A&Z r ��t� Owner Email:
Owner Name: t=l�+�' Phone:
Mailing Address:
Physical Address:
Region: ►-7e_0
Facility Contact: t SOH 5 Title: Phone No:
Onsite Representative: G Integrator: Q�l+� `t L-c-
Certified Operator: Operator Certification Number: 2-2
Back-up Operator: � ' Back-up Certification Number: / ,B Y6I
Location of Farm: Latitude: u u Longitude: ❑ ° u
s Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry^ Capacity Population
Cattle Capacity Population
❑Dai Cow
Finish
❑ La er
to Feeder
❑Non -La er
airy Calf
J
r to Finish
"'-
❑ DairyHeifer
to Wean
z
Dry Poultry. ,.-TNT: _
❑ D Cow
El Non -Dairy
w to Feeder
Eto
to Finish
ers❑
Beef Stocker
ers
Feeder
❑ Pullets❑Beef
Turke swit
eef Brood Co❑
❑ Turke Poults
❑Other
.,
Number of Structures:FLI
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 r No ❑ NA ❑ NE
❑ Yes
❑ No
rNA
❑ NE
❑ Yes
❑ No
1PNA
❑ NE
❑ Yes
❑ No
[60NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
ElYes
o
❑ NA
❑ NE
Page l of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes " No [INA [INE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No A El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 S cture 6
Identifier: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
I
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
fa No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
QgNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Jp 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
MrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No- ❑ NA ❑ NE
maintenance/improvement?
i
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑TNA ❑ 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 El Evidence Wind Drift El Application Outside of Area
Jof
12. Crop type(s) Fe SQ y �S`� r 7A7.,I'�Q�t C r 0444�
--
13. Soil type(s) PR' aL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�l No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CoNo
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
09 No
❑ NA
❑ NE
.Comments (refer to question { Eacplam any YES answers and/or any recommenda#ions or any other comments s
Use drawrttgs of facility to better eXpI' n'situatious..(use additional pages as necessary)'
Reviewer/Inspector Name t4t I Phone: d r ~ SA�
Reviewer/Inspector Signature: Date: O
Page 2 of 3 12128104 Continued

Facility Number: 6j— 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.
❑ WLIP El Checklists El Design El Maps ❑Other
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P1 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
JFNo
❑ NA
❑ NE
ElYes
RNo
El NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Pa No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
Page 3 of 3 12128104

I
Type of Visit '*f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: I )/ ► � ►ply Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: l t 1 t ke LVmM �s Title: LN M _ Phone No l0 - r
Onsite Representative: f Integrator: —s _
Certified Operator: zd (d (4L - Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E__1 p 0' Longitude: = ° =1
Design Current
Design Current Current
Swine
Capacity Population Wet Poultry
Capacity Population Cattle Capacity Population
❑ an to Finish
❑ Layer
wM::... _jjFDesign
Dairy
❑
Cow
Calf
❑
❑
❑ Dai Heifer
El D Cow
El Non -Dal
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4io ❑ NA ❑ NE
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? El Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes El No ja NA [I NE
c. What is the estimated volume that reached waters of the State (gallons)? 11
d. Does discharge bypass the waste management system? (if yes, notify DWQ) El Yes El No C�NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No ❑ NA ❑ NE
other than from a discharge?
Page I of 3 I2/28/04 Continued
Page I of 3 I2/28/04 Continued

Facility lumber:-061
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 I Structure 2
Identifier:
Spillway?:
Desigmed Freeboard (in): C1
Observed Freeboard (in):
Structure 3 Structure 4
5_ Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;KNo ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Wo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '23 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
maintenance/improvement?
❑ Yes 0No ❑ NA ❑ NE
I I . Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes )KNo ❑ 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 Winjddow� /❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) res * ir0.5-f l.rYr- �X} - 1AJ4
13. Soil type(s) Q O tC,C L9,_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes NJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes W No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes )N[No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes A 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):
L
er/Inspector Name 1 �i L�IV rOA� Phone:In (33�7er/Inspector Signature: Date:
I2/18/04 Continued

w
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
oNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N 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
f�_No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(P'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�OA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PSLNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
( No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
11
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(1�1 No
❑ NA ❑ NE
E
12128104

[Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: f/��I� , G ,� I� Owner Email:
Owner Name: 1'_&&&Phone: _
Mailing Address:
Physical Address:
Region: F
90.
Facility Contact: Title: Phone No! Onsite Representative.^ integrator: Lcc
Certified Operator: lid U Operator Certification Number: "JXs
Back-up Operator: Back-up Certification Number: I v
Location of Farm: Latitude: 0 0 [� ` = u Longitude: 0 ° = 6 0 is
Design Current
Sv►irte Capacity Population
Wean to Finish
can to Feeder I QOV I
Desigrr n Cuent
Wet Poultry Capacity Population
❑ Layer
ILL] Non-Laye
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
El Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder I
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Ot C
❑ Other
JEJ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INo El NA El NE
Discharge originated at: El Structure El Application Field El Other
11
a. Was the conveyance man-made? ❑ Yes ❑ No P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No INA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No FnNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes '�TNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes t�No ❑ NA ❑ NE
other than from a discharge?
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No rNA ❑ NE
StIture 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
If
IfNo El NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
PCo El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1�No ❑ NA El 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
4y o ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
I
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
*o ElNA ❑ NE
❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] O 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)
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�jNo ❑ NA
❑ NE
Use mentn(s (refer to: question #r • Ex fain YES answers and/o y �� a o y- 4'
q )• p Yam*
m.
Comments g . of facility #b better explain situations: {use"additional pages as necessary) n other eats p
r'an recommendations or aMki
Reviewer/Inspector Name IPhone:
Reviewer/]nspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
ElWUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No MNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[__1 Yes
No
I --] NA❑
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,n
ILI No
❑ 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
❑ No
15 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�dVo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�iNo
❑ 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
V_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
Fj No
❑ NA
❑ NE
12128104

+Division of Water Quality t)�j
Facility Number 0 Division of Soil and Water Conservation ~3
to
0 Other Agency 1- \ L1.
(Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason far Visit lti Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 7 D� Arrival Time: Departure Time: 1� County: Region: I
2-0
Farm Name: Cff Lk4S5 C,til� N LU�1YLk �1� Owner Email:
Owner Name: M U VGA (YtJ UC- Phone:
Mailing Address: 1 � '6-7't i l Iq �.
Physical Address
Facility Contact: Y V y\V Title: Phone No:
Onsite Representative: _ i U� 'k k 9_'2'k'0'A_ 1395yntegrator: \A)X.-'
�- -�f f
Certified Operator: �L:� Operator Certification Num r: �1
Back-up Operator: Back-up Certification Number:
a
Location of Farm: L tude: e ©` EN" Longitude: ®° = ` IN]"
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
L ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turke Points
❑ 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)
Design Current:
Cattle Capacity Population:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
❑ Yes
4No
❑ NA ❑ NE
❑ Yes
❑ No
A ❑ NE
ElYes
❑ No
NA ❑ NE
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes otNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No
other than from a discharge?
12128104
�INA ❑ NE
❑ NA ❑ NE
El NA El NE
Continued

Facility Number: 04
Date of Inspection LL111 107 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
. Structure I Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No EINA ❑ NE
Structure 5 Structure 6
❑ Yes P�No ❑ NA ❑ NE
❑ Yes y No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes-10 ❑ 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) rV
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes T�kNo ❑ NA ❑ NE
maintenance/improvement?
e
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence
of Wind Drifl El Application Outside of Area
12. Crop type(s) �K-o m C--W SaAa2�:Lnjw�k�
13. Soil type(s) gockkICAL LQOrv7 Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0)No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes )0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Tr'�'No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
T
Reviewer/Inspector Name �VI N)NM Phone:
Reviewer/Inspector Signature: Date: oNE-
12128104 Continued

Facility Number: —QO9 Date of Inspection 1 07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP C] Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'N 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
IkNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ANA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F 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
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
El NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility No. ®C — Q)C)9 Time In Time Out Date
Farm Name LJ` Integrator
Owner Site Rep
Operator No.
Back-up No.
COC / C le: Genera or NPDES
Desi n
Current
Design
Current
can - FNO
Farrow —Feed
Wean --Finish
Farrow — Finish
Feed, Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: De ign
JILJ gG JLI YG�t
Crop Yield IVl
Rain Gauge
Soil Test PLAT'
Observed
Calibration/GPM
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard �� Daily Rainfall 1-in Inspections �--
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
( 3 Date Nitrogen (N) Date Nitrogen (N)
12. ?
Pull/Field Soil Crop Pan Window
7
��

sion of Water Quality / v �a .-8 �
Facility Number Q�f 0 Division of Soil and Water Conservation
-- Q Other Agency
Type of Visit 0<_ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: arrival Time:j9l% Departure Time: f 0 D County: ��r�^� Region:
Farm Name: Cy��'�jS L /'L1,— J� /XlLtOwner Email:
Owner Name ,/�%Ul� farms_ __ Phone:
Mailing Address:
Physical Address:
Facility Contact: y" Title: Phone No:
Onsite Representative: Integrator: 4'WtV4
Certified Operator: mod/ L li d Operator Certification Number: ��
Back-up Operator: I)Zep,9 _. ZAu-Kd Back-up Certification Number: Z��i__
Location of Farm: Latitude: o Longitude: = ° u
Design Current Design Current Design Current
Swine Capacity Population Wet Pouttr}' C►►specify Population Cattle Capacity Population
Wean to Finish &MO 00 0 10 Layer
❑ Dairy Cow
❑ Wean to Feeder Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
1110
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9 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
4 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
X1.No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

)3�
Facility Number: — Date of Inspection —d
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
&No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3j 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z 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
RNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(3 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D9 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
FM No
El NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EKNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 WindDrift❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes K 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 [4 No ❑ NA ❑ NE
❑ Yes LgNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name _ —5 Phone: bo
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection �' 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
W No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PjNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I" No
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ 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
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;&No
❑ NA
❑ NE
Additional Comments 8' d/or Drawings:
Page 3 of 3 12128104

Type of Visit ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
f� Q. Arrival Time: �L� c'7 Departure Time: fi r+ O 0County: Region:
Farm Name: Iny�tr4,4.��� rti /L/& ✓S 2-CZ - Owner Email:
Owner Name: 4— Phone:
Mailing Address: a 6-2 � / �C
Physical Address: r�l
Facility Contact: Title: Phone No:G/?;7—
Onsite Representative: ��rsr -G Integrator:
Certified Operator: J�d�1 t✓ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = " Longitude: El ° =,
I=] u
JDesign 4 CurrentDeWacifopu
r�ent -�� WD;eZi SwineCapacityPoulation Wet Poultry Oplation r �Cepa� city_ P�opulakion
J
FE Feeder to Finish _ ,;;:
❑ Farrow to Wean
Dry Poultry
t?; ❑ Farrow to Feeder ;�
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑ Non -Layers
❑ Boars ❑Pullets
_ _ t ❑ wl
Turkeys -
Otherµ ❑ w
Turkey Poults i
y
❑ Other f El Other
Number of Structures:
❑ Wean to Finish
❑ La er
Wean to Feeder
- t7
❑Non -La et
DischarlZes & 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)
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
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 KNo ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
QNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
j4No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection 3--a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ENo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): ,3"`lam
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JQ 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
JO No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[)Z No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
KNo
❑ 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
Wo
❑ 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
WNo
❑ 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 types) ��S Gu 7� Ss�cf6ra.s 4 /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[ANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
K No
❑ NA
❑ NE
Reviewer/Inspector Name �T U C� , �.� Phone:' / 0//
r
Reviewer/Inspector Signature: Date: // 3-
12/28/04 Continued

Facility Number: 69 - pq Date of Inspection 3-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No El NA El 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
21No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5; 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
R) No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
� No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EQ No
❑ NA
❑ NE
12128104

(Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: Jo%air/a Tune: ��
O Nat Operational O Below Threshold
0 Permitted 13 Certified 13 Conditionally Certified 0 Registered Date -Last Operated or Above Threshold: _-- — ---�
Farm Name: rr. jixCr c „ A, County:_
Owner Name: _ _. _!�� �_��. �. _ 'Phone No:
Mailing Address:
Facility Contact: Title:._
Onsite Representative:
Certified Operator: �a u u
Location of Farm:
—_._.... Phone No: --
Integrator /V7r.r r ,2 %ij;e _Sroc.&w
Operator Certification Number: l f qd l
[R Swine 0 Poultry ❑ Cattle ❑ Norse Latitude ' < " Longitude 0 6 Qu
Mebarges & Stream
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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
Z/s ,f
❑ Yes ❑ No
A1114
❑ Yes ❑ No
❑ Yes 01 No
❑ Yes [;KNo
❑ Yes XNo
Structure b
12112103 Continued

FacMty Number: Cj' — 9 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes (p No
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 maintenanceltmprovement? ❑ Yes II No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 1P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 1P No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type e- r p i 3
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E� No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 7 No
b) Does the facility need a wettable acne determination? ❑ Yes q No
c) This facility is pended for a wettable acre determination? ❑ Yes P No
15. Does the receiving crop need improvement? ❑ Yes [. No
16. Is there a lack of adequate waste application equipment? ❑ Yes 14 No
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ( No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J3 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 [(No
Air Quality representative immediately.
Feld Copy ❑ Final Notes
ReviewerAnspector Name
Reviewer/inspector Signature: Date: D -O.5� d
12/12R?3 Condwsed

FarE ity Number:
Renuired Records & Documents
Date of Inspection �/o
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �j No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes IP No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;9 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes jp No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes No
27. Did Revieweranspector fail to discuss reviewhuspection with on -site representative? ❑ Yes ❑ No
28. Does facility require a follow-up visit by same agency? ❑ Yes [ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [] Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit 12) Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Beason for Visit (PRoutine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Datc of Visit: " d.?- D Time: 4' o
Facility Number I
Not O =rational 0 Below Threshold
Permitted -10 Cer ifed 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm name: e1'&'-a CtZ_ /Y"" Countv:
Owner Dame: /Wu" 4044-. �^Phone No:
Mailing address:
Facilit% Contact: �vh.0 i Title:
Onsite Representative: edic, VOu n 4'
Certified Operator: /?0 yOl!/14
Location of Farm:
Phone No:
Integrator: jet& �- A'yun_ LL4
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' �" Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acitti Po ulation
Wean to Feeder ❑ Laver ❑ Dairy
Feeder to Finish 1E] Non -Laver ❑ Non -Dairy
❑ Farrow to «`ear
El Farrow to Feeder Other
El Farrow to Finish Total Design Capacity pv v
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ S rav Field Ares
Holding Ponds / Solid Traps 0 JD No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
rg Dischae ori`inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discnarize 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 galimin?
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 anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: a/
Freeboard (inches):
05103101
❑ Yes [M No
❑ Yes ❑ No
❑ Yes
❑ No
N/� _
❑ Yes
❑ No
❑ Yes
No
❑ Yes
29 No
❑ Yes W No
Structure 5
Continued

a' . -
Facility Number of — 09 Date of Inspection -.%.� •Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes] No
seepage, etc.) t
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [P No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [9 No
11. Is there evidence of over application? El Excessive P/o�n'din/g �f El PAN El Hydraulic Overload El Yes ® No
12. Crop type 0 S &e_ `rrD2CX _!iG/cx' 3 Er -
s
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 ,L1pl, No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes [10 No
16. Is there a lack of adequate waste application equipment? ❑ Yes [W No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
W No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[19 No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
Cl Yes
[9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
❑ Yes
4 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
09 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
IM No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments refer to uestGzd Ezany-s k
Tarn an AYES answers andloran reCommeud ons or other comments:_""
-i•G
COC, No'f tece_ veve_ yak;
Reviewer/inspector Name I
Reviewer/Inspector Signature:
05103101
Field Copy U Final Notes
I•C3CG•L.� '1'�1Ck� IN
Date:
Continued