090168_INSPECTIONS_20171231

�.AM
NORTH CAROLINA
Department of Environmental Qual

(11 -5 111 �00
Di'vislb of Water Resources
Fau#lity Number � -Lib o l � Dlvislon of Soi! and Water Conservation
Other Agency
Type of Visit: om nee Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routlne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: u ( Arrival Time: Departure Time: r ooCounty: Region: ff
Farm Name: o o dC ` L 'FrA ► t 1 Y'F" Owner Email: `i—
Owner Name: i`G"l o a5 6- 0 c P"4 Phone:
Mailing Address:
Physical Address:
Facility Contact: et, V._4 13 (3CZu- C4-i L Title: Phone:
�c
Onsite Representative: Integrator: — 57
Certified Operator: b f✓ t`I Certification Number:
Back-up Operator: KeA4or �s�� Certification Number: (� �. G 3
Location of Farm:
Latitude:
Longitude:
Uesign Current
Design
Current
Design Current
Swine
Capac[ty Pop.
Wet Poultry
Capacity
Fop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Q O
0
Dairy Heifer
Farrow to Wean
WDeslgn
Current
D Cow
Farrow to Feeder
Dr, Poulcit
P.o
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthcr
Turkey Poults
Other
Other
Dischar es and Stream impacts
I. is any discharge observed from any part of the operation?
[:]Yes
1o❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Q A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ 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 observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!j'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Dumber: - Date of Inspection:
Waste liollection & Treatment
4. Is sttirage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Z[>�NA NE
❑No A ❑NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
02-Na❑ 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
❑moo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� N9/❑ 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?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0-1Qo ❑ 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 D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): At o
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes E]*—No [3NA ❑ NE
❑ Yes a<o ❑ NA ❑ NE
❑ Yes [�-Ko ❑ NA ❑ NE
D Yes ❑1lo ❑ NA ❑ NE
❑ Yes [] C ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
fo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L-0,Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes to ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facil[ Number: - Date of Ins p ection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-NQo o NA ❑ NE
25. Is O'e facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ado 0 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 ❑�❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [3-Ne-0 NA ❑ NE
[]Yes [B'Ko ❑ NA ❑ NE
❑ Yes ED-Na—❑ NA ❑ NE
❑ Yes �o ] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o r 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 #) Explain any,YES answer's undloraiiny edditiDnai,ke' coi Imendationsior`any;other comments �oaf };
..bganecessarydrawinfaci"Use ),.
Codk(o-1 1�3C,C17 18
c-(A( ad0-308- 6es(
Reviewerllnspector Name: t U
c
Reviewer/Inspector Signature:
Page 3 of 3
ZC�(6
Phone:J,�6 3J
Date: r
21412015

7 00
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090168
Facility Status: Active
Permit: AWS090168
❑ Denied Access
Inpeection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County:
Bladen Region:
Fayetteville
Date of Visit:
12/05/2017 Entry Time: 01:30 pm Exit Time: 2:30 pm incident 9
Farm Name:
C.E.R. Inc.
Owner Email:
Owner:
Ronald Coleman Hutchinson
Phone:
910-645-4459
Mailing Address:
PO Box 397
Elizabethtown NC 28337
Physical Address:
3874 NC Hwy 87 E
Elizabethtown NC 28337
Facility Status:
Compliant ❑
Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
34` 35' 34" Longitude:
78° 33' 41"
Two miles south of Elizabethtown, Farm is an the right
Question Areas:
Dischrge & Stream Impacts
Waste Col, Star, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Ronald Coleman Hutchinson Operator Certification Number: 17960
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Calibration Sept 15 Sludge Survey Extension to 21-31-2018
page: 1

Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number. 090168
Inspection Date: 12/05/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 5,880 4,100
Total Design Capacity: 5,880
Total SSLW: 793,800
Waste Structures
Dislgnated Observed
Type Identifier Closed Date Start Date Freeboard Freoboard
Lagoon 1 19.00 27.00
Lagoon LAG 1 19.00
page: 2

,J
a
Permit: AWS090168 Owner - Facility: Ronald Coleman Hutch Facility Number: ' 09016B
Inspection Date: 12/05/17 Inpsection Type: Compliance Inspection Reason for Vlsit; Routine
Discharges & %ream Impacts
Yoe
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?
❑M
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑M
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
■ ❑
❑
3, Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Mate Collection, Storage S Treatment
Yes
No Na—No
4. is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6, Are there structures on -site that are not properly addressed and/or managed through a
❑
E ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
ate Annlicatlo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number: 090168
Inspection Date: 12/05/17 1npsection Type: Compliance inspection Reason for Visit: Routine
Waste Anallcation Yes No Net No
Crop Type 1 Coastal Bermuda Grass
(Hay)
Crop Type 2 Coastal Bermuda Grass w/
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
Goldsboro
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
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
N Cl
❑
Records and Documents
Yes
No No Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

•
Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number: 090168
inspection Date: 12/05/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
orris and Documents
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
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
N ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑ ❑
�therls8}IBS
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑ .
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
■ ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon I Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

TyOe of Visit: CFCompliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: OlRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other f0 Denied Access
Date of Visit: Arrival Timer Departure Time: ee ounty: '�f Region:
Farm Name: Owner Email: 4
Owner Name: /i Phone: �...
Mailing Address:
Physical Address:
Facility Contact: _ Title:
Onsite Representatives 1 Integrator: S
Certified Operator: G RC 1 i4K" Certification Number: r 7 ? 0
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity I'ap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
n
I
INon-Layer
I
Dairy Calf
Feeder to Finish
WTO
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? 2Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field [Other:
a: Was the conveyance man-made? ❑ Yes [ZNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? �CA
d. Does the discharge bypass the waste management system? (If yes, notify DWR) gYes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:)Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[FacilityN mber: - Date of Inspection: ��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0'1q5_ ❑ 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 EI�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 [�fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Dles ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ["lo ❑ 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
❑'110
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
[?o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
[] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): JZL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ld o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
[] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:;-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�- o
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ZNo ❑ 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 E6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [j] No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -7 Date of Inspection:
20 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo
25�I1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ErNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes El;o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 02"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes dNo
❑ 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 [5"No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [� No
❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 3No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewerllnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
-- es)
Phone: IY 339
Date: Ov IL
21412011

Date of Visit: �3� Arrival Time:1 1)*'j Cr Departure Time: ' D I County:
Farm Name: �J , J� , 1� /i G, Owner Email:
Owner Name:f Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representa
Certified Operator:9'�'t,rXv! yt.� •n� g-z�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poul try
Capacity
Pap.
Cattle Capacity Pop.
n to Finish
La er
DaiiCow
n to Feeder
Ped
Non -La er
Dai Calf
er to Finish
Dai Hcifcr
Farrow to Wean
Deslgn
Current
D Cow
Farrow to Feeder
Dr, E;oultr,
C•_a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeX Poults
Other I I
Other
Discharges and Stream lmuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field Other:
a. Was the conveyance man-made?
Yes ❑ No ❑ NA ❑ NE
®.Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
,Yes
[:]No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
-Yes
[:]No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0—Yes
[:]No
[DNA
❑ NE
of the State other than from a discharge?
Page I of 21412015 Continued

Eacili Number: jDate 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 [gNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9"
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes g No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes a No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE
44
maintenance or improvement?
Was_t_e Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA Z!JNE
❑ Excessive Ponding ❑ Hydraulic.Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[g NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E�.NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ No
❑ NA
®,NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
C� 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
�E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[2,NE
the appropriate box,
❑WUP []Checklists []Design ❑ Maps [:]Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
FNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[3-NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
2 -NE
Page 2 of 3
21412015 Continued

j Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA VZ NE
rf
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA aNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
M NE
❑ Yes
[] No
E] NA
tj�_NE
❑ Yes
❑ No
r] NA
�NE
[:]Yes ❑ No ❑ NA CgNE
0—Yes ❑ No ❑ NA ❑ NE
[] Yes [] No VA 8.11IE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
FZNo
❑ NA
❑ NE
® Yes
❑ No
❑ NA
❑ NE
�� des
�n�fla�rs
�.r i� tl.� ��S Cac�r�i H O� �,� � f /✓C/��i �'".cS,S�r-c.�s ,�bsfri��� �
r/J'L iliac 'F
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Phone:
Date: LP / 3"` lrAz
21412015
Page 3 of 3

�DS�P�Z.ofS �
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090168 Facility Status: Active
Inppection Type: Compliance Inspection
Permit: AWS090168 ❑ Denied Access
Inactive Or Closed Date:
Reason for Visit:Routine County: Bladen Region: Fayetteville
Date of Visit: 09/29/2015 Entry Time: 01:00 pm Exlttime: 2:30 pm Incident 9
Farm Name:
C-E-R• Inc.
Owner:
Ronald Coleman Hutchinson
Mailing Address:
PO Box 397
Physical Address:
3874 NC Hwy 87 E
Owner Email:
Phone- 910-645-4459
Elizabethtown NC 28337
Elizabethtown NC 28337
Facility Status: MCompliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm:
Two miles south of Elizabethtown, Farm is on the right.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Latitude: 34' 35' 34"
Waste Col, Stor, & Treat
Other issues
Longitude: 78" 33' 41"
Waste Application
Certified Operator: Ronald Coleman Hutchinsoi Operator Certification Number: 17960
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Barker Phone:
On -site representative Kathy Barker Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

A
Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number: 090168
Inspection Date: 09/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 5,880 2,723
Total Design Capacity: 5.880
Total SSLW: 793,800
Waste Structures Observed
Dlsignated
Type Identifier Closed Date Start Data Freeboard Freeboard
Lagoon
1
19.00
53.00
Lagoon
LAG 1
19.00
page: 2

Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number:
090168
Inspection Date: 09/29/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Discharnes & Stream Impacts
Yes No Na Me
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
rl
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
■ ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
M ❑
❑
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
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
B. Do any of the ,structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yee No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090168 Owner - Facility : Ronald Coleman Hutch Facility Number: 090168
Inspection Date: 09/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No No No
Crop Type 1
Coastal Bermuda Gress
(Hey)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
Goldsboro
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?
Cl
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?
❑
E ❑
❑
1 B. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yea
No No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑ ❑
If yes, check the appropriate box below,
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090168 Owner - Facility: Ronald Coleman Hutch Facility Number: 090168
Inspection Date: 09/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
no No No No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑0
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑0
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
E ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑0
❑
❑
Other Issues
Yes No No No
28. 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,
❑
■ ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
N ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
■ ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

ITvve of Visit: QwCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: (WRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:. d0 Departure Time: County:
Farm Name: R &A A kA � 1�I� C 0', Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I kC-1"' Title: Phone:
Onsite Representative: t t Integrator:
Region:6
—P
Certified Operator: OfM/1Ll`t Certification Number: ` 7t0V
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pvp.
Wet Poultry
Capacity
Fap.
11
Cattle
Capacity Pvp.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No [3-NA-
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
a ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Condnued

I&
Facility Number: -I b Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3=id'6`❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No 4_,�
❑ 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
[r]"lgo _ ❑ 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
❑011o_� ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
vo ❑ NA
❑ NE
maintenance or improvement?
Waste 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 [DoNr ❑ 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): Cud
13. Soil Type(s):
f.
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
o NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l _I No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
57 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below:
❑ Yes
± No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectio;'_No
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El
NA ❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
A. 24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ?�❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT') certification? ❑ Yes � o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Comments (refer,to question #) Explain any YES;ans,
Use,drawings of faculty to better explain sltuations.'('us
c4jc�A�•sjjo'�'
Reviewer/Inspector Name:
1
i)
No ❑ NA ❑ NE
I�lo ❑ NA ❑ NE
�No ❑ NA ❑ NE
]"No ❑ NA ❑ NE
Phone" {,l�
Reviewer/Inspector Signature: A N Date:
Page 3 of 3

1 rin S ':Lg j, _lk L( 60
ivision of Water Quality
Facility Number - @ 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival TimeDeparture Time: c0 County: je-OL
Farm Name: C K l oc Owner Email:
Owner Name: 9b..au 41, v40� t" W bm Phone:
Mailing Address:
Physical Address:
Facility Contact:
K ��t4"��� Title: `%[� Phone:
Onsite Representative; L Integrator:
Certified Operator; (4, lri Certification Number: l 7 'G 0
Region: " k—"
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
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts --?'
1. Is any discharge observed from any part of the operation? ❑ Yes [ o ❑ NA ❑ NE
i "
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 C]rNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes FR'&o ❑ NA ❑ NE
❑ Yes [�f]No [] NA ❑ NE
❑ Yes ' No ❑ NA ❑ NE
Page I of 3 21412011 Continued

44
Facili Number: Ur- Date of [ns ection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ =i
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Q_NT--D 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
[]-fib
❑ 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
[r] o
❑ 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
4i>p
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�I s
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,j Imo,
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10_Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑.Aim
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2-K-0 ❑ 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): . fi , (2%(-�(,J (�
13. Soil Type(s): G O d's t0/'o IV•17�`
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 D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rZT�io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[DllC10
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps D Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Qio ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [5"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [C"io ❑ NA ❑ NE
Page 2 of 3 21417011 Continued

Facility Number: - Date of Inspection"1%A
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 91&0
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 [E No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes Oy"No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [E�`Ro
❑ 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 03No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes [!J"'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [io
❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �rN
❑ NA ❑ NE
IComments °(refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,,-, }
lUse'drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
VI O
0
Reviewer/Inspector Signature:
Page 3 of 3
Datg
21412011

(?Division of Water Quality
Facility Number ®- � 0 Division of Soil and Water Conservation
Other Agency � ~�1 j
Type of Visit: EK=pliance 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 0 Denied Access
Date of Visit: / Arrival Time: v ; Departure Time: County:
Farm Name: 02 Owner,Email:
Owner Name:Kj2y,&Qd G `rq fn •+.. Phone:
Mailing Address:
Physical Address:
Facility Contact:
V f-'<y.- Title:
Onsite Representative: 3'jo
Certified Operator: Aa=azff z, f,4c K S 0- �
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
Other
Other
Latitude:
Cc , Phone:
Integrator: /1-m14_4 �
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
—son-Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [-]No
[:]Yes [ &No
[:]Yes C&No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - L jDate of Inspection: k-10 -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�&No
❑ NA
❑ NE
a. [fyes, 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): /41-9-
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
7❑-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?
f,';� Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): err�,-►► ') -�_ lot er-s r"
13. Soil Type(s): iTD'-'f N12 6t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable EZ-Ycs ❑ No ❑ NA ❑ NI-
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes 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 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 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 214120.11 Continued

Facili Number: jDate of Ins ection- U
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!=No
4
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check ❑ Yes" ENO
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 fC No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [&No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes EKNo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ig No ❑ NA ❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(SNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or ana ott er comments . '
lase drawin s of facility to better explain. situations use additional `�a ►es'as necessar `�
g• Y P (� `- P' 1, Y)�'' `
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 27a'q 33-3300
Date: kr / D—,;E8/,-7—
21412011

rM
ivision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: ompliance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: P7L_75___1 County: Region:
Farm Name: Owner Email:
Owner Name: ; `ts $�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Gt [Y Title:
Onsite Representative:
Certified Operator:
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
Boars
Other
Other
Latitude:
C� Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C3 No ❑ NA ❑ NE
❑Yes
❑No
[3 NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes :0 No
❑ Yes ®,No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

' Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[&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): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CS 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
g] 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): I CI
13. Soil Type(s): r__V " rV1"14
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes F&f 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 2& No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
[]Yes � No ❑ NA ❑ NE
❑ Yes (2 No ❑ NA ❑ NE
❑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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes K No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA. ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes � No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[]Yes C No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes C&No
Yes 4 No
❑ Yes WNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional=recommendations or.any other comments.,
Use drawings.of facility to better explain situations (use.additional pages as necessary),
'
/�!` //i/d
x rI J AlOtt) w01
��' • ..L-cam � is �7c� ��7�� �.n..-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: '3-3 DC)
Date:--�/f
21412011
Page 3 of 3

9Atw-S
1..0 + a 7N
IN
Facility Number
�ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0- outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: =2A2Arrival Time: �� Departure'rime: County: v Region:
Farm Name: V' • G 4 1L . fNL ,, ` J l Owner Email:
Owner Name: tCx 4 tLc cc 11 I S�FYI Phone: _
Mailing Address:
Physical Address:
Facility Contact: y Title:
Onsite Representative:`t't `Ling 1,
Certified Operator: 21,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
U Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: �—is
Certification Number:
Back-up Certification Number:
Latitude: ❑ o = d Longitude: = ° = ` ❑ "
3
i
7
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
on -Layer 1 4==3
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poultsl
IEEE
❑ Other
Discharges & Stream Imimets
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 Cow
Number of Structures: ' l__-_'1
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 B<O ❑ NA ❑ NE
❑ Yes
❑ No
(,-,�AA
El NE
El Yes
El No
9-1 A
❑ NE
El<
❑ NE
❑ Yes
❑ No
❑ Yes
U<o
❑ NA
❑ NE
❑ Yes
Pilo`__�E] NA
❑ NE
Page 1 of 3 12128104 Continued

I'/
Facility Number: — Date of Inspection
Waste Collection & Treatment
,,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
B No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
2<o
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): P
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S 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
ffNo
❑ 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
['Nlo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L?T: o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Q'�lo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ekgo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ck%
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
.Alos
i)
13. Soil type(s) tg- A i-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L-4115o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3TR o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[;�'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EE No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®Wo
❑ NA ❑ NE
Comments (refer, to -question #):::Explain any,_YES answers and/or any recommendations or any other,comments
of facility,to;better:explain situations. (use;addition'al pages as necessary):
t
CACI w
J � I
ReviewerlInspectorName` L�° = e�y• Phone: Q ' Y,33`
Reviewer/inspector Signa re:Date: /
Page 2 of 3 12128 04 Continued

Facil;ty Number: Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 27No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Eg o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
f9<0
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q Po
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Klo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D- o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eo
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,L''1No
LJ-Ko.
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�
LI 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
,�,
L-!'No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
,,��//
C1 NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
in59
Adrlitianal Cumm.ents andlrir` Drawings .aL
Page 3 of 3 12128104

�AfS /-0-'/-20/O
sion of Water Quality
E
ility Number D q / Cc $ O Division of Soil and Water Conservation
0 Other Acencv
Type of Visit
C^�oml�pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
utlne 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: j2'z8 d 9 Arrival Time: Departure Time: 3: 44 County: ��� Region:
Farm Name: 1C. E • R • ruc - Owner Email:
Owner Name: Ro NQ td N'41G krNso,4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ro"0.i d 14`A-icA.'►4se'�J Title: 0�.j"je—Phone No:
KA.44,1 Barker $
Onsite Representative: lea dyic--rNTe �/ Integrator:
�
Certified Operator: Rout H L.+c.ir.;nr50" Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 El f = 11
Longitude: 0 ° = 4 0 „
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Harrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current
Capacity .Population Wet Poultry Capacity Population
❑ La y er
iJ ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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 3 No ❑ NA ❑ NE
❑ Yes
[:]No
L3NA
❑ Nf
❑ Yes
❑ No
B A
❑ NE
f NNA
❑ NE
❑ Yes
El No
❑ Yes
L'S�
[I NA
❑ NE
El Yes
NoNo
l_7 No
❑ NA
❑ NE
12128104 Continued

Ficiiity Number: 0y —/(a $
Date of Inspection J2'zB-D9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier: Lag #
v
Spillway?:
u
Designed Freeboard (in): /9
Observed Freeboard (in): 9
Structure 3 Structure 4
LI Yes ❑ No ❑ NA ❑ NE
LJ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes S 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 E 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,.tthh'reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes Ll No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L�1 No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require El Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) _&ritituok i`f ,�� 5�a�/ G►Zti N t'Dye rs��af1
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
NNo
[I NA [I NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
��
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
;e"o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application'? ❑ Yes
ErNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
'L_'f No
❑ NA ❑ NE
�. I'hY� nL4fGIn1A/SOAL is/l�4 '�O /'t�oar! y—/NL�f $'{)'laCf4/^Q� �Y[4�?Od�'O Of� /N�if�et� %AjVoN /s✓v/"�DY1N
L1i�i+i u µpvvovcc� q+` e n rl or he%r� V)CC t #..4 ary 26, 9-009 ke -09.
Iq, ivlr. NW4CZ1.INSG/•! F'Qil� fe 1►a�ve COC r f��_r�•rl ava,b.Ll�. Mr. Nu�iel.�w�sQni 54a 4ka4
Ms. Ka4i.) D.t9cP.r $arkerr -i� . SPeC. "4A4 kZv r..Po4c6ocK sill - ee ro, tc sf w•tk ;
zo, R/l Co.KpoHeAJ43 o-(-Ae CI ;VAAP -J-5 L- -11- Sarlce.r n4 f6pG (A. " HC
Reviewer/inspector Name 1F�c i< R?-VV@.� ` '`' �'t`` Phone: 9/0. �3.]•.3
Reviewer/Inspector Signature: Date: /Z - 2-8 -Z 00 9
12128104 Continued

FacilityNumber: D 17 —/ (late of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all omponents of the CAWMP adily avails le? If yes, check [c Y s El No [I NA ❑ NE
the appropirate box. L'1 WUP Checklists Design aps Other
21. Does re ord keeping need improvement? If yes, check the appropriate box ow. L+7 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard L Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [] l20 Minute Inspections [ "Monthly and V Rain Inspections [Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2 No ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L� No ❑ NA ❑ NE
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 securea' 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?
❑ Yes ❑ No ❑ NA & NE
❑ Yes El No ❑ NA
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
Oa NA
❑ NE
❑ Yes
+[��� NNo
❑ NA
❑ NE
❑ Yes
3'No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
I ►.,. f' Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[B'Y" es
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4#21 ,TL.` irccorbis t,Je.re.. Nai PV`_SC.'jAA 'rrrspr,a-h,orj. Mr.;iw4c'40^fvjralu
clad kauar pur.,.p;N5 .}� e_s i dale-5 a— eNvehrs n-.- J,J wbf-
Ihavr, arpr.ue.A, -TIM 1 foti-w.-A, gv,p lwS did Nb+
12-0 w.: l�ta ir✓7rw'�`o na -Pb-,- I-Gco rcl iN.1� ini tii Ni-l-i ci+S , �' 4 re+rce.. is 14. above, ;Whirs
ciko-ve-
Mv. wYCWNSuH X NOT YGc.plrci Ot- 1'JI i4`q�IIJLM[.S irraal�oarc3 0.5 ee' . mct 064
buip4m/2L,2oo9-0ge-2,* laa.L4 em;m-Aa.i1�f acer.rred oN DGuMbar zoo9, Mr.
1.}„rlat,tNso,.i S}altd �Inw� k4 wti..l S r�Cgrds wte.KL taSao..N Eeve�
ay )
31. McL,wSor+ f1.d -�.-$OO vvr�liw &
Noje-; _T_ oh3�rvtd 9-i,uc.� lQf.n� !z✓e_I afA`c.'I.'yg�C,E.K_
10-11-Dkvr aws 12.-2$'2-oo9, iVYon1 Coifed Ms, k,.4yDu9onl
i�aV -srl Ter... SPlec1 r__V�0✓ 4- 44k 5-h-,LC- -"Val 9-iNC4-Fv;.e.boaXd
/-.
I GV� - l - Yf.1LLjrtR \/PPDA [IPN O-F 4'c�'b ..' L, r J J,pp rrv—,,d,15
11;05-A44 on /Z-2.8-2-oo9, Favr.. a�3 6���.s un►d4v r. teOf.Y� Polk
S lVav<.,b:✓ Zao9,
A �1t,uc-c_
K AIA�LC O"PVipAJ /s pr�i -^We� bG�N� QYaCiKCi
Hw
12/28/04

BTmS 10 zs _o9
Ion of Water Quality
Facility Number _ g _ Q Division of Soil and Water Conservation
In Other Ageney
Type of Visit
ompliance inspection
0 Operation Revlew 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: /0 `i9-o9 Arrival 'rime: 770 ... Departure Time: ,'30 County: Br`�0tA,`*' Region: /C
Farm Name: ' ` T—Nc—• Owner Email:
Owner Name: RN0..ICL. In; i` r r 500,j Phone: 10 F'2�Z — 7-5---
Mailing Address:
Physical Address:
C�
Facility Contact: L�`0`'�y Title: Phone No:
Onsite Representative: jk,4)4� Integrator:A�I
Certified Operator: C. `U 1''�� °'� Operator Certification Number: A'V� /7 ?6O
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = o = 1 Longitude: = o = 1 = 1I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: aid
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
E A_
❑ NE
❑ Yes
❑ No
L'NA
❑ NE
❑ Yes
❑ No
['�NA
❑ NE
❑ Yes
Q NNo
❑ NA
❑ NE
❑ Yes
l 'No
❑ NA
❑ NE
12128104 Continued

Facility Number: p
Date of inspection NO -I -49
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): ZO "
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 3<0 ❑ NA ❑ NE
❑ Yes 0- o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Diloo ❑ NA ❑ NE
❑ Yes 91vo ❑ 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
C to
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑'1lo—
❑ 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
El -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Io
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 0-ido ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ` Window ❑ Evidence of Wind Drift ❑ Application Outside of Area �/
12. Crop type(s) Ee_pl lu rti aI /� �nn� J ;U U/6 r-.tfti/ CD s• J �Oi�N' Get L7 ` �,y f� "'.'V
13. Soil type(s) o
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18, Is there a lack of properly operating waste application equipment? ❑ Yes
VNo
[INA ❑ NE
❑ NA ❑ NE
1�4o ❑ NA ❑ NE
�1�2 ❑NA El NE
No ❑ NA ❑ NE
Comments. {refer to „uestion #) IN xplain any YE . answers and/or any,rVhmme _1dations or, Inyrother comments.
~ n.� re p, b p`i gip.
Use drawingsoffaciliky to better exlilain s�tnations: (use adilit�onal pagesIs necessary);
Reviewer/Inspector Name / S =s P Phone: �l1�.�.�•33'0O
ReviewerAnspector Signature: Date: /0 —/ `J — 260
12128104 Conlinned

Facility Number: 4Cl— Date of Inspection
Required Records & Documents ��,,//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 23 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [13 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3-go ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ©'< ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Io[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,,,
Ld-1Von ❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
3 o ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
,,.�,,�
[3 o ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,�
LTNo ❑ 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
L lqo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3^ ❑ NA
❑ NE
12128104

vislon of water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: —f 09- Arrival Time: ' C� Departure Time: County: '� Region:
Farm Name: '— ~' Owner Email:
Owner Name: n� l� Phone:
Mailing Address:
Physical Address:
Facility Contact: 2 %h Title:
Onsite Representative:
Certified Operator: Rlrn,
Back-up Operator.,
Location of Farm:
Swine
Latitude: 0
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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?
"
Longitude: o°o, a
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

Facility Number: / Date of Inspection r�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Inj Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo ❑ 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
N No
❑ NA
❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
M 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 thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
r
Rmo
El NA
D- —EE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
❑ NA
(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 aYes
❑ No
❑ NA
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA
ET<E
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA
2TNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Driti ❑ 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
0 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
aNE
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
❑ No
❑ NA
,KNE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerlInspector Name Phone:
Reviewer/inspector Signature: Date:
1titeiv4 Uonrrnuea

Facility Number: — Date of Inspection l!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E-NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA I NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [:]No ❑ NA ®.NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap 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
[RNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
RNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
U�NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
❑ No
❑ NA
RNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ENE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
0 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
15a 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
2�NE
f 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
ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
BLYes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ELYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-J K �i(Jes , /i%✓. /7f�9i�iSr�� G(la� A/D� r SrT� .
Page 3 of 3 12128104

(Type of Visit 0—Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routlne 0 Complaint Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: -31 Arrival Time: 0 0 Departure Time: 3; c7� County: `— Region:
Farm Name: 1C, r--- Owner Email:
Owner Name:,.?��a� U`vt �a i'� ��—� Phone:
Mailing Address:
Physical Address:
Facility Contact: 4,27-7er," a/ `tCAr itiV' Title: Phone No:
Onsite Representative: [?"`--A— Integrator:
Certified Operator: / :� JOperator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = & 0 Longitude: 0 ° = 4 0 11
Design Current
Design Current
Design
Current
Swine Capc ty Popuation
Wet Poultry Cap city Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Ury Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
10 Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑Turkey Poults
ther
Number of Structures:
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
up No
❑ NA
0 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
❑ No
❑ NA
ENE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
aYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M-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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[.No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
.9 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement'?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA ONE
R Yes ❑ No [—NA ET
❑ Yes ❑ No ❑ NA P!�NE
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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ETNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
M NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
RNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cl No
❑ NA
.'-'l NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
9,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 S��l/`e �— �dv Phone: qj�7— #:T3 J-3'D-D
Reviewer/Inspector Signature: Date: q
17/2R/OQ Cnnlinuvil

Facility Number: — Date of Inspection 3 (�
Required Records & Documents
19. -aid the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ENE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No []NA ZNE
the appropi rate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 2�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
❑ No
❑ NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
0,NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
❑ No
❑ NA
RNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
RNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RNE
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
9NE
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
EINE
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
M-NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
mYes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
R Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
7
Page 3 of 3 12128104

Type of Visit OComp.Price Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Timer Departure Time: : County*Region:
Farm Name: — -Fn Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Au 1; n 51= 1 Title:
Onsite Representative: P
Certified Operator: 2in2j
Back-up Operator:
Phone No:
Integrator: 4AQ olj21
Operator Certification Number: D
Hack -up Certification Number:
Location of Farm: Latitude: = e = d =66 Longitude: = o = 6 =
ti
Designrent
Design Current
llesign Current
Swine j Cap ty
Popu at on
Wet Poultry CaP K, Population
@attic C*ap ci Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ La ers
ElBeef Stocker
❑ Gilts
❑ Non -Layers
ElBeef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
JUNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — G Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): % 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
E9 Yes ❑ No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes ER -No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9 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 ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA L,NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 2.NE
❑ Excessive Pending [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 1 o lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[ENE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[2�NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
(LNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[2,NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
qNB
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):
iGGQ� 1; 7/' /7bl�'� f /JI? J� ► t� W r. r / �L�
/%N/ X"X 82c.�Y ore/ e, 77fG �rC/nBrirp�l�`��c�vrrs�OLcf /l� �T•rp1n70 i e/e.
r�li'J�/I �f�n�Cf/o�Gr.� %t2vGl�rrn /"GQer,;l'Yd / a0� r�%�`_'�i��45 iic.�cl�r-rrL �►kb�/
WyLcnatS OF Q�.. tii Sysi Nr/r�Pu/�7p,�ydDuan62
Reviewer/Inspector Name . Phone: CyTJ-- V
Reviewer/inspector Signature: Date.�� j�
19-.-I -_....__.__J

Facility Number: — Date of Inspection
1 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA KNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA KNE
❑ 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
9 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
r'_A NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
®.NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
26.
Did the facility tail 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
DNE
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
Z 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
E 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
0 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
MYes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,LYes
❑ No
❑ NA
❑ NE
Additional Comments an l/nr Drawings:
7Z, ; cf% 07",
�l�e► �/�"'` 1 'v� d r�Ac�-` i .'V
dY A1'A'x
� -rr k CUSS +ud
r�
Page 3 of 3 12128104

Facility Number
eMivision of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit O-Co—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /� Arrival Time: / D Departure Time: �3D County: P Region:
Farm Name: 1✓ , C-, Owner Email:
Owner Name: C— Phone:
Mailing Address:
Physical Address: II
Facility Contact: ��'`Fse �d4 #L'L ��� 0-12=1itle: Phone No:
Onsite Representative: Kr,11.1i Integrator: r? 13 ko d
Certified Operator: -4= Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ 1 ❑it Longitude: 0 ° 0 I 0 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge? '
Q Yes ❑ No ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
O'No
❑ NA
❑ NE
J �o
Yes
❑ No
❑ NA
❑ NE
® Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? WYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / G
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 9 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA RNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA rZNE
❑ 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 Drill ❑ 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
[;RNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
ONE
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
0 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
[9 NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�c
f�cp�1> I11arl�r�
wd. 7
Reviewer/inspector Name Phone: JJD�D
Reviewer/Inspector Signature: Date: / �p
12128104 Continued

Facility Number: Date of Inspection
"•. Required
Records & Documents
,t 19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No ❑ NA
'UNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No ❑ NA
aNE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design [I Maps ❑Other
21.
Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes .❑
No ❑ NA
5D NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No ❑ NA
® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [2TNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA 9 NE
26. Did the facility tail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA [0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[9NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
EkNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
XNE
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
K 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
E[Yes
❑ No
❑ NA
JKE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Q Yes
❑ No
❑ NA
❑ NE
Additional Cdntment9 and/or DrawinS. • i' < °
.b . x . ,„ �0 ...— t � _, 4 ._
�✓Y h�R. d��S� dam- w`►`� /�f�. /,f'TiJ1lJl��l—�- �� �cr��r` p+e � e.'/�CJ
�n 74_X ai- 1-7 C -_I e JJc,-j ,itq F7 X
'%' /
Page 3 of 3 12128104

1
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
Other Agency
type of Visit 0 Compliance Inspection 0 Opera n Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routlne O Complaint 1OFollowup O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: r Arrival Time: Departure Time: _�nT
County:
Farm Name: r 1 Tel r . r
1 \ Email:
nwnPr Namn� 11 � A I off f7i! l' �i It S�Y`� Phnne!
Mailing Address:
Physical Address:
r
Facility Contact: ?j—L , n , t✓ISiJ Title:
Onsite Representative: e-Y r
Certified Operator: -nL4,' nStT'�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: -,L\ L.1
Latitude: = 0 = 4 =61 Longitude: = ° = 6 = 6{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullcts
❑ Turkeys
❑ Turke Poults
El Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
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?
Page 1 of 3
❑ Yes ❑ No ❑ NA JKNE
❑ Yes
❑ No
❑ NA
SNE
❑ Yes
❑ No
❑ NA
KNE
❑ NA
i 3NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
KNE
❑ Yes
❑ No
❑ NA
jZNE
12128104
Continued

Facility Number: —& Date of Inspection
. " Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / �d
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?
10 Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA EP NE
❑ Yes ❑ No ❑ NA (RNE
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 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA 9NE
(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 J NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ❑ No ❑ NA 91NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ;4NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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 M NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ,'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ❑ No ❑ NA KNE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA jiqNE
El Yes El No El NA J4NE
pofe_r tnaped 4r. v
jDDe����5
/1?r. �it��i i h_svn- T`a-,z-Tr�s� Pub �s�•►�� ��� �- J,� ���' H��
ar��; $�� � �F
Reviewer/Inspector Name s, ,_ �� �, F �, t ptiScf1, : �� Phone: �J4 l�3 ,�C%a
Reviewer/Inspector Signature: Date:
Pare 2 of 3 12128104 Continued

f
Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA 9NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA W.NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA �R 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 aNE
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
3 I. 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/[nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
'9 NE
❑ Yes
❑ No
❑ NA
UNE
❑ Yes
❑ No
❑ NA
5,NE
❑ Yes
❑ No
❑ NA
51 NE
❑ Yes
❑ No
❑ NA
19 NE
❑ Yes ❑ No ❑ NA ;0 NE
❑ Yes ❑ No ❑ NA 4 NE
❑ Yes ❑ No ❑ NA C9NE
❑ Yes
❑ No
❑ NA
®NE
❑ Yes
KNo
❑ NA
M Yes
❑ No
❑ NA
24
Add tiortal'Cdromer is and/or Urnwln9s y[ `
Page 3 of 3 12128104
Page 3 of 3 12128104

Tipe of Visit Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Itm County:
yD
Farm Name: �%Ir . _ a' Owner Email:
Owner Name: ��1 n 4&' Phone: _
Mailing Address:
Physical Address:
Facility Contact: itle: Phone No:
Onsite Representative: J��-+�'-� _ Integrator:
Certified Operator:
Back-up Operator:
` l Region:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = t =66 Longitude: = ° 0 I 0
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
�•
❑ Turkeys
Othe
urkey Poults
❑ Other
I
mber of 5truetures:
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
+Q Yes ❑ No ❑ NA 40E
❑ Yes ZNo ❑ NA ffK
® Yes
❑ No
❑ NA
NE
❑ NA
❑ N E
ayes
❑ No
Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
aNE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? C5Yes ❑ No ❑ NA ❑ NE
r a. If yes, is waste level into the structural freeboard? []Yes []No ❑ NA LINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f (o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA RtlE
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 Z NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ZNE
(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 J.NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ERNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes []No ❑ NA [9NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ERNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
P NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ No
❑ NA
9NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
KNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
RLNE
Reviewer/Inspector Name ;4,/". 1 Phone: g113pO
Reviewer/Inspector Signature: Date: / j}
Anon 7 „r 2 U 1212RI04 Continued

I
Facility Number: 17 % /15 Date of Inspection S"a 91
Required Records & Documents
• 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [19-NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 9NE
❑ 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 10 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
E,NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
P.,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
KNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
gNE
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
If yes, contact a regional Air Quality representative immediately
'�JNE
3 I. 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
ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
J9-Yes
❑ No
❑ NA
❑ NE
f:
Additional GoEnment"s p!k or Dra► 14ln s � ` k r ° t x k a
g�.� ` .�.0 .�� L
ST'r� 3—ram •
�o K a
:33• FD110x rtp
Page 3 of 3 12128104

0 91 W /4 sr",
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint DO(ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D�Od'�IArrival Time: ' �D Departure Time: � County:
Farm Name:g]� ,-�C7 ,(: ,f • _,L- Owner Email:
Owner Name:. �DI'I0- / -/; d Phone:
Mailing Address:
Physical Address:
Facility Contact: nYi/r' /2t hS'itle: Phone Na:
Onsite Representative: S A-H -C Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 4 = Longitude: = o = 6 =
SA
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
❑ La er
❑Nan -La er
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ pullets
Brood Cow
❑❑Beef
Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures: EE
❑ Other
Discharzes & 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
0 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)
Z Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ayes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
KNE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
14. 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): 19
Observed Freeboard (in): 115
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[]No ❑ NA PUI 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
❑ No ❑ NA 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[:]No []NA 91NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes
[]No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
JO NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
5a NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
JQ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
W�j`�Y. WQ S CQ?nj>✓f � e4 e) u e �� r `r � et'R ��1/rYy
4rDun7!t 1~r tOr�
j _57'W Cflmr•7'� �o p
a as Sine-� ; ,.� rr po.4e— le�:3l -4;zm e
Reviewer/Ins ector Name Phone: �%
p -~y— 33r D
Reviewer/Inspector Signature: Date: — O
Page 2 of 3 12128104 Continued

(.Facility Number: C�- — /� Date of Inspection -f—
Required Records & Documents
�• +19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ®NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA M NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA E&NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA 5�NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
R NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
5,NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
KNE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
C&NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
�LNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
E[ 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
ONE
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
9,NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
®No
❑
32. Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
Yes
NA
33. Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
Ad iitlo a Commeiits and/or 1)rawin s�
�0� ; •-�.�a7 4� z� v rrs rII�� d i '�G� • �LS� • ff k5 � �`'S � o/ �- ®•�ltJa ra�,�
w04
vio)v V?
a- 3
rage a of j 1(L/L61U4

Type of Visit PoCompllance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up eReferrai 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — Arrival 'rime:WI �.' beparture Time: `,]~� (� bounty:�� Region:
Harm Name: r r Owner Email:
Owner Name:
QPhone:
Mailing Address:
Physical Address:,
Facility Contact:
Onsite Representai
Certified Operatoi
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 ° 0is
Longitude: = ° �.
Design Current
Design Current
111rDesign Current
Swine @opacity
Population
Wet Poultry Capacity Population
Cattle acity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer 1
❑ Dairy Calf
Feeder to Finish
El-Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turke Puults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
RYes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field J9 Other ffmz
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
ONE
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)
IN Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
50 Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
5& NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: (� �" f�, Date of Inspection
f Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1 1
Observed Freeboard (in): / 3'_
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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?
[SYes ❑ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes ERNo ❑ 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? b,Yes ❑ No ❑ NA ❑ 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 ayes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Ao
❑ NA
RNE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA
59 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) %kjU,�__
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
S No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
t@ No
❑ NA
❑ NE
rr
16. Did the facility fail to secure and/or operate per the iigation design or wettable acre determination?[] Yes
ELNo
❑ NA
lE
17. Does the facilitylack adequate acreage for land application?
q g pp El
� No
❑ NA
S_
E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments refer to uestion # : Gx�l�ain• en YES Hewers - • `q ) p y �nr any recommendations nr any other comments.
Use drawings,�f facility to better explain slfuations: (use additional pages as "ttecessar>y):
�fi-vS�1J rrti- rIr ��v .e- wlev
wu3 We hf-0 i %Tv %1 ww-LS/
i
✓r J' ' i 5,��- ' 3 / t'rv� ! H.a•�i e !� t n cif/�-' h r
-�,e . ' 1 I' b,
�C
/
�S �ii�l�� �u,G 70 � f-l•UL��s
Reviewer/Inspector NamePhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 / 12128104 Continued

Facility Number: — Date of Inspection f i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
Aux
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes �KNo ElNA [INE
❑ 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?
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?
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
❑ Yes
8 No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes [SNo ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
C,Yes
❑ No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
19Yes []No ❑NA ❑NE
Additional CommefsandloiCDruwingst
^� / I' i� �I�I�YV r/'Y1.. � ��L�Q' / ��1'1�. '� l 1 J / / [i C�.J "f.S ���?J� U'�C%✓�-- �-p'7/`�'
pin e�..
/ �+La �L'�-riTi �4 f.� c� 1 �v... � �� + i �'H '� . tJG`�fsr� Yi rS LJ • / �'
en Sr�i�..r �j� jY,3 ����� � rcr.►�"7
T`i G1J0� Macs a�r� rJ cwv,, , J ow ew�ti K) %rf A e,�6 Flu,'^^�
A-
� D• WQ,5 NOt: � ,�� � �'9/.SC.r���+-F n5 r•Tv� S�JrL �-icl��rr ��+,5�`�'�f-;�-"�"
3 GU�•� ci
Page 3 of 3 s� v
I2a8104

Facilit
y Number: ...... �,/.. ..°.�.., Date of Inspection:
AddfianaT Comments and/or Drawings E "'
N
13 f �
NvUB" Cq-w jr uJPYrevF ax3 `d ,�
' r3 17
7�-
J _c97 16—
�r!dU? y,�
H"/i n oD'''' 11 as b rC n. ,s % C4,
r U),j
f l�j'Lj W r!! /
r
l�v e
r- -)4Y
F i
4/30/97

131/tlS e-,V4,ea1 7-01-0g
Type of Visit 0
CCommpllance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
(-Routine O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: s 'Q Arrival Time: Departure Time: %0; Q County: /V dleA-0" Region: /CX-a
Farm Name- _ -�-/� C.— , Owner Email:
Owner Name: 4i4N otA/ Phone:
Mailing Address:
Physical Address: J-'`
Facility Contact: 1S/ a b'U'4'g Title: / [+'� . SOS, Phone No:
Onsite Representative: A�'a� Integrator:iAl c �D to A)
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = d = tl Longitude: = ° = t =
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Cap�clty Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
Feeder to Finish
15*Z
iry Heifer
❑ Farrow to Wean
Dry Poultry
❑ QM Corr'
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
ElBeef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Pouits
❑Other
Number of Structures: EIJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CI No ❑ NA ❑ NE
[:]Yes
[]No
DINA
❑ NE
❑ Yes
❑ No
3 NA
❑ NE
D NA
❑ NE
❑ Yes
❑ No
❑ Yes
3<o
❑ NA
❑ NE
❑ Yes
❑ No
DA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste levei into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: /f/f
Designed Freeboard (in): 1_9 -___
a
Observed Freeboard (in): �S
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 ONo ❑ NA ❑ NE
El Yes ❑No 3< El NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 l No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //
9. Does any part of the waste management system other than the waste structures require El Yes 3 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) Rn2t ,L"rL z �> +�► 1 S�+M:.1.� �trz.�.� (0, S.) W
13. Soil type(s) r-,oA I I o -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 1=I No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes B<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes N"o ❑ NA ElNE
18. Is there a lack of properly operating waste application equipment? El0 Yes o ❑ NA ❑ NE
ReviewerAnspector Name �/ � .� Phone: 1/0, V-53: 3S0 0
Reviewer/[nspector Signature: Date: -S 23 -- 200
Page 2 of 3 12128104 Continued

Facility Number: Q — jfo Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ej N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes INJ'No fA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
N�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,G
Ll' oo
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
VA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,_/
B o
❑ 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
,_ �/
L1 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
ETNo
❑ 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
E oo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B o ❑ NA
❑ NE
Page 3 of 3 12128104

0 1!
0a4c.r-eA b.,,l RR 7-zy- zoo?
I
V Division of Water Quality
Facility Number Q (p g O.Division of Soil and Water Conservation
Q Other Ageney
Type of Visit ® Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (9 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: � Arrival Time: ; SS Departure Time: 3 ; County: Region:
Farm Name: E RTNC_ .. Owner Email:
Owner Name: RoNo,11 dul'cir.i„/Sn+J Phone:
Mailing Address:
Physical Address:
Facility Contact: kagJ 1s/ ^ Title: Phone No:
Onsite Representative: Integrator: Al"eG4. 2?P2;7.JA1
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El -Boars -
Other
❑ Other
Latitude: = 6 = 6 Longitude: = ° = ` =
Design Current Design Current
.Capacity Population Wet Poultry Capacity, Population.
❑ Layer
I❑ Non -Layer
Dry Poultry
Non-L
Pullets
Pou
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?
Cattle
Design Current`
Capacity; Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
DryCow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
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 P No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(� No
❑ Yes
6d No
❑ NA
❑ NE
El Yes
0No
El NA
❑NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El yes
P No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ffNo ❑ 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
[4 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
VfNo ❑ 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
0 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
5fNo ❑ NA
❑ NE
maintenance or improvement?
Waste.Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
(2 No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) K,,vvriju�Gi .4&. . 1'0,5,
13. Soil type(s) ._G0_ LA.
--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
(? No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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 �,K K�,v Phone: ft �' ,3300
Reviewer/inspector Signature: Date: 6ZZ(al2 b-
e16/160Mr IVnjlnuvu

0/z4,/o 7
Facility Number: �-% — Date of Inspection'
` Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ W-UP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 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
M No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
+� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
flD No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W 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
No
❑ NA
❑ NE
[f 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[;9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[;?No
❑ NA
❑ NE
Comments anal/or Drawin
12128104

6
I
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: A 0 Arrival Time: Departure Time: si�41� County: R14 Region:
Farm Name: C E P, 1:1V C- . Owner Email:
Owner Name: Rn/ r' j lT&Q�CA Phone:
Mailing Address:
Physical Address: `
Facility Contact: (� 5 Du_Q4 A/ Title: / e. SD e__ . Phone No:
Onsite Representative: ) Integrator: all, St-CAJAI
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' 0 Longitude: ❑ ° = ' =
Design
Swine Capacity
Current
Population Wet Poultry
Design Current Design Courgent
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
%Fe to Finish
❑ Farrow to Wean
�2(Tb
pry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Turke Pouets
❑ Other
❑ DairyHeifer
[:]_Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes I$ 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
[P No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P 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 1 of 3
12128104
Continued

A
I
Facility Number: jog-J&T Date of Inspection
01
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o 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?: 0
Designed Freeboard (in): J 9
Observed Freeboard (in): 41
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes "No ❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes C#No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
ElNA
[INE
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
KA No
[I 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 Name f �e, S Phone:
Reviewer/Inspector Signature: Date: %O z 2
Page 2 of 3 12128104 Continued

Facility Number: Of — (P Date of Inspection ! /
s 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes toNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ .Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;il 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
O 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RVNo
❑ 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
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

_�... ICI nos
0
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 41D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: __&14.0 64-- _ Region:
Farm Name: Ci• F. A- one - Owner Email:
Owner Name- & na: (d Q h:A y, S92 k6 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
` Swine
Phone No:
Integrator: M urP � y - & re 1.11 +
Operator Certification Number: 1al!�Q
Back-up Certification Number:
Latitude: = c = i Longitude: = ° = t = tl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
i ❑ Layer i
❑ Non -La er Ia
❑ Wean to Finish
❑ Wean to Feeder
21 Feeder to Finish
5 J3 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other-
❑ Other
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 El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dair Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dairyi
❑ Beef Stocker
i
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
&Yes ❑ No ❑ NA ❑ NE
® Yes
❑ No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
QgNo
❑ Yes
O? No
❑ NA
❑ NE
❑Yes
ANo
❑NA
ONE
12128104 Continued

F'acf�ty.Nuthber: , — I (� 5
Date of Inspection 1 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
V4 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: red
Designed Freeboard (in):
mow.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[,No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[5d 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
[&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/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R 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 ❑r Evidence of Wind Drill ❑ Application Outside
of Area
12. Crop type(s) �zr,n. uAm — %,.. l 3�, 30.5 SvK. A q (�� b%
13. Soil type(s) A �Kin A .,,....,.„.
t4. 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
54 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
[K No
❑ 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
RNo
❑ NA ❑ NE
�. '�i•er�-t e s4; A 0. K 0 4F j r,.VS ci, r+ ti,4 tQ+.'r�aLa-�r� cr.+� 9 of `f tm
�v-vse-5 . e .?.7 r 'ALA % 40L5 Sso-,— -Ls Qoems,bye ,
Wa Me- 6&r,Y&J u P 'E►rry -0 vsti. .Sy64e� our!- of S t.�
� µwGLS OneUCn-C,& t4lf.+ 'Fr. We . {{'jic.t� s ,.c'-'_6
ry
Reviewer/Inspector Name u,': `Tr a <� " `"F& x,; Phone Qlg II IT:S
Reviewer/Inspector Signature: Date: 11.ej 10S'
12128104 Continued

t~ac; ity Number: 6 Date of Inspection i1 O
Reauired 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 LO No ❑ NA ❑ NE
the appropirate box. ❑ WUP. ❑ Checklists' ❑ Design` ❑ Maps '❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Applicatioe ❑ Weekly Freeboardo, ❑ Waste Analysis' ❑ Soil Analysis' ❑ Waste Transfers ❑ Annual Certification
❑ RainfaR' ❑ Stocking✓ ❑ Crop Yieldo' ❑ 120 Minute Inspections. ❑ Monthly and I" Rain Inspections,- ❑ Weather Code i
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
j bgr*W ❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ 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
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. 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 Rev iewerdnspeetor fail to discuss review/inspection with an on -site representative?
❑ Yes
[9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
H Yes
X No
❑ NA
❑ NE
alas 6ro v�k+
w a� "c-*
-6 G�Ga.� �
G�e� � �ff '� �a,-s
%Ao+- 4w_ - f
wmr-+e
C: ep.,, "Q
*Le wa.b�G
}S
�Ivlhvl+l �Qr i e."�e 4�y 'ao
Q.S dwo ► d�
`-6 (
do s 4-b o�asj� +..c cor-re-cA-icm S r�f�a `cis
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint ® Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: dSr Arrival Time: .s% �%� Departure Time: County: le J Qafw Region: r
Farm Name: C E*. r?. T ►'s Owner Email:
Owner Name: \Aw*Phone: Sic]
Mailing Address: P O 1309 -3 9 7 a 71
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: oV, 11..%.+c,\. 0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finisl
Gilts
Phone No:
Integrator: I'"eN%AV w rsw r.+
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0' 0 Longitude: = 0 0' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer k
❑ Non -La et
Other
❑ Other I T J
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M1!
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
D] No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection S_�! °r
4aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 W 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/improvement?
It. 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
51 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',❑
Yes
❑ No
❑ NA
® NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
.rQ1'w+ SI'�'C �:►S+�'� aJ +xG 1�bw-v�� to '�hC ��J�' �1�V�1 .fNrpGpOC.�ff4i'1.
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Fhone:
Reviewer/Inspector Name'
l; .,...
Reviewer/Inspector Signature: dazaDate: 5'/ -14 / o.r
Ir 12128104 Continued

Facility Number: -- /6k Date of Inspection s/Y
-t�j.
Required Ikeeords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [� NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 5� 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 P NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ® NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[R NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[�2 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
NNE
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
[�j 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
M 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
MI NE
yu
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
[:1 NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
191 Yes
❑ No
❑ NA
❑ NE
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3
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12128104

Facility Number Date of Visit: Tune:
O Not Operational O Below Threshold
10 Permitted M Certified 0 Conditionally Certified © Registered DateLast Operated or Above Threshold: .................
FarmName: »».» ..n :.. :.»...._ .....e.1� ....»._ W._ ._ ._ .._.... ...._ County: ..._1!�._.».......».__.»._ .....E.lp ...
Owner Name: I»� r�.rs.�....»_ ..Sr�a at�SQ F,,... _». _».._. 'Phone No:.. �� ! �... G.S' ..�.► »....».»»..
Mailing Address:.._._ P:.. »......»_. zS....... 3 �»2. ...._.._..................._ �.�r..L �t r. � �h^-'.mow . ..C__ _ f 7
FacilityContact: ............ ........ _............_.._.......... _ ..__...._... Ti``tle:.._ ....._.....»._.. .......... _........ ... _.... Phone No: _ ... _.... ..._................ ...... ....... ......
Onsite Representative:......»,%�
Certified Operator:,q, ._ �: __..._ �,c:r ri!,��' » __ Operator Certification Number:.'
Location of Farm:
;( Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude • 6 «
Disc es & Streams Impacts
1. Is any discharge observed from any part of the operation? J6 Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ;0 Other
a. If discharge is observed, was the conveyance man-made? Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes j No
c. If discharge is observed, what is the estimated flow in gal/min? I/ /A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes R 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 Jj No
Structure I Structure 2 Structure 3 Stricture 4 Stricture 5 Structure 6
Identifier:
Freeboard (inches): C
12112103 Continued

FacilityWumber: 9 -- ` Date of Inspection / o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? C1 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintemmce/unprovement? ❑ Yes j No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Q No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 19cErm cuLai �, 5 erg a ! i <p ,t �a -• -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes W No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes M No
Odor bsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Feld Copy ❑ Final Notes
RG yn D J e- C- k ( 't" r c.' .5 + b h _ 4-
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C C o V e_r +i '% S. M crkC r'l 0{ ca. _� r-v% u. t 1 r
Reviewer/Inspector Name ;
Reviewer/Inspector Signature:
//ll�lrs
12112103

rFaciUtf Number; 9 =44AY
Reauired Records & Documents
Date of Inspection 10
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes tj No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ( No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? KI Yes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PM No
MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) JM Yes El No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19 No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ;M No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes P No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes JM No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
\
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12112103

Facility -
Number I
Datc of Visit: Time: L_
not O erational Below Threshold
Permitted Certified Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ,,,,! 1V e_ County:_ avRcN
Owner?ti8me: _ 2400%.Mis Id� f'o ,e
Phone'No:
Mailing Address: Po .8i:l,c �397.- -• -- ��[ �cw 1 . /�/ G �-�
Facility Contact: Q oin.414-- Hwi;�., :,.r Do- Title: Phone No:
Onsite Representative: 0,0V%O:L k2—i j4 , _ Integrator: ` 1 r ur rk.
Certified Operator: 00K,liA C• 4ur.}CLi.Operator Certification Number:
Location of Farm:
[� Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Laver ❑ Dairy
Feeder to Finish JL1 Non -Layer I ILI Non -Dairy
—f—
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ' ' ❑ Subsurface Drains Present ❑ La oon Area 0 Spray' Field Area
Hol&ng Ponds / Sblid Traps Q f ] No Liquid Waste Management Svstem
Discharges g tream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lasoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes. notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ow
05103101 Continued

.I i
Facility Number: —/6,,:F Date of Inspection I Y-df—W-1
5. Are there any immediate threats to the integrity of any of the structures observed? (icl 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 Application
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
Cl 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
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required 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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
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.
,a..a VnIHkY ✓- -_ e �':. - - y '� ,ey L.•.-k�i.N'?°k. .. a .. GSM%," i + .<l� .,.i L�.;X
Comments(referto1qucstion'#)plainiunyY>ESanswers,andl�orianyr�commendatipnsoranytutlteir,comments,.::
UsC_ awings oflfacllity to better explain situations; (useradditionalxpages necessary) d
tts
P ©Field Copy El Final Notes
..a�..� � �
f Q5 A-; - `
,Qis cusr ¢dQ !,�-,p,cr�{ a r c+2fcs,�/�`ns� -fah c ho7n s, & -fa f4 e'r44 c o
Pu�'P e aCs, .zu rn ft CA- r" I Via, -{ion+ 4Jo
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S .2 7 DA
05103101 (J z Continued

6
�.
{ "!.�•i,R,y�, 1 •a '.: I'a A ;3 'Y"," � •,rt >""h4� / J R 7" ,y} ] t - khe 11111.1 L P,t 1 a 'r rI
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( 1ry
1.3` H"'r:"'+d:`"1!.'ra.,..1..'IYsiih fi�..n::dYt1.':..ir: , :.try. f"!t�li.l W:-I' '.J I{i:s;t�,Kr'r`I.ilk'�ry Hi£�d+iie:;l'L C.;a,lirJ-'i6s'11H 4.a,..
Type of Visit I%Compl€ance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit i�► Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit:
Permitted [] Certified Conditionally Certified [3Registered
Farmvalue: ... 7^S.r.........................................................................
OwnerName: ................................................... +``.?.!1.....,.....................,.....
MailingAddress: .................................................................
Sn r
Facility Contact: ......�n.47 ...... �.....o6en...... .............. .Utle:.........................
Onsite Representative:......... . P��v.......,.. ....................................
Certified Operator;,,,,,,,,,,,,,,,,,, nab �
h.o so...........rJ ................
Location of Farm:
H �5 Time: �4
O Not O erational O Below Threshold
Date Last Operated or Above Threshold: .............. ..........
County: ........��
.Jt i................. I .............. ..F .........
Phone No:.......tC�--{�,i5
................................... Phone No:.....................
Integrator: 73m'w'n
Operator Certification Number:,,,,,,,,, 1�61D.............
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish SSW❑Non-Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes t% No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
identifier: ............................................................................
Freeboard (inches): a7
05103101 Continued

F'acHity Number: q — Date of Inspection F35 C?Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) `
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Anulication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
IN No
11.
Is there evidence of over application?/ ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
% No
12.
Crop type e� c'nGLV S.Mag `am` (3
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
0 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[YNo
18.
Does he facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
❑ No
(i U checklists, design, maps, etc.) /�M
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis soil sample re ort
16 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I% No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
NfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes t9 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N No
24. Does facility require a follow-up visit by same agency? ❑ Yes 02 No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments'{refer to uestian # Ex lain an YES answers and/or an recommendations or an other comments..
Use drawings of facility to betterYexplain situations.,,(use,addltior. pages. as necessary) -' El Field Copy ❑ Final Notes
AL
4
I r J
"' •�D i 1 SG.r�P lL �+� �tn a �a��Q
l s- W�P nos U_3L4"P ct� s �tiPrm,17 � n
Cc�r►� p�t7i<� �K) Scwn i-�r_rreA,
Reviewer/Inspector NameS,
Reviewer/Inspector Signature: Date: o �'
O5103101 � Continued

Facility Number: -- Date of Inspection F q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, arid/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters,. etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes []No
❑ Yes t No
❑ Yes % No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
O5103101

of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 19 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date oir Visit: ,7d a/ Time:�.
Facility Number r99
Q Not Operational Q Below Threshold
Permitted M Certified Q Conditionally Certified [3 Registered Date Last Operated or Above
/Threshold: ...............•.......-•
FarmName: ........ Lr, er1.z-Cf...�......./.../..................................................... County:.... .. 1..�4.d�/ ............../.... I......................
Owner Name: .............2. .�...11?�`l "�....................................� Phone No:J.`S Irk!.... .............
Facility ContactrNi✓... .. d ....... Title ................................. Phone No:....................................................
Mailing Address:............. :....., rr� ...s.?...G..........lri/......���j,r......./..G.?...........................................................
f 7
Onsite Representative: ........... ...... ........ Integrator:........., ��✓.d%...Q ��e!��✓.S�
Certified Operator: �� ....1I . ' '" . !`�............................ Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude « 4 41 Longitude 0 6 "
Design Current Design Current Design Current
Swine Capacity Population Poultry Cavacitv Po ulation Cattle Capacitv Population
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish O ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑BoarsEl Total sk. W
Numberzaf=Lagoons' ❑Subsurface Drains Present. 110 Lagoon Area JCI Spray Field Area
Haldtng Ponds / Saltd Traps I No Liquid Waste Management System ti
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0jrNo'
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑YesNo
b. Irdischarge is observed, did it reach Water of the State'? Of ycs, 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 ,6To
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
01/01/01 /'�'i /i���! /: Continued
2.7

Facility Number: -- 14 Date of Inspection 7/21/2000
Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, D Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )PO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Pi�yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 3KNo
11. Is there evidence /of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes eWNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records &Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, c ckl, design, moue.)
19. Does record keeping need improvement? (ie/ i it]'�gation, free, waste analy ' & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
y101000os;or- kric�e� Oos -*vre owd. ii4i-z=iog NsAsit; • YoI.> wilt •ecl'0y 00 fiiMO
correspondence.abou this Visit. • • • • • • • • • • • • • • •
❑ Yes KNo
❑ Yes No
❑ Yes KNo
❑ Yes ;KNo
❑ Yes A No
Yes Q No
❑ Yes)<No
❑ Yes XNO
AYes ❑ No
❑ Yes U:No
❑ Yes ,R No
'� [ f 1 Ii i' 1 1 :1 1 = 'V
Comments (refer to question #t): Explain any YES answers and/or any recommendations or any oilier comments
Use drawingsof farili to better explain situations. (use additional. a es ".necessary):i'
�y P ,p g.
❑ Yes )(No
❑ Yes dallo
❑ Yes RNo
❑ Yes J'No
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature: ��� _ Date: , 5�A0W

r
Facility Number: 0 -- G Date of Inspection 14 O/ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes V No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
[:]Yes
)4 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
KNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
ONO
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes )<No
Additional omments an or Drawings;
7Z,
A%C�c' 119 /w ee,�
5100

r S
i® Division of Water Quality f,
E
Q.Division of Soil' and Water Conservationk,l,l"�' It e k t! til 3 €jj :
dQtherAgeney i.
r
• � Ll
3 3
I � Y
i
•
,! 3 6. .. i y yi6'.kiE.,�_, ,'e, ti•,€„; t� ei
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine ® Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date uF Visit: .f 2 d 'Time: ,Z % U Printed on: 7/21/2000
Q
0 Not O erational 0 Below Threshold
Permitted U Certified ❑ Conditionally Certified © Registered Date Last Operated or/Above Threshold: .........................
Farm Name: .............. .../ ..,..,F-��-• ..............,. k�' i
...................................... County:........lr^...............................................
OwnerName:....... ,/�Q�!%a (. t ..................................... Phone No:.......................................................................................
//..00r✓.... . Title: .. Phone No:
Facility Contact:........�f�fi�!¢'�.......?"��...�.................................................................................................................
Mailing Address:...... ?4....c....�r�.....r./.C`'��...1......�......Q,...`......... ..........................
f...
OnsiteRepresentative: ........................... ................................................................ ................ Integrator:......................................................................................
Certified Operator: fa�'+f'r"...................................................... Operator Certification Number: ..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude + d 66 Longitude • & 66
Design Current Design Current Desigak : ,Current
Ca ttci Po i>flation. Cat
'' dK_,.. Ca aci �Po elation Poultry , tle Ca' ei 1Ro 'tilation,
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 54W6 ❑ Non -Layer 1 10 Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other . r
Farrow to Finish Total Desl gn Caoacity;. ,
Gilts
Boars Total SSLW
Nplaibetf otLagoons / ❑ Subsurface Drains Present ❑ Lagnon Area Spray Field Area
HAUji Ponds`/ SoIId�Traps ❑ No Liquid Waste Management System
ba
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) ❑ Yes ❑ No
c. II•discharge. is observed. what is the estimated flow in gal/ruin?
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 ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure h
Identifier: ...................................................................................................................................................................................I— .........................
Freeboard (inches):
5/00 Continued on back

....�ti•''•�`a+'Mxx'S�nT"^"s+r'Tr+rQJ""'�n'.`.� � - :�-�.ry,,,,�-Y,,,,r r: ,y-,�. .rs,�,.s ;r�•m.�srrw,v,�a -.. ..-a=nrr.,:, -.r.
t.� Q Division of Water Quality "F
i
* " Q Division of Sotl'and Water Conservation
_ i ,.: . �
QOtherAgencys'. y F; i
�Pik�3y r �
E
f Visit O Compliance Inspection O Operation Review O Lagoon Evaluation for Visit O Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access .. �
Date of visit: ,T air of Time: 2 %,3 G Printed (oil: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold `
0 Permitted M Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
�
Farm Name• ti. r. Y ........... /.....................................................
,....,l/� ....�..r .......... .. Count t/ .�:4�%...
OwnerName:.........!.... t...!,o..... ........... .................i•3..................................... Phone No:.-.....................................................................................
FacilityContact: ........ 'litle:................................................................ Phone No:.....................................:............
517
Mailing Address:....... .. .:....1 ....V;�.f2r...... i? ¢ �-.� `"� .....1.!�.... ...... �r� .. ......... ............... :..........
OnsiteRepresentative: ...................... I .................................................................................... Integrator:......................................................................................
Certified Operator:......... .......w�:/.......,. ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle' ❑ Horse Latitude • 4 tiff Longitude • 6 «
Design Currenx
❑ Wean to Feeder
® Feeder to Finish (�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars�'`'�—
Naatiier of Lagoons
�!
rr .-
Holdin—PondslESolid`Traps
6.z.
Design Current Design Current
,poultry, - Ca 0 aci ' population Cattle - Ca1114dPo ulation,:
❑ Layer ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑ Other
Total DesignCapacity','
❑Subsurface Drains Present Area ❑ Spray Field A ❑ Lagoonrea
�n ❑ No Liquid Waste Management System >_ t
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observcd;,was the conveyance [Ilan -made'?
.t
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II'discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system'? {If yes, n6lifY
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
Identifier: ............................................................. ....
Freeboard (inches):
..r
5/00
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5 Structure 5
Continued on back

G
Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?-(ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ 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 Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type h.Wza-W' .� _g���'rr�
13. Do the receiving crops differ with tdose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ or emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: iQ yi ags;or.dgficjenvies •iv re pgCe d `ial� th;s;visitT 'Ya>�r wi�i �ee�iye ti fu�ta r
coriesaorideRce: abvuk this :visit........... .................. .
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
,Comments (refer:to question*): ,Explain any YES answers and/or a'ny recommendations or any other comments §` �; k !i,°i I' {�rjrzlil$'
p situations.- ( p
Use drawings of facility to better ex lain lions. use addiponal a es , necessary) AL
lr- "'�' t 1 -T7s- i ? {• ''. z ��j I, ii€'���1 i `a i {�'� y �S {� m5{,�. �' 1� ✓.
Reviewer/Inspector Name
Reviewer/Inspector Signature: `S� Date: .2 % 5/00

`^."�ti..�'vrra-�arr+.^mn�4PR'P..r .�,++���. .,ram"„-A,-a^'1i^'+�'aA&��'RW.�wr�+-.,.+w,-+,..—'��n'+.^,.-,....'++r+ti,r'w� - --.T ,. ,rw T-.,,.'`:.«-...,r..w„�.y, �. ,nw,.-..•. ,-�... .,
i
Facility Number: — Date of Inspection Printed on. 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosibn,' ❑ Yes ❑ No
' seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ 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 Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop typea.W-4-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP.)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
•Yi���itj>}s;o� cl�fc�e��ies v►�re ��ed' il�rring th}s�v�s�t} • ;Y;o>� wi�� •�ee�iye �o fu>�th�r; . � . .
..�;roriesnmidence:abaut;th'is:visit.:•........•.•.•:::�:�:�:':'::�.�............•.::•:
s (refer to question #) ' Expiarn'any YES answers and/or an
❑ Yes No
❑ Yes/ ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/Inspector Name E i,,..l
Reviewer/Inspector Signature: ! Date: - r -25 Q1 5/00

r
Division of Water Quality
Division of Soil and Water Conservation
O Other Agency
{Type of Visit U Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit WRoutine O Complaint Q Follow up O Emergency {Notification O Other ❑ Denied Access
Facility Number Date of visit.: Tillie. ; � Painted an: 7/21/2000
O Not Operational Q Below Threshold
Permitted [3 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above. 'Threshold:
FarmName: .......0......... ............. s........rY!45-......................................................... County:.......glvjel ... ................................................
Owner Name :....... ..JLrI........................SLT?r-.................... Phone No:........,(A..�7-/ ........ ...(s..................................
.. Phone No: ..~
Facility Contact: .............. L�:{.,Qt.I..,k�4..,t��f�.......q....�..7..................'I'itle:.............................................................. nr...................................................
Mailing Address:.......P.0....IL?.u{5.......3 (....1......................................... f.Y..C� .........+`�.. 26337
Onsite Representative: ................:fa.................................................. Integrator:.... ........+i..Q. .... .........................
1
Certified ............... , t't5.02,�,T... Operator Certification Number:..........................................
Location of Farm:
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �� �'� Longitude • ��«
Design Current
Swine Capacity PODulatiOn
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Nun -Layer I I JE1 Non -Dairy
❑ Othcr
Total Design Capacity �?eD
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lag .... n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was Elie conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
C. I1' discharge is observed, what is the estimated flow in gal/ruin?
d. Dews 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 l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes �o
❑ Yes 1No
❑ Yes �No
❑ Yes LNo
o
El Yes
ElYeso
❑ Yes I�Ko
Structure 6
Identifier...................................................................................................................................................................................
It
Freehuard (inches): 31
5100
Continued on back

Facility Number:0 1-16TrDate o1' Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes )(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
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 Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes gNo
12.
Crop type r^
13.
Do the receiving crops differ with those designated in the er ified Animal Waste Management Plan (CAWMP)`?
❑Yes
No
14.
a) Does the facility lack adequate acreage for land applicatio ?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15.
Does the receiving crop need improvement?
❑ Yes
o
16..
Is there a lack of adequate waste application equipment?
❑ Yes
ri CNO
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
❑ Yes
KNo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
)�No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CTfo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
MIo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? El Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes AfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes YfNo
Rio viQla4igris:oi- clg#icientk •were hofpd• 00-brig •this visit; • Y.oir 'Will •teeeive 1)o ful�fti
•�corresondence:a�otit:ti�is'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):
rrm /ems 90V) we1/ 1tV1.1A;tee . AL
96,od keeargs J-- .Pray Welds
IF
Reviewer/Inspector Name _�: k At �E)�g —
Reviewer/inspector Signature: Date: _l2 �} _ 5/00

Facility Number: 09 Date of Inspection s Z- Printed on: 7/21/2000
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hglow Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes qNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
3l. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
5100

ay; Division of Soil and,Water Conservation.- 4 eration Review ° .'fY5 ;!`"' },,lI`+i !sg
D Division of Sjv
oil and WatekdiLn ervation'- Compliance Inspection t { {''
Division of Water Quality jCornphance1lnspecttrvn{ ,+r��J3s3 7 '�iii!,' €Fi'r� fr �Ir i,r' ;jt•,'`�I{tf !i1
�. Other Agency.- Opera, on Review r
O Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review AEOther
Facility Number Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
[] Permitted © Certified 0 Conditionally Certified 0 Registered 113 Not O erational Date Lsist perated:
..........................
r
Farm Name:........ ...............................
C4f+k................................................ County:......... 1... !�/Y,�.
4Owner Name: ....... .................. {. .. f.�............Phone No:.............................
Facility Contact: ...............................................................................ride:................................................................ Phone No:
...................................................
MailingAddress: ..........................,.......:....,.......................... a�.�....................................................................,............. .,........................
Onsite Representative:.., ..... ............. t�.. %L.. ... . Integrator:............... LL..,.............................................
�'c'
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
..... .......... ..........................................................................................................................................
Latitude Longitude �• �' �"
Design Current ,F,. Design Current Design. Curr'egt ,
Sabine, Capacity Population Foultry Ca acit Population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
!' ❑ Non -Layer �i' ❑ Non -Dairy I
❑ Other
s s
r r,.
�,� . is n , �; E•,
Tots! Design Capacity
TotalSSLW
is
Number of Lagoons JE1 Subsurface Drains Present ❑ l,uguon Arca ❑ Spray Ficld Area E ;
Holding Ponds/Solid Traps ❑ No Liquid Waste Management System
M I�.
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
h. IF discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. It discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If ycs, 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 Structurc 5 Structure 6
Identifier: rl
Freeboard(inches)...........16.................................................................................................................................................. I........... ..... I ........... I.................
5. Are there any immediate t to the i 0gri of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc,}
3/23/99 Continued an back

f'':�"��Vr/ •-r . _ j'J�va" sFu.r,rt�srr^?f' d t4•'.��i'..p,i;.t-"f- rti ` "-1""
:r
Divrsion of Soil aril Water'Conservation C1peration Rev
• �Ei P ! r F - - -, 1ElE !! i,IJ' l _
.Division of Soil! and Water,Coiiservation ,CompLance�In
f I E I
,'l iii,tlirt ` f�r�j(�!!' ik DIVISIUn of Water�Quality� PO
W
ncCltaaoe InspeCrtOn�''lt'�
� Operatlti 3 ZE i
Other Agey � on:Review �, # Ih ,
d3.. _ ;e.Af i IIL.LI111
! 1i'j
r
rE
;#I'i.
1 •i+i: � ,� I EE
E_
�i
1 EE
Q Routine Q Complaint O'Follow-up of DWQ inspection Q Follow -tip of DSWC review Other
Facility Number Date of Inspection
... Time of Inspection 24 hr. (hh:mm)
© Permitted © Certified 0 Conditionally Certified [3 Registered 113 Not O erational Date Last perated:
Count .1 /Ct�
Farm Name: CxOfA.9.4,...�....... �.. Y ........11-
� ................
Owner Name:...... ,t ... ..........
.... Phone No:.............................................,.,...............................
Facility Contact: ........................................
..............................................................................'Title:...................... ... .Phone No:
MailingAddress:........ ...............................................................................................................
Onsite Representative:........ .........1 integrator:
Q Yl .... ..........................��J .<...................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A
........................................................................ ................... ....................... ....................... V
Latitude Longitude �• �� ���
Design
igPoo latio
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons,
HoldingPornds /Solid Traps
.. -.,:.. .,..E , ...
uE�rl'E s MM E# �n ,lIII (
Desl n Current r� i I ¢y E! .t#,, Design ;Current,
E1 I E E � ,- ! o f ki u I �a� ,I Iv ,! IEE•P tI i t�
r I PoulirY'1l ;11 ; 'Ca aci,ty, Po uon .,i !Cattle .Ca p acit P
1latio ulatlon Er,
❑ Layer ❑Dairy
E 1' ❑ Non -Layer ❑Non Dairy a'
❑ Other ;r
' { ' Total Design Capacity'-
1' r Tota1,SSLW
E psi
❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area ui
❑ No Liquid Waste Management System
Discharges tic 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
h. If discharge is observed, did it reach,Water of the State? (Il'yes, notify DWQ)
❑ Yes
❑ No-
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
T Is there evidence of past discharge from any part of the operation?
❑w O
f❑.Yes
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 5
Identifier: ef
t
Freeboard (inches): .........� ......................................................................................................................................... I ........ I ............ ,ti.
.......
5. Are there any immediate t to the i gri of an of the structures observed? (ie/ trees, severe erosion,,,
❑yes
[:]No
�] seepage, etc.). _.
z7
3/23/99 t '"'"
Continued on
back,,'

[3 Division of Soil andWater
Division of Soil and Water
I ! f „' 3 Division of Water QuaLtj+
a
t" Other Agency'!Operation'
►nervation 'Operation.Review
rnservahon� Compflrance3Inspectiow
LQ Routine O Complaint Q Follow-ug of DWQ inspection 0 Follow-up of DSWC review Q Other
Facility Number Date of Inspection 6r19-
rime of Inspection : O c�>24 hr. (hh:mm)
19 Permitted o Certified [] Conditionally Certified 13Registered [3Not O erationalpp (Date Last Operated:
Farm Name: ............. .... t. R.:.... !'..:........................... .......................... - County:.......D kZ CN.... t � t'i....,..... .......................
Owner Name: ........ I�.O..�l.fi. i.......... A..!l v)'1i Phone No ... ......... ..ft ��5..............�Jr�7=...............,
............................. .
Facility Contact: ....... R.M.R4K ........."_I;.NSIMTitle:...................
Mailing Address: ............. ..,..............?77.2...........................
Onsite Representative: ........... RQh.ld.............. f.jwcCL.f.ri.. ..................,
Certified Operator: ........ Ac?.n,4 AckL N rs�7''�
.............................................................
Location of Farm:
Phone No:
n,......,NC......a8,3....
Integrator:.............�t�lf lWh ��..... ............ )Y6,,4.,..x1IC
Operator Certification Number:...... 1.9241.1p ..........
.......................................................... .. ........:...........:...............
................................................................................:., .................
............_........ .: .
..
Latitude �� �° ��� Longitude �• �c �«
Design Current Design Current
Swine 3i Capacity Po ulation Poultryl Cattle
Ca acit Po" ulation
❑ Wean to Feeder
PQ Feeder to Finish
Sggb
p
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�` ❑ Layer ❑ Dairy
F.
❑ Non -Layer I If ❑ Non -Dairy
❑ Other ;.
;. gyp
Total -SSL W
., �Number of La Dons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
g �,
Holding Ponds'LSolid Traps i, ❑ No Liquid Waste Management System
3.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water or the Mate? (If yes, notify DWQ)
c, If discharge is observed, what is the estitnatcd flow in gal/tnin?
d. Dees discharge bypass a lagoon system? (Ir 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
Identifier:
Freeboard (inches) . ..................a'............
❑ Yes 4No
❑ Yes
No
❑ Yes
( No
1A
❑ Yes
KNo
❑ Yes
� No
❑ Yes
[% No
❑ Yes [Z No
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

Facility'Nuntber: — r 1 Date of Inspection
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 environmentai threat, notify DWQ)
7.` Do any of the structures need maintenance/improvement? VYes ❑ 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 EXNo
11. Is there evidence of over application? ❑ Excessive Ponding❑ PAN ❑ Yes [No
12. Crop type 4-1 I kermtll (AV., l. cwlla. 1/ r►rnmt#�Q (ozft. WdejMLe,
13. Do the receiving crops differ with those designated in the Certified
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
imal Waste Management Plan (CAWMP)? ❑ Yes`"Wo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes KNo
s
❑ No
_
.S} 8 Yes
❑ No
❑ Yes
toNo
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sam.Cle reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [ANo
❑ Yes KNo
Yes ❑ No
❑ Yes MrNo
❑ Yes [f'No
❑ Yes Z No
❑ Yes ;KNo
❑ Yes KNo
❑ Yes KNo
0: Vo viola>(iggs;or• defidendpe •were %witig 4bKvisic • ;Y;oo ;wiii-teeeiw oc; fuier :`
correspondeike. about. this visit.
Comments' (refer,to,questioni#):.Explain any=YES;ans► ers and/or any, recommendations orilrny other'coinments i,' I ,',�s �
Use drawings of facility to better explain situations. (use addWonal pages as necessary}
Ind '6- w� w At : ihstde slycs a 44� k ree�I . Tkr� wrrs also Some ��4t5
!!� AC _� p OKJ We 5je oT f aSa° n � ► e s � a ss caves
eros
9. ��� 1" 010+ plf ou� Ae ;7-w� A,..—
&i6rV5 c
1 �. - I"-Ci � 1 �3 L �+ `�At� -cur We-CZC� GS O T�ryh�ihct �csr1 .
Reviewerllnspector Name :. a' 4'"'•f�Cft ,DL�J"I J . ,' ` ,``7 o'; t`al '�'
=a3 a3 , ,,li fl '_�
..
Reviewer/Inspector Signature:
Date: A "R91-
3/23/99

Facility"Number: — hate of Inspection -- -f-'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes []No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes[LJ<No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes V No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Po
Additional omtnenU ti ,; -:0 1 , ;
11 Il or �I'SiWingS:_ 1 "F �al ,r I I� ` '' �, '�' �l ! �
A. D ischa,�.e Q%Qe5 hvt"Lze4,, ee4J1%/ -/0 dtc ;Cja .r Wokd Ak
14-e- 57�Qce-,
& /Jo SO/ 52 k cis , vv, MT.
4kt4, -,,o:d .SwVks be �kt, aWPVA4aL./ ans-4
5 Id 6e 4ke*i 60 d� Lam � 5 4 .-
off Some .A�r�S" l"�►� �r�` I cv� n4 CJV"
b� a o� rr� wash► s H^'� ��
-t-Aerc rs s4%(/ ek we-4 q.rea- 44maepi 4wo W Af Lit'MI, nF
7-A;-5 n -� Ie Corrm4e.1 lair, HL""'_h sJn �QS - �►
k1 W .cane true Q ar.L� 1��J Ar 5 a TO dr►' ,
� J, le : 1✓%r-. "A,'Olsrn hRs Ld � h "-S c4 '4h A i s / s
�� 11 II P�
n 71 to fro G S S o-1� � .D t
dd4-P, q ZAe 6�P`?iv�w,,'
U
W A. h
f ea eltvs it C141y. e v"Ofnq ^c.,.t c.� 5 -e Ctv c-
rr p � I
p/yy� r�-P-r�� irJJr�`Jc. or,�. � . 7'�lis %at
IS CP
bn f�e PAn1 bdanre,
3/23/99

' \t
rn;,i
I'�.� D1Y151on of Sall and Watf GCOI1SerVatlon-'Operatiori,RevleW l����,�.,i
a
13 Division of Soiharid Water Conservatrun Cnmipliance Inspection
9 Division of Water Quality - Compliance' Inspection w s?
Other Agency : Operation Review
JO Routine IlComplaint O follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 12=24 hr. (hh:mm)
(Permitted © Certified © Conditionally Certified 0 Registered 5 Not Operational Date, Last Operated:
Farm Name: .....! � �!ti.....F>'L _. County: ( `..-..........................................
OwnerNamc:.....{..........................................[.t .4 .-............. Phone No:.......................................................................................
Facility Contact: .....Kw `-r-—l.s:?[........ . ....:.....!L.q. O iltic:............ Phone No:...................................................
MailingAddress: ............................................ ......... ...�....................... I ........................ I .......... ........................ ..y........,................. ....... I....,........ ..... I....................
....0... ��!Onsitc .R.,.......... ............................................
Certified Operator:....-�t�{�-�.� Operator Certification Number: ..........................................
Location of Farm:
............................................................................................................................................. ........ -7
Latitude 0 4 14 Longitude 0 & «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population. Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts'
❑ Boars Total $SLW
Number of Lagoons
Holding Ponds I Solid Traps
I❑ Subsurface Drains Present ]I0 Lagoon Area I❑ Spray Field Area
No Liquid Waste Ma
Discharges &Stream Im�pacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)`?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. ll discharge is observed, was the conveyance. man-made?
1). II'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the,Statc
c. li' discharge is observed. what is the estimated Ilow in gal/min'?
d, Does discharge bypass a lagoon systcru?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
t
Freeboard (inches): ....................
Structure 2 Structure 3 . Structure 4 Structurc 5
t a
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
ZXa_
Structure 6
1/6/99 Continued on back

i 5.
Division of Soil and Water Conservation 0 Other Agency
13 Division of Water Quality
10 Routine _ O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC_ review O Other �
Facility Number Date of Inspection
Time' of Inspection a : 00 24 hr. (hh:nun)
0 Registered 9Certified p0 Applied for Permit Permitted 0 Not Operational Date Last
__Operated:
FarmName:.............Gii ....h.►...... c...................................................................... County: ............... .�P. An............................................
Owner Name: ............... &.W.1 .........11k .f'r!!.n. Q..,H..................................... Phone No:...........g10. ... b.q5.....��,�,,...% ........... . ......... .... ......
Facility Contact: ......f\017 1,RL........F t. j.t.ka-14.V. 'I.. Title:................................................................ Phone No:...................................................
MailingAddress:. ...............:., a.....,..... &P.k...........319......................................... .... ct C.a.Le 7.t,wr?.......................... ....:
p J j .,
Onsite Representative:............ 0i.'. , ........... TCY!I..r1. S,C.�:t'1.................... Integrator:......... !? Pl'..�.5.... ..... co:l.':Q1,l.n4...
Certified Operator:.............K9A. 1d.........................&{.G�. j.q,: � ...1.......... Operator Certification Number:........r,f F
..1Z. e...........
Location of Farm:
Latitude =• =, = « Longitude 0. 0 ° = if
Design Cnirrent .: )sign Current IJes�gn Current
Swine CapaeitylPopulation Poultry Capacity jPopulation` Cattle. Capacity Populatan
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish �,3 ❑Nan -Layer I JE1 Non-Dairy
Farrow to Wean.
El Farrow to Feeder ❑Other ,
❑ Farrow to Finish
Total Des>Egn Capactty.�` �g�p
❑ Gilts '.
❑ Boars T 'Totafs§ may'
Number of Lagopns l}Holding Ponds ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray field Area
v:a k
❑ No Liquid Waste Management System
,, q h Y ;
s
ate.: �.,, r .,: , v .. �� - • ,:. W r
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
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
r,
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
Of No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
XNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
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'faii to have a certified operator in responsible charge?
❑ Yes
jX.No
7/25/97

Facility Numhrr: a
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ti,a goons Noldin fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Cl Yes P,No
❑ Yes KNo
Structure 5 Structure 6
Identifier:
Freeboard(ft): ....... a..............................................................................................................................................................................................
10. Is seepage observed from any of the structures'! ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed'! ❑ Yes No
12. , Do any of the structures need mainlenance/imlirovetnent'? 'Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediatepublic health or environmental threat, notify DWQ)
l
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify D Q)
15. Crop type.................. .... ... . ....... ..... .. ... ... ,............. ,....... ...................
r
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
i\'o
17.
Does the facility have a lack of adequate acreage for land application?
I
❑ Yes
IN
No
OK
18.
Does the receiving crop need improvement?
❑ Yes
ANo
19.
Is there a lack of available waste application equipment?
❑ Yes
XNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
` ❑ Yet
%No
For
Certified or Permitted Facilities Only t
,
23.
Does the facility tail 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
ONo
0 No. viol ations or deficiencies, were noted during this. visit. '.You will receive no further
coerespbndence a4011t this,visit.- .
Comrneitts.(refer to question #) Explain any YES answers and/or any recpmtnendations-or any -ether coax menu . '
se drawings of facility to better'explain situations. (use additio6 it pa is as necessary)
• �I I`� 11
C44 Alcl'� L4vi
O-VI JOAO
AJ
UXIO
7/25/97
Reviewer/inspector Name 3
r
Reviewerfinspector Signature: irle, __9,,1t_ I)ate:

i
g Division of Sokq
il and Water Conservation ❑ Other Agency ��Y�� ��
® Division of Water Quality
Q Routine O Complaint Q Follow-up ofMVQ ins Lotion O Follow-up of DSWC review O Other
Date of Inspection
Facility Number v J
Time of Inspection 24 hr. (hh:mm)
© Registered ■ Certified © Applied for Permit 13 Permitted 113 Not O eratianal Date Last Operated:......... ,,,,,,,,,
Farm Name:......... ..........
/......... ., .. !/!'.:............................................................ Cottnty:..,........... i......................................
.......................
Owner Name: ........ A�?�''A/�.... ............. ...... Phone No: ���d�l%Y�................,....
Facility Contact:...,�CCrI�!P>fl...ntm.........,, Title• Phone No•
9 .� .J/............................................... ...................
Mailing Address:..... ..u..... rr�'., �� Xa v.J�...(!`..��.......2.tQ.�,r................................. ..........................
`...,�.....,.. r... ....
Onsite Representative:........ 9W ....... r .. .................................... Integrator; .....,..�*..&...�^ . ..............................
`e,
Certified Operator........... ... 14-4 4> -0........................................... Operator Certification Number....................................,....
Location of Farm: 9 7 i ,-4/ -A a....K 47'
�... ........... I ................... ..............................................................................................................................................................................................
......................................................................................................................................................................
Latitude Longitude
a' Design Current, '
1 Al
Design - . Current Design€ "Current
Swine6, Capacity Populattan
Poultry Capacity ,P6pulati'n Cattle ,Capacity Popufatfg
❑ Wean to Feeder
❑ Layer
❑ Dairy
>:
® Feeder to Finish
OL p
f
❑ Non -Layer
10Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
ID Other;.
❑ Farrow to Finish
T6W Design Capacity,
Gilts
17
Tta1 oSSLW::
El Boars
s.
lliiNumber,of Lagoons 13Holdtng Ponas , r ❑ Subsurface Drains Prese!LtJILJ Lagoon Area
10 Spray Field Area ,'
No Liquid Waste Management System.....u$��
4.
general
1. Are there any buffers that need maintenance/improvement?
❑ Yes'sj
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
El No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
jo No
c. If discharge is observed, what is the estimated flow in gal/min?
A)14
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
JWNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
RYes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
7. Did the facility Fail to have a certified operator in responsible charge?
❑ Yes
R No
7/25197
Continued
on back

Facility Number:&9 — 1G
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
JR No
Structures (Lagoons,[fold ing Ponds,,Flush ['its.etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JE No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard(ft): .....
.......................................................................
10. is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
®'No
12. Do any of the structures need maintenance/improvement?
54 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
f Yes
❑ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
U No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
t5 Crop type �A
...,,�r...................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes No
B. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only,
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25, Were any additional problems noted which cause noncompliance of the Permit?
E3•No.violations:or deficiencies.rvere.i�oted,durirtg this:visit:.:You.will receive�l<to,ftirtlier_::
:. correspondeko alioui this; visit . .. .: .
❑ Yes No
❑ Yes ,� No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes '&Mo
A;C,~/XI /�rJ/� �dcrC .fc��lJE �ar �,t�..r ,PE...+aU, .+ f •-- d1,c 6.-.�.✓ - Xa
Zi fO.l�.t
/V, 7A��r-.�/ �s Cj� f��-f 's ��o.�,�.i oo.� Rs..�ov,�i O- -- All �l��v,�-r Xr�.1
/ i • Nv /.►�o�a� , ��C1,r,Es-,.�ayi,:a I.s�vo.�
_M.. w
Reviewer/Inspector Namcr. "r
Reviewer/Inspector Signature: �Ge d __� ,��� Date:

[Q DWQ Animal Feedlot Operation Site Inspection
14D Routine Q Complaint Q Follow-ut) of D%VQ insoccrion U F011a►v-uo of USWC review" Q Other
Facility Yumher
Farm Status:.._
Date of Inspection
Time of Inspection r2,r Use 24 hr. time
Total Time (in hours) Spent onAeview
or Inspection (includes travel and processing)
i
Farm Name:.. . n C 7K
Co u n rv:...._.. lez—.t c 7---' _._...._..�
Owner'
_.1 L�l�+��'!7�/J SDh— Pltooe \'u:.� -����� - ���SL� __..
Mailing Address:._ [r d /3cJ l33 r
OhsiN Representative: _� 11�t17�/i.Qr�t- Integrstor:..........J._-
Certified Operator: _.—div ��.�- _ Operator Certification Number:. -
Location of Farm:
LatUdde Longitude �• t_ _.lr Q:r
5t Not Operadonal Date Last Operated:
,lvpe^gr vpemoon ana uestgn t-apactty
k ..
to re.lder
to Finish
r to Wean
'oultry- Vntisber Catde
7 Laver I .` ` ❑ Dair
❑ 8rf
farrow to Finish I Other Type of Livestock •• „� �
.�Nnaiber atZagflans fHaliiiiitPotid"s; : �- r� Q Subsurface Drains Present ;�
may-:» �; d Area `"
�. * -� y�.} er r. w �i s n; ❑ Lagoom Are ❑ .Spray Flel ei -g.
Genera!
1. Are there any buffets that need tnaintenanct!Improverrnent? Yes ❑ No
2' Is any discharge observed from any part of the operadbo ? ❑ Yes No
a_ Ifdischart?e is observed, was the cohr i yonce man-made'? ❑ Yes No
b. If discharge is obsc:vcd- did it reach Surface Water? (If,ves, aotify D%VQ) CI Yes X vo
c. If discharge is obsen-cd. what is the estimated flow in gaVmin?
d: Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
J. Is there e-iidcnce of past discharge from any part of the operation? ❑ Yes No
4. Was there arty adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any parr of the waste management system (other than laeoonsiholding ponds) require Yes ❑ No
maintertanee:'improvemenr'
Cowiriued on hack

6. is tac;iicy not in cornpiiance wim any apnttcaotc
7. Did the facility fail to have a ce:tifiiedope;-ator in responsible charge (if inspection after 1/1/97)?
8. ke there lagoons or storage ponds on site which need to be property c'.osed?
Structures (l.aoons andlor Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): La Gan l
n
io. Is seepage observed from any of the structures?
Lagoon 2 Laeoon 3
I I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancaritnprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do atiy o f the structures lack adquate markers to idntify start and stop pumping level's?
14. Is there physical evidence of over application?
(Ifiri excess of WlvtP, or runoff ntering waters of the State, notify DWt)
15: Crop type
Yes R'm
ElYes NO
❑ Yes X I Io
Lagoon 4
❑ Yes Z'vo
Q Yes kNo
%,.Yes ❑ No
k Yes ❑ No
0 Yes ONO
16. Da the active crops differ with those designated in the Animal Waste Management Plan? Q Yes %-No
17. Does the facility have a lack of adequate ac -ag- for land application? Cl Yes ;LNo
19. Does the cover crop need improvement? ❑ Yes ;KNo
1 . Is.there a lack of available itrigadod equipment? Q Yes P(No
Fer Ceriified Facilities Only
2U. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? Q Yes ONO
2I: D6es the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes KNO
22. Does record keeping need improvement? Q Yes ONo
23. Does. facility require a follow-up visit by same agency? ❑ Yes 9Na
24. Did Re'viewe-1Inspector fail to discuss re• iewfinspection with owner or operator in charge? Q Yes XNa
t;ornme�ts: (refer to:question: R):.; Esp�ain.any: YESanswets� aadly�any re�tntiteadattatt�oi=aa}R�e�catiuitirits<_ :.::;:•:.. . .
115e•tirawuagS:Of 3C.Iltyto" eaerle.:pl s. ...2.ra
......... _..,_.. awl. a.:i►... fr ; �.
....µ ... ...,. a�sttuattons=[taddEhona}:ga�cs:aswnecessazv�-:�„.:•:^'r�,� � � ...•
Ala
A�e4*1
JUM 0 7 ��- d ak 4 alit
G�`�"��7� .f�LGtG/� . �iit�c...[•v sYL/.Jd� Uu.�.0 .�t��r�-L .�rr�'f�'�Cli � A,
W' t"(,.T.C/y4 �, D [/y /� •1�'C{ GC�7Ne l L�(f � � i t1/L (�'��✓.
!✓a:CI p77vC_'�'
�I
Reviewer/inspector :Name
Revitiver/Inspector Signature: pate:-9�
... n:..:.. �'rr'...� n. .r.... fi.'..-._ i��...Y..., c'......._ C.......... _�..,��_.....�� lf,.;r r •r .•n�

rrr• w`'� .
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
t�vw u� Date:lo D
Timer: o
Farm Name•
Owner Name: k7e) on
On Site Representative:
Muting
Physical
Latitude:
v+C, r / one No;
/' �uT G r S t� teBator. �� �iC
eration Descrioti n-, (based on dasip eharaekrislies)
7e of Swbw No. of Mimab 7 e of Poulrry No. ofArIbMU e of Cauk No. of Mi=U
LYa Dairy
0 Nmwy 0 Noa-Lycr G Beef
0 Feeder
Other7Yve of Uvawct F s, 7 , l;, a Number of Animals: Sf3f� Q
Number of Lagoons: I(i elude in the Drawings and Observations the freeboard of each lagoon)
F�ity.Il�e�tis�.
Lagoon
Ls lagoons) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes O
No�r
Is seepage observed from the.lagoon?:
Yes 0
Nobc�
Is erosion observed?:
Yes C)
Now
Is any discharge observed?
Yes 0
No)V
0 flan-nsade © No: ManwAde
Co"r Crop
Does the facility need more acreage for spraying?:
Yes ❑
Nq*
Does the cover crop need improvement?:
Yes ❑
. NoJ2'
(Mr the crops which ed iV rorwaeat) 7
Ckop type: ��� Acreage.
Setback CrUrda
Is a dwelling located within• 200 feet of waste application? Yes 0 Now
-Is a well located within 100 feet of waste application? • Yes 0 VOO—
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes 0 No
Is animal waste land lied spray irrigated within 25 feet of Blue Line Stream? Yes 0 NUSIn
applied of sp Y g
AOI — ranam 17.1996 _ .. „r•
v

Maintenance
Does the facility maintenance need impmvemeent?
U there evidence of past discharge from any part of the operation?
Does record keeping need improvem =t?
Did the beffity fail to have a copy of the Animal Waste Management Plan on she?
Explain any Yes answers; '
cc -F=W4 Atsess wsr UAk
Drawings or rr Observatiatts:
Yes O
NW
Yes 0
No 0
Yes
No
Yes 0
No Cl
Date: /a to
Use An=imsena f Nee&d
f} I j
� Go w � �-a1 C"u w In 1 C- In
&Ae wG s
- ( a r n a n 0. so,-+vr Ae4, :) a e YGr(� e.►�Cer a� r .! ^ b ..
Ca v\ �� r •a v�
wasWaspk�e
t y _ r �1 •
A
re
rt.
AOI — Januai717APM