090155_INSPECTIONS_20171231

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090155 Facility Status:
Active Permit: AWS090155
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit
Routine
County: Biaden Region:
Fayetteville
Date of Visit:
03/31/2017 Entry Time: 02:00 pm
Exit Time: 3:00 pm Incident #
Farm Name:
Farm #2813728
Owner Email:
Owner:
Murphy -Brown LLC
Phone.
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
3603 NC Hwy 211 E
Clarkton NC 28433
Facility Status:
Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Farts:
Latitude: 34° 28' 10" Longitude:
78' 35' 35"
Hwy 211 east of Claridon approx..1 mile east of Elkton, NC_
Question Areas:
Dischrge & Stream impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: James C Smith Operator Certification Number: 17907
Secondary OIC(s):
OnStte Representattve(s): Name Title Phone
24 hour contact name Michael Ammons Phone
On -site representative Michael Ammons Phone
Primary Inspector. Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS090155 Owner - Facility: Murphy -Brown LLC Facility Dumber: 090155
Inspection Date: 03/31/17 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean 4,000
Total Design Capacity: 4,000
Total SSLW. 1,732,000
Waste structures
Dlslgnated Observed
Type Identit3er Closed Date Start Data Freeboard Freeboard
agoon 1 19.50 42.00
agoon 3728
page: 2

Permit: AWS090155 Owner - Facility : Murphy -Brown LLC Facility Number. 090155
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
DischaEges $ Stream Impacts
Yam},
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?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DW+O)
❑
❑ 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)
❑
❑ 0
❑
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
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yea No Na No
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 (Le./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed andlor managed through a
❑
M ❑
❑
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
❑
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 No
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ ❑ ❑
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%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: AWS090155 Owner - Facility: Murphy -Brown LLC Facility Number. 090155
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea No Na No
Crop Type 1
coastal Bermuda Grass w/
Rye Overseed
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy fine sand, 2
to 6% slopes
Soil Type 2
Wagram fine sand, 0 to 6%
slopes
Soil Type 3
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?
❑ 0 ❑ ❑
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?
❑ ■ ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑ ❑
Records and Documents
Yaa No Na No
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?
❑ 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?
❑
Weather code?
❑
page: 4

1 1,
se-h...M:x+e.
ivision of Soil an`?d Water Conservation' ❑ Other Agency
Mi Division of Water Quality E
0 Routine 0 Complaint OFFollow-u of DWQ ins ection 0 Follow-ue of DSWC review 0 Other
Date of Inspection ,Z 9
Facility Number O S Time of Inspection :aa 24 hr. (hhanm)
13Registered ®Certified © Applied for Permit ©Permitted 113Not O crational Date Last Operated: .............
Farm Name: �a*✓!d.... P Jw.� a. .............. County:.............. .................. .......................
Owner Name: ...O..Z.Ji.v...'t.........O"✓['hone No
...................... --
.....................................
Facility Contact:Title: Phone No: ,e �?Gl;..,to �......... . //......................................................... ...........................
Mailing Address:.....?.a-......liar l�f/,e'R�,e�. .et!:.. .c..1.O........................................... ..........................
l
Onsite Representative:....... ....... . 4. ._. .. Integrator: ....... S.r�(�?C[1�.�.....o�... _.�feS4lin✓.I
Certified Operator. ........... ............ 1��............................................. Operator Certification Number
Location of Farm:
Latitude •=' =11 Longitude =• 4 r'
x Design N Cuez ent,
Designer ° '<4�'
Cairre'nt`
� �,`�,�w � �x
^Aw4 '.,ry ?'+@
CaPac><h' Populatron. Patritiy u�Capactty�Populatton Cattle _Caac>rty ]Population
❑Wean to Feeder
El Layer $ ❑Dairy
❑ Feeder to Finish
❑ Non Layer ❑Non Dauy
W
® Farrow to Wean
l/GOd
El Farrow to Feeder
W s
❑Other
<.i'.^4•`k EC �}
" 3 Total Design Capacity
[I Farrow to Finish
e
yam`
❑ Gilts
K't A ek p T.
s Total- SSJI✓;`K
❑ $DarS
§ Z.
's9� C�;_-.,,ice,�
Pondsx
lltmtm"Eim�o
❑Subsurface Drains Present ❑LagoonArea
b-ldwg
Spray Field Areaw
'` ❑ No Liquid Waste Management System
µ
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes RNo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ' ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gallmin?
A. Does discharge bypass a lagoon system? (It yes, notify DWQ) ❑ Yes fZNo
3. is there evidence of past discharge from any part of the operation? ❑ Yes (ffNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? [IYes 19 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 1@ Na
maintenance/improvement?
6- is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P4 No
7/25197
Continued or: back
a`k

Facility Number: of — IS
8. Ade there lagoons or storage ponds on site which need to be properly closed?
❑ Yes *No
Structures (L.aQoons.Holdine Ponds, Flush tits, etc.)
9. Is less than adequate?
�S
storage capacity (freeboard plus storm storage)
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ................................... ..........................I ......................... .......... ...................................
......................................................................
Freeboard(ft): 3 sl ......................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes XNo
12. Do any of the structures need maintenance/improvement?
❑ Yes PjrNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes J'No
Waste Application
14. Is there physical evidence of over application?
❑ Yes 4 No
(If in excess of WNT, or runoff entering waters of the State, notify DWQ)
15. Crop type
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWW)?
❑ Yes PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IVNo
18.
Does the receiving crop need improvement?
❑ Yes
WNa
19.
Is there a lack of available waste application equipment?
❑ Yes
�'No
20.
Does facility require a follow-up visit by same agency?
)(Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑Yes
No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 No.vialatians•or. dei'idencies.were noted -during this'. visit - You.will i&e' ive•_661tirther•
::�corresporidenceab'outthis:visiti-:-;;-:�:-:--:• •:-:: :�:-`��•_• •..::�: .•.•. .•.•.�.-.-. :•
vC• 0 -i '%
S a
7125/97
���-
Reviewer/Inspector Name r' Q ors '` �' z
Reviewer/Inspector Signature: Date: 2.3 ?P2

_s 0 Diisioi of Soil and 1
t
E VM_lhv}sioa of Soil and=1
. Divvcina nf:Watpr Ot
JO Routine O Complaint O Follow-up of DWQ inspection O }Follow-up of DSWC review *Other
Facility Number Date of Inspection ,i Eao
Time of Inspection p 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified 13 Registered Q Not Operational] Date Last Operated:
Farm Name: ................60C ...I. -a$ County:......... d. ....`- ....c.............._...................
................�........--..........
Owner Name : ............... .� ...... �f .... it �..f.-.�'y�ti.t.............. Phone No:............L.� .-.... .'...� �.................
Facility Contact: ... I.......................................................................... Title Phone No:
Mailing Address: P..0' ffDx . .i.. �ikc� y...../ ��................ .... ..
................................. .......... ..............
Onsite Representative:. .............. L ................. Integrator: ...... .�,7ft;?�tl.. ........ �..�2. IW.
Certified Operator: .............. xt-JIM... Operator Certification Number:..........................................
Location of Farm:
Latitude •4 14 Longitude 0• �� �44
Design Current
bwrne
Design CurrentDesign Current
Poultry Capacity Population Cattle Capacity Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design .Capacity.:_. cxco
Total SSLW;:`._
Number of La' gooits"� i ❑Subsurface Drains Present ❑ I agoan Area ❑ Spray Field Area
Holding Ponds / so lid -Traps 4§ :
g p ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance inan-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If ves, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (li' yes. notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idcntif ier:
i�
Freeboard(inches): ......................................................................... .......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
/�b{e', S� visrf �4 M�o ` Ala., -ate �� seepage, etc.)
3/23/99 a4L _ o C6 Contiriued,q! back
S'.J:. ,, : � t� � `tt Wit' �++.atc�i!>v, , �i.rvrn k+*►� Yt�` s"J

Permit: AWS090155 Owner - Facility: Murphy -Brown LLC Facility Number: 090155
inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
yes
No Na No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
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
❑
E ❑
❑
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 No
26. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑N
❑
❑
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 file 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
❑
N ❑
❑
CAWMP?
33, Did the Reviewer/]nspector fail to discuss reviewfinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: — Arrival Time: I r: 3 : Departure Time: 3 County: `oe�tr Region: rRo
Farm Name: ✓,ram COwner Email:
Owner Name:�/3 noir-, L L C_ Phone:
Mailing Address:
Physical Address:
Facility Contact: %'ll %eZ ,�� -.-y +zf Title: 4,tn,14� Phone:
Onsite Representative: �o�,1e� Integrator: Aftl'W4 a/azy.-L
Certified Operator: Certification Number: /7 q0 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design, Gurrent : Design Current
Design Current
Swine Capacity Pop WetPoultty Gapactty Pop
Cattle Capacity Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder Non -La e
airyCalf
Da' Heifer
Feeder to Finish
Farrow to Wean O h r, Design Current
}
:..
Dry Cow
Farrow to Feeder D .,foul Ca act Po
�'
Non Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
'`. Turkeys
Other ' Turkey Poults
Other 10ther
Dischar¢es 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)?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
[]No
[]NA
❑ NE
❑ Yes
[]No
0 NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [] No
❑ Yes 12 No
[:]Yes CK-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412011 Continued

Facility Number: Date of ins ection:
7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!a No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): N Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
5gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 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 Z[ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, eta)
❑ 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): _ /Jp B ZaJe X _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [7l No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E1 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo [DNA ❑ 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 R) No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes V) No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of ins ection:
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 0 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 B No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
gLNo
❑ 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
[g No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3No
❑ 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
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional naees as necessarv).
Reviewer/Inspector Name:
s7—r-y G Phone: /�70J y3J`33Oa
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

v
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grxoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: 33 o Departure Time: ;per County: Region:
Farm Name: C$0G Owner Email:
Owner Name: d '.T LL G Phone:
Mailing Address:
Physical Address:
Facility Contact: a Title:
Integrator: d eveal `
Certification Number: /?90Z
Onsite Representative: S�
Certified Operator: 7�,ys jam;
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
r "�
Design
Current
Design Curren#
Swine
Capacity Pap. '
a Wet Poultry x
Capacity
Pop.@tittle
Capacity Pop.
Wean to Finish
-
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
".
-
- ''
Dairy Heifer
Farrow to Wean
0000
Design
Current
Dry Cow
Farrow to Feeder
.,Ur Nl',ouIt . • '
Ca aei
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turke Puults
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 fR No ❑ NA ❑ NE
❑ Yes ❑ No
[::]Yes [:]No
[—]Yes [:]No
[—]Yes L,No
❑ Yes V,No
❑NA ❑NE
❑NA ❑NE
❑NA ONE
DNA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: - ,j' Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural pins 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): - — -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R 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
10 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR 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): L-16
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
21 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
E] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
( No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LR No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes JR 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

F'acili Number: - ne-s— DateInspection: —/97
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo ❑ NA ❑ NE
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [SNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes I] No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
2$_ Did the facility tail 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_c., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [S No ❑ NA ❑ NE
[:]Yes ZLNo ❑ NA ❑ NE
❑ Yes [�![ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Z 'e, �`j G(h"o'er Z"" i j3"i't7
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �f0"3� :33oQ
Date:
21412011

F."
Type of Visit EMompliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit C7 Routine 0 Complaint 0 Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: �1=/� Arrival Time: ° Q O Departure Time: County: L34''L- Region:
Farm Name: arm z - Owner Emad:
Owner Name: 1w ve r ." L L Phone:
Mailing Address:
Physical Address:
Facility Contact: rn r- �" Title: L /ills r-r Phone No:
Onsite Representative: Integrator:
100
Certified Operator: 0'a- q Z . Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 0, Longitude: =° [=,
Design Current
Design "urrent
Design Current
Sw�ue Capac�ty�rxlPopulat�on
WetPnult�ry
CapacityPopplahoq
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
Layer
❑ Dairy Calf
❑ Feeder to Finish
*'¢�
❑ Dairy Heifer
❑ Dry Cow
Farrow to Wean
D . Point :-.
`_
❑Non -Dairy
❑ Farrow to Feeder
❑ La ers
El Farrow to Finish
❑ Beef Stocker
❑Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other & ❑ Turkey Poults
❑ Other
I ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
ER No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P-No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 9- ^lam Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JgNo ❑ NA ❑ NE
a. I f 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): j g22
Observed freeboard (in):a'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�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 29-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 9No ❑ 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:1 Yes RNo ❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) )C_:f�}X
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DjNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[RNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9-No
❑ NA
❑ NE
Reviewer/Inspector Name I �- �► Phone: 3._71 _7_701n
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection6//
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [?I -No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[jNo
❑ 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
[R No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ 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
[Z 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
RNO
❑ 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
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
59.No
❑ NA
❑ NE
Addition al.Comments and/or Drawings:
H
Page 3 of 3 12128104

Ficili kNuni6er
Type of Visit 0,do-mpBance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Ifatc nr visit: -- (i-j -Irrival Tirne: Departure Time: County:
Farm Name: Q t/1 -,f�' /� Owner Email:
OK ner ,lame: AILIV426
7 4 ?) LtJ� L-. L Phone: _
Mailing, Address:
Region:
F�
Physical Address:
Facility Contact: iG Dfr 'Title- Phone No:.
Onsitc Representative: Integrator: 171
Certified Operator: C r!5 S �� Operator Certification Number: I796
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish _
❑ Wean to Feeder
❑ Feeder to Finish
JZ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑o Langitudc: =o = ` = µ
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
UVj
Dry Poultry
Non -
Poults
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidenoe 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 0,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: q -^ /j Date of Inspection -/O / D
Write 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 ? Structure 4
❑ Yes 1KNo ❑ NA ❑ NE
❑ Yes �d No ❑ NA ❑ NE
Structur4 5 Structure G
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
(KNo
❑ 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
R No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
� 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
LgNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
f allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ER -No
❑ NA ❑ NE
❑ Excessive Ponding [:1 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]O Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) GO t-yt`-
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
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
P,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5&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):
Reviewer/Inspector Name .v.._ Phone:
Reviewer/Inspector Signature: Date:��� /
12128104 Continued

Facility Number. — 53 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [NNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
.3.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
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
O No
❑ NA
❑ NE
Othcr Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(FkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
)ZLNo
❑ 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
IN 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
[RNo
❑ 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
UNo
❑ NA
❑ NE
I2/28/04

sion of Water Quality -1
Facility Number~ O Division of Soil. and Water Conservation
Q Other Agency
Type of Visit (bRmffipliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit EYlioutlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: , i a D County: r ' Region:
0
Farm Name: Fa +`►�'_ �� � ff Owner Email:
Owner Name: RroV u.1_ _ _ - 1 t✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: F Title: ate[
Onsite Representative: r Gl rS
Certified Operator:
Back-up Operator: `r— I
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: / 77
Back-up Certification Number: 1
Latitude: = o = 1 Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current...,;_
Cattle Capacity P'opulat 6 i ,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:ED:
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 [N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EN No
❑ NA
❑ NE
❑ Yes
[NNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
y
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
mNo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KNo
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9 No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
di rrm�T
Reviewer/Inspector Name , i� Phone: 9y &.U-J3Dt>
Reviewer/Inspector Signature: Date: —
{L/LWV'I VV!{l{!{HGlI

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

Type of Visit ADir"ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit E3 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Zj
Date of Visit: Arrival Time:.'U Departure Time: ; 5 County: iiii Regionl! 7 0
Farm Name: t illwil— C /\
23 O G } Owner Email:
Owner Name: _ /�'I �: o b4z,_ L C— Phone:
Mailing Address:
Physical Address:
Facility Contact: 0V -5
Onsite Representative:
Certified Operator:
Back-up Operator:
Operator:
Location of Farm:
Title:
Z!!X, Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = { Longitude: = ° =
ii
pill
Design
Current
:„.
Design_ "" Current Design
rent
Swine
Capacity
Population V1'et Poultry
t:apacih i'opilatian Cattle Capacity
Population
❑ Wean to Finish
❑Laver
❑Dai Cow
❑ Wean to Feeder
n-Laver
iry Calf
` ❑ Dairy Heifer
` r " ::; ❑ D Cow
�. �:"�"�,
❑ Feeder to FinishvI'
qooc> olt
Dry P�ury
® Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
10 Beef Brood Co
❑ Boars
El Pullets
❑ Turkeys
Other "-
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Disci ies & Stream Impacts
1. Is any discharge obsen ed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ;q No ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
f4 No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

Facility Number: g — ,j Date of Inspection 1,2 �Z-Ld
Waste Collection g Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V4No ❑ 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): a O
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C4No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes [KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 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) e-ben :
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
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
r lrsV L of . I L/LulvY l Urirrrrgru

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check ❑ Yes J4 No ❑ NA ❑ NE
the appropirate bok. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
K No
❑ NA
❑ NE
23.
if selected, did the facility faii to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E& No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(ANo
❑ 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
MNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PQ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
Q 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
El No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128,104

Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: _ Arrival Time: , G ` Departure Time: / County:
Farm Name: �d're" ���� � E> Owner Email:
Owner Name: tC7Cy f�kS �� �/� ��'r+a� Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: (jy/ 3 '_CA ] La Title: PhoneNo:
Onsite Representative: Integrator:
_ Integrator: A.v�'C9
Certified Operator: ' V i✓%/7?� 6r• Operator Certification Number:�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = " Longitude: 0 ° 0 t = "
Design Current rUesign Current Design Current
rCapacityPopulation �W,et Poultry Capacity Population Cattle Capacity Population to Finish ❑ La cr ❑ Da Cow
to Feeder ❑Non -La er ❑ Da' Calf
er to Finish "Da' Heifer
w to Wean 9O�❑ D Cow
oultw to Feeder'"' " `
❑ Non-Dairyw to Finish ers❑Beef Stocker
Non -La ers❑ Pullets❑ Beef Feeder
❑Beef Broad Co�, ❑ Turke s�''❑ Turke Pouets ❑Other N�tmberof Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
09 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
21 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — �j Date of Inspection
Waste Collection & Treatment
} 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 0
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X 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 4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes r-' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [0 No ❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect 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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
i
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
(KNo
❑ NA
[j 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
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ 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):
i
R
Reviewer/inspector Named C Phone:
Reviewer/inspector Signature: Date: 2 —,7, �� 7
12128104 Continued

Facility Number: T- , j Date of Inspection D%
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JB No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5d No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A 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
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CR No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IM No
❑ NA
❑ NE
Comments and/or
12128104

Type of Visit Otompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t34routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: ���: 3 D Departure Time: County: +ram"' Region:
Farm Name: rG Owner Email:
Owner Name: 3f Du. 'yi.S or Q,rs L1naL_ Phone:
Mailing Address:
Physical Address: ��++
Facility Contact: 15 0777 % Title: Phone No: 42 ct3®;7
Onsite Representative: `S— Integrator:
Certified Operator: l��r��!Z �/Dr.!Jr� _. Operator Certification Number: e2j.�7a;>
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = = « Longitude: = ° = 1 0 "
urrent
Desigfflol
- .,;µ Design Current
Design Current
Swine Capaculation
MkWetioultry� Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Da Calf
❑ Feeder to Finish
�'
❑ Da Heifer
® Farrow to Wean D (&�e7
Dry 1'ot3ltry� ?�
❑ D Cow
❑ Farrow to Feeder
a .� = <,: _„
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
Lay
❑ Beef Stocker
❑ Gilts
-Layers ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
QQ 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
RNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JO No
❑ NA
❑ NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CkNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1 Facility Number: -- Date of Inspection
1
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
R No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 6,2
Observed Freeboard (in): 3,7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 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
9No
❑ 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 5Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ER No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes �No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below, ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s) AV
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or any recommendations or any other comm nts. ti
Use.drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 910­4(33-333c2
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

I Facility dumber: I ' — Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
11 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5ANo
❑ 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
Dq No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
QIVo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LK No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
IgNo
❑ 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
ES 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
BNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0,NO
❑ NA
❑ NE
Additional Comments and/or Drawings:�3:
Page 3 of 3 12128104

Type of Visit
Compliance Inspection
O Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date of Visit, /�Q ' Arrival Time: ! 0 Departure Time: ' County Region: _ FR a
Farm Name: a r rn -'o �{73 OG Owner Email:
Owner Name:.T&,ro 'ry tJ N-lti Phone:
Mailing Address: D Zs O X 7,5-19 Ste- �f: /l Ale • o'�>ls�
Physical Address: l� !I �'at�f> Y�--L
Facility Contact: && , i-rn-cam_ —Title: Phone No:
Onsite Representative:. __.r- ell Integrator: X'_bw^_
Certified Operator: Vitz L Operator Certification Number:' 'r - —
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: 00 =' Longitude: =° 1--l' ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�. ❑ Non -Layer
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Other
❑ Other --- - - -
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El 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
El Dairy Cow
El Dairy Calf
El Dairy Heifer
I
El Dry Cow
ElNon-Dairy
El Beef Stacker
El Beef Feeder
El Beef Brood Cowl
i
c. What is the estimated volume that reached waters of the State (gallons)?
s
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
gZNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection lv_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C2 -
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 9No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[I.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
[QNo
❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
21No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) C e& Z 9117lea-l-
13. Soil type(s) _ � 44 y-3
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
KNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
t4 No
❑ NA ❑ NE
rQd m'C ! .S �J 6
Reviewer/Inspector Name Phone: / 3�
Reviewer/Inspector Signature: Date: I/0���
16/L6/V4 uonunuea

Facility Number: / Date of Inspection
Re uired 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 [8No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
54 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5d No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EHNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CKNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g[ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W 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
K 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
51 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9jNo
❑ NA
❑ NE
Additional Comments aizdlor Drawings::
12128104

(Type of Visit i Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit IF Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visit: Time: ' �
Q Not erational Q Below Threshold
Ml<'ermitted 13 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: F e'" •� li _ County: eo14 F/�n
Owner Name: +t�tpp +c -.-.. a l� .. ea ke dl...... .. Phone No: q/d
1Viat7ing Address: /V L --- `f;`----------
Facality Contact: l►la /f Q u emSK---------- Title: Phone No:
Onsite Representative: 1,4_1f 10 e�r�41 .00--/_cr.1._ integrator_
Certified Operator. _T '41"n-------- f/yo �r.., _ _ Operator Certification Number:? -
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude • �u"
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation? ❑ Yes I1Zo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes 2140
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E�,Ko
c_ if discharge is observed, what is the estimated flow in gaUmin? —�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Lt Xo'
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ml o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 91 o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 21V0
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — 1
Freeboard (inches):
12112103 Continued

_ Facility Number: -- f Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes is<o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes + No
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 010
9. Do any stuctums lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [�No
elevation marldngs?
Waste ApElfication
10. Are there any buffers that need maintenances improvement? ❑ Yes [JNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
70b� /4Ai/frG i3o /y�
12. Crop type Snv�.11,n _Cs.� fih�a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �io
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 24
16. Is there a lack of adequate waste application equipment? ❑ Yes [� No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 01 o_
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Bfo
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.
❑ Final Notes
ReviewerAnspecter Name
Reviewer/Iaspeetor Signature: ��� _. Date: /O>6 -o y
12112/03 Condn ted

Facility Number: y ? r s— Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility L4140 have all components of the Certified Animal Waste Management Plan readily available?
(it1,WJ1T, ch,pldlsits, de5sig , etc.)
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application EWwebea ❑ ❑'Sail -Sampling
8-J3 ,) j y G -» 2 �. 5' � � , r7' a Le -zp� -"y 2 � z
24. Is facility not in Compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑-StocWmg—Fw ❑ e.op Yield Fmm [ 4kni fall
❑ muw4aqwguons ❑Form
❑ Yes EW'o
❑ Yes 91-M
❑ Yes G[,h
❑ Yes Leo
❑ Yes Olo
❑ Yes
❑ Yes [3No
❑ Yes 13f4o
❑ Yes , G o
❑ Yes GIC
❑ Yes ERCo
❑ Yes FKO
❑ Yes ONO
❑ Yes QNa
❑ Yes 9-141,
12112103

Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification S Other ❑ Denied Access
Facility Number Date of Visit: I Tune: `t 00
O Not rational O Below Threshold
ES Permitted 01 Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ...•.....................
0 G � a 8 County: �. �!! F 12 0
Farm Name: ---- �.............,� _.�...__._.......
Owner Name: Qj►d /� �"
.. .t�t.M>s..._.....Q �... 1,.r o.k� *t s .......... Phone Na: _.Ci._1.O .2 6 1 Ob
__.P_._._._._._._....._._.``�Maaltn Address: ........................ —------- --- _ N C �YSB...
Facility Contact: ..... W - (4.. iz u.. `M'� .......................Title:..... ¢� � Y''�'��--... ....... Phone No:
Onsite Representative: ....... A—J a ra LJ oe 4 e•.� _ Integrator:
Certified Operator: .. p114u __.....__.. _ . 1r� ..fi�.�.............. _..._... Operator Certification Number: ��...._. �....._. __.
Location of Farm:
10 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & && Longitude ' 4 �u
Discharges - Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galtmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identitcr:. .............I................. ............................ _..... .................. _....... .................
Freeboard (inches): a / ,,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [g No
❑ Yes [j No
❑ Yes ❑ No
Structure 6
12112103 Continued

Facility Number: 0? —/, � Date of Inspection 3. 7 ~ 650
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoolication
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
e) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reouired 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?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ict discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Use draw nZiiof4faclh to better a =lam s�fuations + useraddittonalany recommenila�oas or any uthercommen#s,
Comments refer to uestion E Isut xn YES answers and/or
cc.k
ty '� ( Pages as°necesj
w ® Field Copy ❑ Final Notes
11 I may: v, �: M
'V iJ i7G�- vCC wG p jaC.c w +L' �c,.cs♦icc) riab
LAJ CA� r P Y e S G f+ A r d ca-a Gait. ► 4 /c r + f tii � CC Lf.�.'�l1 1 o r. ca&
�f �l t. y)Ka� n s y 4 b O Gam+ p o SS tip j 4i, r p la j /C Nlr1x. i h C �� ~ *'a s4 cot i- W C r c 1
rt
t~fcts iR..s+ S 6 c
GC�o tic a►+. ar.d2Usa4jG
GoAJfadncW_,tI•Care.4c__,tc�
4.e�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 4 Continued

O Routine O Com Laint tp Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
p / S'-S
Time of Inspection /z :b-o 1 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex.1.25 for 1 hr IS min)) Spent on Review
® Certified ❑ PermittedI or Inspection includes travel and processing)
❑ NotOperationalDate Last
Last Operated:.... _..._ _.... _..._ ..... ..._..... .7._....... ........ ...._ ... _.....�.....�....
Farm Name: — .1......�.�....T__..—�......._ .._ _ �.. _ _._ County:.....111i�J._ ....�......._ . _
/_•�` ��' Phone No: r f� Land Owner Name:....�}��:� � _..5..-....�'� �._. l p .2ltz� GU
Facility Conctact:.... ........ .......... Title: Phone No:
Mailing Address: � � � ��7 �%i� mod✓„� f t/ L . !7Q 3 %2.. ._.. _ _ ....... � _� .....
Onsite Representative:...., o! ..�1 �-�-4% �. Integrator:
Certified O p e r a t o r: __. .... Operator Certification Number: Z O2Q
- .... ...1- _ _... _...
Location of Farm:
Latitude • & u Longitude 0 4 �K
Type of Operation and Design Capacity
m� pus - k..,� ,«er^'�S`^
Design Current za 'Design. Curren[ CDesE n Current
Sw ne Ca"aci Po` uliition Pguttry _.: Ca ac�ty<, I?o elation attle N Ca aci ' T ulatlohy
:.
❑ Wean to Feeder FU_
La ❑ Dairy
❑ Feeder to Finish Non La er ❑ Non Da
Farrow to WeanVM
�.. 3 a 3
Farrow to Feeder Total DesigM.CapacityJR.�F
Farrow to Finish��
' x ❑ Other
•:.,��'w,"^"' � ;?4e.�.:,-, n+-r� � _ :.a.sue a`�-v:;k.,r�,,..>....w •''�^d+,v�:m;, �»�Kd�t+ti.'ir�m�.,:.}�4?¢.,'ero'.:�.,a., "..�Szt��{�x,r�. osav .w. .,,..
Numbeof Lagoanshl Holding�Ponds / ❑ Subsurface Drains Present
a oon Area: Spray Field Area3
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other ��
a. If discharge is observed, was the conveyance man-made? ❑ Yes ANO
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes NO
c. If discharge is observed, what is the estimated flow in gallinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes {No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes )ZNo
5. Does any part of the waste management system (other than Iagoons/holding ponds) require ❑ Yes JV No
maintenance/improvement?
413Q/97 Continued on hack

Facility Number: .... . .... —._.T....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes yj/No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes XNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structureaaoon. and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? 9Yes 0 No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes IoNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes kNo
12. Do any of the structures need maintenance/improvement? ❑ Yes N(No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes �No
Waste A licati u /
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) [
15. Crop type !' ...-....... ... .......... ....... ............ ....... ....... ..... --..... __......... _.. - -.................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? XYes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes >(No
18. Does the receiving crop need improvement? [Yes ❑No
19. Is there a lack of available waste application equipment? Y ,No
20. Does facility require a follow-up visit by same agency? A(Yes ❑ No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ANo
Eor Catified Facilitics
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
24. Does record keeping need improvement? ❑ Yes No
-Comments (refer to question # Ezplatn"any YES answers:and/or;any recommendations or any.other comments: x V
Use.drawrngs"af;facility to Setter explain situattons.i(use aildtttonal.pages ras necessary):
f�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

0 DSWC Animal Feedlot Operation Renew
® DWQ Animal Feedlot Operation Site"Inspection
0 Routine 0 Complaint O Follow-up of DNV inspection 0 Follow-up of DSWC review O Other
Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
IN Certified ❑ Permitted
Date of inspection L7-/[>-fi [
Time of Inspection /1 =o ca 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review C�
lor Inspection (includes travel and Processine)
❑ NotOperationalDate Last Operated:
Farm Name: „ F2�` - �' -�� County:
Lead Owner Name: Phone No:
�=�•........-�.�.��'��.�.-� w'� - - - -
Facility Conctact: — Title: Phone No:
Mailing Address: 17
Onsite Representative:.
Certified Operator:
i"
Location of Farm:
Latitude 0 & QK Longitude 4
Of Vneration and
integrator: —
Operator Certification Number: ? 0, 017—
Design Current Design .';:';,Current Design Current
Swine Ca aci Po ulation Poultry ,u. Ca achy "'Po Mahon Cattle' . Ca aci Po ulation
0 Wean to Feeder 10 Dairy I
❑ Feeder to Finish Non -La er ❑ Non -Da
Farrow to Wean
low.y
rl Farrow to Feeder Total Design Capacity
Farrow to Finish h w
Total SSLW '
❑ Other
Number of Lagoons / Holding Ponds / Subsurface Drains Present f
❑ Lagoo 10 Spray Field Area
1. Are there any buffers that need maintenance/unprovement?
Z. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man -trade?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
4130/47 maintenance/improvement?
❑ Yes to No
❑ Yes J] No
❑ Yes ANo
❑ Yes �3 No
❑ Yes ;)_1No
❑ Yes .9 No
❑ Yes )z No
❑ Yes a) No
Continued on back

Facility Number: _......—
..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes XNo'
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes No
Structures (Lagoons and/or Holding P_ onds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
XYes © No
Freeboard (ft): Structure 1 Struchire 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes /MNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes kNo
12, Do any of the structures need maintenance/nnprovement?
0-Yes -tk'N6
(If -any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
❑ Yes 0
/
Waste Application
14. Is there physical evidence of over application?
❑ Yes 'No
(If in excess ofWMP, or runoff entering waters of the State, notify DWQ)
C
15. Crop type __b -C=42'
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Xyes d No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes XNO
18. Does the receiving crop need improvement?
X Yes ❑ No
19. Is there a lack of available waste application equipment?
e4 Y ,o
20. Does facility require a follow-up visit by same agency?
"Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
for CeXtified Facilities
22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available?
❑ Yes No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
24. Does record keeping need improvement?
❑ Yes No
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):
. _ i/L,� f^-Z,E/-.��i-f .r,?� / "6JQ.��✓ �Cfl . r;�,�4�ii4..� ,�/!':�T��. L..;�--
i f' !'
}.. ,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc: Division of Water Qualij); Water Quality Section, Facility Assessment Unit 4/30/97

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSO}'C review ® Other
Facility Number , Date of Inspection a—a9
Time of Inspection ; oca 24 hr. (hh:mm)
Xpermitted 9certified [3 Conditionally Certified © Registered Q Not Operational Date Last Operated:
Farm Name: ................ OC..... � 020 ..... ...... .. County:............ Z%.............��._................_....---......
.. _.. 1L Grtl
Owner Name: d1� � 5 j� 7 Phone No: .....�....�........~............................
...... .......
............ ............ ........... .............. %.._......... f................._�........... gg /eno
Facility Contact: .............................................. Title: Phone No:
.Mailing Address: ............ . a.'.............T,�.1......................................................... ..---•--...... ";.trScr...... .. C...---............... .._._..__...
83 �g-
Onsite Representative: ............Q................l...R% l Se�.� ............................ Integrator:�ClL�!' !..r.`�`•
.....4r.........
Certified Operator: .........!:i.G.'... .............. �. Operator Certification Number:... .......................................
Location of'Farm:
A
............................. ................................................... ............................ I ....... ..................
Latitude 0 • �� ��� Longitude • �`=
Design Ct><rrent Desrgn ;Current Design Current
Swine. Ca�act Po 'elation. Poultry Ca achy: Po elation Cattle '$city r=Po elation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean Lkx� �� rt
Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars Total Ssuw :
Number of La Dons' ❑ ❑ Spry Subsurface Drains Present ❑ Lagoon Area 5 ra Freld Area
ii6on
Holding Ponds Is M
Traps¢ ❑ No Liquid Waste Management System,
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? cA rk Ia�0,,j jpm), ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made". ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ElNo
Structure I Structure ? Structure 3 Structure d Structure 5 ucture 6 s11
Idcntili�r: /
Freeboard (inches): ! �r x
/
5. Are there anv immediate threats to the integrity of any of the stru tures observed? (ie/ trees, severe erosion, o
A� D aim S! Vi5ri✓ieepage, et .)
3/23/49 ,��, r �,� Urfiyr Continued on back
S vv
e

FFDivision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit PCompliance Inspection O Operation Review AZ Lagoon Evaluation
Reason for Visit O Routine O Complaint AFollow up O Emergency Notification O Other ❑ Denied Access
Facility Number s" Date of visit: ZS=QD TiHne: Printed on: 7/21/2000
O Not Operational O Below Threshold
Permitted ❑Certified ©Conditionally Certified ❑Registered Date Last Operated 1or Above Threshold: ............
Farm Name: DC #1 2� Count.':..-.. IC2d�?.��........................................
•......
Owner Name: .....D43nj............C�?.r:�.i;`tc Phone No:
..........�..L....r.....��.................................... ........... ......
Facility Contact: ...11.... .. n.... r S ^� ....................... Phone No:................................................... Title: '
MailingAddress: .......... ..BOA....... Y-F-.7............................................ ............................
OnsiteRepresentative: ---------- -Jf...........................................................................................:...Integrator: ......................................................................................
Certified Operator:...-.s�-..vl..h r^.................
.....
.c:J-.................................... Operator Certification Number: ........ ........ ..-........................
Location of Farm:
A
[]Swine ❑ Poultry []Cattle []Horse Latitude ' ° Longitude �• �4 C�cc
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to VVcan
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 0—ry
❑Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ I-a-,-n Area 10 Spray Field Area
Holding Ponds I Solid Traps �� ❑ No Liquid Waste Management System
Dischumes & Stream Impacts
1. is any discharge observed from any part of the operation:' ❑ Yes No
Dischame ori(rinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Il-discharge is observed. was the conveyance ratan -made? ❑ Yes rN
o
b. Ifdisc:hur«e is observed, slid it reach Water of the State.' (If ves, notify DWQ) ❑Yeso
c. 11' LhS barge is obs%:rvcd. what is the estimated Ilow in gathnin"
d. Does dischame bypass a la,oun system:' (if yes, notify DWQ) -❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a dischargc? ❑ Yes 9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate:' ❑ Spillway 0 Yes ❑ No
Structure.I Structure ? Structurc, , Structure 4 Structure 5 Structure b
Ide n t i f i c r: .................... ....... .............. ...................... ................... ................. ....................................
Freehoard (inches): � —
5/00 Continued on back

Facility Nurtber:Q9Date of Inspection-ZS`_-11J I Printed un: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed" Oe/ trees, severe erosion. ❑ Yes ❑ No
seepage. etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑Yes
❑ No
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement'?
❑ Yes
❑ No
11, Is there evidence of over application'? ❑ Excessive Pondin., ❑ PAN ❑ Hydraulic Overload
[] Yes
❑ No
12. Crop type
11 Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
❑ No
14. a) Does the facility lack adequate acreage for land application'?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination'?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
Cl Yes
❑ No
16. Is there a lack of adequate waste application equipment'?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit rcadily available?
❑ Yes
❑ No
18- Dues the facility fail to have all components, of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard. waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time ol'desiLm'?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
❑ No
22, Fail to notify regional DWQ of emergency situations as required by General Permit'?
(le/ discharge, freeboard problems, over application)
El Yes
[I No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency'?
❑ Yes
❑ No
25- Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
.. .. viol".attc.. . lief cieneies v� ..noted during �>t�is:v. . . ...Hill re. a x. . #'tti•ther
corresptn dense: about: this visit ..::..: ::: .. : : :. . .. : : ...: .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): q
14•5jr- "-5- �s G1t 1417aa7 - /L'rJe �C Mir cr ,2T wQS l a�S .lIP s/fbc tcJ(. /3u
5 �cCc I �.tSPB iGy�. eif- A6 A+ we4 r- (/I fr. pr rti GtQ�P/4�rP� rA �t��j { t�Ve_
1 Ca i��d Keu�' c1 �e57a� O t- �rou� n �! c-d ui5ed �: w/ a7- d l5cr�lQ�.tr Y a �So Q�4/1i�
.1� Q 5 Jay p /�,0-r Qdiat � Axe-,icko , /� �I"lird +Lte
Shy i ooII %u�/ �,s,'/ reT r� lug lev��. spd �e /�
D,,), 5 Q �d r ,- /a CI,C4 le-aw a r.,d L 6 " M a- ,� -Z� -:� a.,,..� reel /Qdc F & Im' e .
L ajird5_j / 4 ' eores)de/,cJ � yyr S__ .
- - -- _ �S �. e;►�+�r9Grccy' s'r cx m-��, LeU�� a}aSS��,
Reviewer/inspector Name -� y
Reviewer/InspectorSignature: ,�,� Date: 5100