090203_INSPECTIONS_20171231

funeral Information:
Farm Name:
Owner Name:
On Site Site Representative.
Mailing
Physical
.. _ _ .. .__._ -- it
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time: .
s1 F�fs
rco�nty: • 1�A
phone No: 5 —q � R)
Mute -Ne-ols
0-16
r
Latitude:^^ ! I Loo 'rude:_/_J
e t • (based on design characteristics)
Type of Swine No. of Animair 7ypeqfPo&dny No. of Anbnab Type of Caffle No. of Mitrals
W S. D L"W O Dairy
O Ntwwy G Non-Ltyer 0 Beef
O Feeder
Other7ive of Uvestoek NWnber of Anhnals:
Number of Lagoons:.
(include in the Drawings and Observations the freeboard of cut Lgooa)
Lagoon
1s lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Yes ❑
Ndtk,
.Is seepage observed from the, lagoon?:
Yes U
Nm'Cj�
Is erosion observed?:
Yes D
No%
1s any discharge observed?
Yes D
NoQ.
O Manmade 0 Not Mae -mads
Cover 0 -op
Does the facility need more acreage for spraying?:
Yes ❑
No$,
Does the cover crop need imptrovem nit?:
Ye(.
MOW
( list the crops which need hVrovownr)
Crop type_ 6 _ _ Acreage: /9 '-2 Q
Setback Criteria ,
1s a dwelling located withi> 2OO feet of waste application? Yes O -Na�Q,
Is a we'll located within 104 feet of waste application? Yes 0. NOS
TS animal waste stockpiled, within IOO feet of USGS Blue Line Stream? Yes O
'Is animal waste land applied or spray irrigated within 25 fees of Blue Line Stream? Yes D Nob`
A0I — January 1744

Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Explain any Yes answers.
Signatum:
cc: Facaity Assessment Unit
rawin r_Qbservationc•
�re.e�k� p•es�,•� L � x �� u
AOI — Januu7 17.1996
Yes 0
No'a
Yes O
Noll�
Yes ❑
Now
Yes O
No ❑
Use Attachments if Needed
- , n: N..�,.� - _ �: �. _ � ~a. _ ..-may. �i.r.r•A-�f.,gnr.��wra�. __

Site Requires Immediate Attention: �� s
Facility No. 09—
DIVISION
9 —
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9 1995
Time: 13,'15
Farm NamelOwner: ,Bladcn.f Sow /-n&epk„
.`Mailing Address: 94-, ,.? f3r-7( IL3 7 6a 10IVd `'V c 2s qq /
County: '910de ti
Integrator• Phone:
On Site Representative: /?/owe Se_3se.y,5 Phone:_ ',qla S S 8 - 5-73 0
Physical Address/Location: /VC -z*Z
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or[�) Actual Freeboard: / Ft. !�aInches
'.Was any seepage observed from the la oon(s)? Yes or(� Was any erosion observed? Yes or<l
Is adequate land available for spray? e) or No Is the cover crop adequate? �e or No
Crop(s) being utilized: •&VA4..kd-oA,_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?�e or No
100 Feet from Wells? � oeor No
_Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray ior(R)
within 25 Feet of a USGS Map Blue Line: Yes or
:Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (94 or No
.Additional Comments: Fotlaw- ,p i -�o lie- c.-,d.Lr-,_4 r
Two C Z �> t_.a- a "S -- —
Ri c. k Re.v e. t5
'Inspector Name
kk P
Signature
,cc: Facility Assessment Unit Use Attachments if Needed.

Division of Water Quality
Facility Number F - O Division of Soil and Water Conservation
Q Other Agency
Type of visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Eteason for Visit: *Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival j Time: 2'+00 Departure Time: d + County: Region:
Farm Name: 5, �lrt/t �gj uj Owner Email:
Owner Name: Ijl,� 4 rJ� fcJ 9�1 , �.�.
C Phone:
Mailing Address:
Physical Address:
Facility Contact: f Iyii!%l?5 Title:
Onsite Representative: q
Certified Operator: 1.PGi k),,.&
Back-up Operator:ZL44+I0
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede+
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: tA461jZ tj L
Certification Number: �r
Certification Number: i?>Ltk r
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er
Poults
Design Current
Discharges and Stream I.m acts
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
Dai Heifer
Dry Cow
Won -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes r P No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
[9 NA ❑ NE
M NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 214/2011 Continued

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: 0 Compliance Inspection UOperation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: '' Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
������wu�no��■ unu
Date of Visit: Arrival Time: Departure Time: 1 ��j �y County: Region:
Farm Name:
S ,5�5 /41 9 ''8 61-1 Owner Email;
Owner Name: L�Phone:
Mailing Address:
Physical Address:
Facility Contact: ! l�`� /1? Q %i Title:
Onsite Representative:
�I
Certified Operator: G�
Back-up Operator:
Location of Farm: Latitude:
k , Design Current
Swine °Capacity Pop,
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean 59 00
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other',
Other
Phone:
Integrator: �d"z.&Wh
Certification Number:.
Certification' Number: , V
Design Current
Wet Poultry Capacity Pop.
La er
Nan -La er I , ±:::�
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'
' Discharaes and Stream Impacts
1: is any.discharge observed from any part of the operation?
❑ Yes
Mt 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 th'e estimated volume that reached waters of the State (gallons)?
`
d. Does the 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
[P No
r
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes .
0 No'
❑ NA
❑ NE
of the State other than from a discharge?
Pagel of
21412011: Continued
5!Jd�'�'i1..�fr."^t.y,. 4m xi..r.�..''v,..s...i_ZY+..'��. .:��4,.i:......Z"!.. 1. �ix',1 �.e .: Y,k'•i•j'h.Si'..-,.)� �i L[.i�^rN i:.s:lR'Y���hi 1�.1 Ss.'�'y�.L.. �n,:,:+�L
J,....Y,`�, 1ti�.,f,,."��J. �r...,..o-i:',. W';...i
Y:..: 1i
n.... •. LI. , fl.�f+.Y. S,��;

Facili Number; ZI - wuD Date of Ins ection: —17—
Waste
12Waste Collection & Treatment
4. Is storage c+ apaL�ty (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %No ❑ NA ❑ NE
w{� a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No ® NA ❑ NE
r
tructure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
V j-\ \ \ U
MAent
��� Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
g No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
[4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
Waste Application
❑ NE
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g No
❑ NA
❑ NE
maintenance or improvement?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
11. Is there evidence of incorrect land 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 > i 0% 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 Approved Area
12. Crop Type(s): C4-eqSS &1 & ,"L Z)
n r
13. Soil Type(s): RL ii-� Ge . R , OC i t�o A 1 Wo,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T�
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] 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall
Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[� No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

+~ �'YvG�?�`... •tom ,_ .r.
JiFicillijNumber: 1101ate of Inspection: —� Z
Waste Collection & Treatment
4. Is storage c1 apagty(structural plus storm storage plus heavy rainfall) less than adequate?
{� �a. If yes, is waste level into the structural freeboard?
n%
tructure 1 Structure 2 Structure 3 Structure 4
Qent
�'Df Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes PNo ❑ NA ❑ NE
[]Yes ❑ No ® NA ❑ NE
Structure 5 Structure 6
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes (g No ❑ NA ❑ NE
r If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
1
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 or improvement?
❑ Yes CP No ❑ NA ❑ NE
4
❑ Yes (4 No ❑ NA ❑ NE
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 Outsi_deJ of Approved Area r�
12. Crop Type(s):C�44$�61 �, llgt � i1'SS
13. Soil Type(s): RIAA_, C1 i Fj' aC t PD fir- Wo Le A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes (] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
(] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE '
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(t] 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 P 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 Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? - ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3
T r .2/4/2011 Cantu_ ued
y A •ti '
t.. ... y�.. ,., ..w F" ip �R..., M .,.. ��.. ._ ... {: r:i• ,3:1 ... .,r r . r�' z,.. ..-. ,�,. .Gr.,f.., ..:r,.� s•� ... I'y. ... ..'s ,. -f :a ,, :�. 'h'.-'�.� r t �i "'y

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes [;K No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
3 t2- �[q "�
3093- 53`r
3M
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
[3 NE
F-1ApplicationField ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the ReviewerlInspector 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 answers and/or any additional recommendations or any other:comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ge, ,yl5 reVI 511 b111 -2,
:544e. 01, - - o v. ' 2, �-/ Z,
L -0a00 n Leto 15
aoLi z.- 2-9
3 t2- �[q "�
3093- 53`r
3M
303- 5-3''
Reviewer/Inspector Name: nai' R- Phone: gjlo-g3333oo
Reviewer/Inspector Signature: �' "l Date: 52-4-12-
Page
2 -4-12-Page 3 of 3 2/4/2011

Facili Number: jDate of Inspection:
.24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes [& No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes © No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
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?
Comments (refer to question #): Explain any YES answers and/or any addil
Use drawings of facility to better explain situations (use additional pages as
i� 5 f l b /I z,
h1 -11,40-7
S 2,�r12
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3 '
❑ Yes [8 No
{
❑ NA ❑ NE
❑ NA ❑ NE b
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA. ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes PQ No ❑ NA ❑ NE
ons or any other comments:_'
'
' oo rr Levj 5
t
L
^
zq 't
30B
2-00q
41't
3090_ 66'
3 ��,_
��q ►�
3093 - �3'►
3014
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3 '
❑ Yes [8 No
{
❑ NA ❑ NE
❑ NA ❑ NE b
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA. ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes PQ No ❑ NA ❑ NE
ons or any other comments:_'
'
t
t
' - f
Phone: 9jO�3'
Date: S'zyll.
2/412011

W Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I& Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:, I� Arrival Time: Departure Time: County: 8t.�}oF4v Region: r
Farm Name: ���r"IO Wes S` f y J7 &Aarrq, Owner Email:
Owner Name: A7W Phone:
Mailing Address:
Physical Address:
Facility Contact: lot F e A-n'I"ISS' Title: Phone:
N
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
Gilts
Boars
Other
Other
Integrator:
T�
Certification Number -
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
pry rouitry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.-
a,
ther:
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
DajpLHeifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ro No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes
❑No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 214/2011 Continued

Facili Number: 9 - Date of Ins ection: Z 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:3 Cornmean-1;+b�7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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 [P No [:INA ❑ 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
0 Outside of Acceptable Crop Window'! J,, [:]Evidence of Wind Drift c❑ Application Outsideeof ,Approved Area
12. Crop Type(s): �• 0*Q -&r(""i 1 uy , 957w, C whL 4021i 5M S1411h o )
13. Soil Type(s): FjtdAt G. � /1fp�-, � Wo '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fp No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ YesNo ❑ 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 [3Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard E]Waste Analysis E]Soil Analysis C]Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r" No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D No
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
[]NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection: 14115
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 V1 No ❑ NA [3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P 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?
24. 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/Storagc Pond ❑ Other:
❑ Yes oLr'j" No ❑ NA ❑ NE
❑ Yes J�g No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
❑Yes fpNo ❑NA F] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
1Comments;(refer to question #): Explain any YES answers and/or any°additional recommendations or any other comments:�tY� a
6e4rawlngs of facility to better explain situations (use additional pages ?as ` -necessary) , � � 10
C,�NS-s�r3 r 1
.'
oil
dZ �/
goo q - "4� 30q o - �R '
3
309
30O, _�73093"-sem
t•
3084- �1 a' 0
3
o o fb -, 6 q u 1,K 5 +� f
�4e
IZ ce4S r-eLa I q1 2S_/ r 1
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]n
Date: yZ��
2/4/2011

Division of Water Quality
Facility Number O Division of Saii and Watcr COuservation
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (6 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
County: D -LAD W Region: PAO
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: a&hui, 0 44-5 Title: Phone No:
Onsite Representative: t; Integrator: " `
Certified Operator: Operator Certification Number: �9
Back-up Operator: VALUBack-up Certification Number:
Location of Farm: Latitude: =0
=d
❑61 Longitude: = o ❑ ❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design CurrentDesign
Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ La er
❑ Daity Cow
Wean to Feeder
❑ Yes
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ Dairy Heifer
Farrow to Wean 3M
❑ NE
❑ Ary Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ NA
❑ Turkeys
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
❑ TurkeyPoults
❑ Other EE]
Number of Structures: a
❑ Other
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters orthe 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
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: (4-70Date of Inspection i a
Waste Collection & Treatment
4. Is storapeapcyty (structural plus stormstorage plus heavy rainfall) less than adequate? ElYes ?No [:]NA ❑ NE
���
` �f yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1%NA ❑ NE
co Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
�Iden
ti ier:
4 Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes bNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I�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❑ EvidenceofWiind Drift ❑ Application Outside of Area
bdCX l'1 c
12. Crop type(s)
Ljo �� IGLC'I , f� � tl o �� j !�2S
13. Soil type(s) & L641 Cep t r D bC I &0A1 Lak
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ YesNo
❑ NA
N
[IE
17. Does the facility lack adequate acreage for land application?
ElYes
6No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
& No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other: comments n
r
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name t Phone:
r3k0
Reviewer/inspector Signature: Zki Date: S (24to
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection S v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ 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 Pa 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
P3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
i
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(( [�No
❑ NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
El
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
`
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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
tR61oD �S
tt �o S�—� 3rct
10q7---
zoo q �/ r2), u
3�
3
Cl
Page 3 of 3 12/28/04

1Type of Visit 46 Compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "
I
Farm Name:`
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: OUS Title:
U
Onsite Representative -
Certified Operator: Q
Back-up Operator:
�1A. ;
, M&2M0'=
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=0
e = = Longitude: E-1 ° =' =
Discharges & Stream Impacts
Design Current
Design Current
Design Current
Swine
Cup�ci`ty Papulation
Wet Paultry
Capacity Population
Cattle C•apucity Papulation
Wean to Finish
❑ Layer
❑ Dai Cow
Wean to Feeder
❑ Yes
❑ Non -Layer
NA
❑ Dai Calf
❑ Feeder to Finish
000
❑ No
❑ Dai Heifer
❑ Farrow to Wean
c. What is the estimated volume that reached waters of the State (gallons)?
Dry Paultry
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Non -Dai
El Farrow Farrow to Finish
�FNA
❑
El Beef Stocker
Gilts
Xdo
❑ Non -Layers
❑ Beef Feeder
PCBoars
❑ Yesio
❑ Pullets
Beef Brood Cow
❑ NE
other than from a discharge?
❑El
turkeys
lam'
Other
❑ Turkey Poults
12/28/04
❑ Other
1
310 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
�FNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Xdo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yesio
[:1 NA
❑ NE
other than from a discharge?
lam'
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes VNo ❑ NA ❑ NE
a If—IQ ;Q —ileto infn 01, KS,. `D m n Ve., n AT_ iU1ATA n Mr
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
(ic/ large trees, severe erosion, seepage, etc.)
[INE
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes io
[INA [INE
through a waste management or closure plan? [[
El 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 V No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
o ❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes $No
❑ NA ❑ NE
maintenance or improvement?
bMNo ❑ NA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes , �No
❑ NA ❑ NE
maintenance/improvement?
1t. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �bNo
[INA [:]NE
ElExcessive Ponding [IHydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yeso
[INA
[INE
15. Does the receiving crop and/or land application site need improvement?
ElYes
o [INA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
E]Yes
No El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
bMNo ❑ NA
❑ NE
--,s$<-a.��axW�,.
Gommentsp (re)er toquestron #) h Explain any YES answers and/or: anytrecommendattons ar any, other cottmen#s. f;;
Llse drapvmgs oAlacility to better explain srtiiations &(useY$acJdihonal pages;as,ngcessary) _ .rt
uBr
�a ;� ��� axe '�€� ������,� .-
Reviewer/Inspector Name ���� � .� Phone: 2V 3�8�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: TM
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ 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
(9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
`GPNA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
r No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JpNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
6, QA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IC1 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
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 [:INA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes EpNo ❑ NA ❑ NE
12/28/04

Division of Water:'Quality OleA
Facility'Number ; an3 o Division of Soil and Water Conservat,on Y5:
Q Other Agency;
IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJS Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 91MArrival Time: � Departure Time: � County:
Farm Name: Mf A S-4% -4- 1-1 n % ` - " Owner Email:
Owner Name: r 1` Qyyx I it Val` mzs
IA Q
Mailing Address:
Phone:
Region:
Physical Address: / �]
Facility Contact: I�I�VF� rrl y�� OriS Title: u V ! � l Phone No: �/_Qs2_ff
Onsite Representative: /_ ! i� ke Q.�n,malS integrator: 1 _�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine ' Capacity Population
Wean to Finish 2 /T
can to Feeder
119719.
Feeder to Finish 000
arrow to Wean 131oo
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Other�.
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=1
= Longitude: =0=1
°=1 =
.Design:, � ' Current: Desi
Wet Poultry Capacity Population Cattle
V.
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ 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 I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
NA
❑ NE
❑ Yes ❑ No
NA
❑ NE
❑ Yes ❑ No
)�4qA
❑ NE
El Yes *o
❑ NA
❑ NE
Cl Yes No
❑ NA
❑ NE
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Mo ❑ NA ❑ NE
Structure I �St� cture 2 StryC
u e 3 Structure 4 Struc re 5 Stru ur
Identifier:
Spillway?:
Designed Freeboard (in): 2030 3 3
Observed Freeboard (in): 5
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 �fNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 04�,10 ❑ NA ❑ NE
maintenance or improvement?
Waste AUnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes[ No [:]NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes W 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) C +N"_l_Y rna44 C 1 116 f-
13. Soil type(s) Q A
14. Do the receiving crops differ from those designated in the CAWMP? r
❑ Yes
X1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
,� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
, 3 N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�jNo
❑ 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):
ftVrLer muA& +o 6- v=j-4
Reviewer/[nspector N
Reviewer/Inspector Signature:
Phone:
Date:
121,
c L -J is
Continued

Facility Number —ZO31
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ]A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
f
Structure 1 Structu e 2 Structure
Identifier: /c3- I � 7 !
❑ Yes o ❑ NA ❑ NE
St fu e7� Atructure S sture
c -[J
Spillway?;
Designed Freeboard (in): 3_D_
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No []NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 1A 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? ❑ YesNo ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes o [:1 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 )3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 0- Lk.✓
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes to No
El NA
[__1 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
10 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
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1� No
❑ NA
❑ NE
Comments (refer to question ff): 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 1 Af- 6LAOOAJPhone: .10
RAn
eviewer/Inspector Signature: Date:
12/28/0f 1 Continued

anility Numberd -QQ3 Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El maps [:1 Other
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
❑ 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
)$ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
ANA
❑ 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 fANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
JANA
❑ 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
�q No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ YesrNo
o
[:1 NA
[__1 NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Cofnments and/or Drawings
t '� ;� �� 4, , � '�
e t UjWaL V\
y
Page 3 of 3 12/28/04

Facikty No. 09 a(-)-3 Time In Time Out Date
Farm Name v M.04 1_1v Integrator r
Owner Site Rep M�-
Operator — rL -t No. a'
Back-up 0h--- No.
COC Circle: Ge or NPDES
Design Current
Design Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Date
120 min Inspections
Nitrogen (N)
Sludge Survey
Cali bratiow_Lp_ _
Waste Transfers
Rain Brea cer
PLAT
1 -in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
M

Division of Water'Quality
Facility. Number Q� �� O 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 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (0 0 Arrival Time: Departure Time:County
411
Farm Named t•1t,�V� S4'c "�� 1I t��+eLur.,u�w "AUwnerEmail: _
Owner Name-k_UkA
Mailing Address: P
Physical Address:
Phone:
Region: P I
Facility Contact: M kR_ Title: �U�l Phone No:
Onsite Representative: �I� Integrator:
Certified Operator: —!T� _d �.,� C��%C Operator Certification Num r: aS
Back-up Operator: �"� Back-up Certification Number: r `f
Location of Farm: Latitude: ° Longitude:
Swine
Design
Current Design Current
Capacity
Population Wet Poultry Capacity. Population
finish 1 a�
"la �-
❑ Layer
eeder '5(d.)
3 l C� 0
❑ Non -Layer
Wean to F
can to F
oder to Finish
13O�
i�Q
E*FarrowtoWean
S-7001
pO
El Farrow to Feeder
❑ Farrow to Finish
ElGitts
[IB oars
Other .
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turke s
❑ Turke Poults
El other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ' ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population,
EJ-Dairy Cow
El Dairy Calf
❑ Dai Heifei
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl I
Number of Structures: U
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 [:INA ❑ NE
❑ Yes ❑ No ? NA ❑ NE
❑ Yes ❑ No ]�NA ❑ NE
❑ Yes ❑ No 04NA ❑ NE
❑ Yes %No ❑ NA ❑ NE
❑ Yes hNo ❑ NA ❑ NE
12/28/04 Continued

Facility Numbera Date of Inspection 7 d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )4 No El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes [I No *A ❑ NE
Structure I Structure 2 ,Structure 3 Structure 4 Structure Structure 6
Identifier. 4 l
Spillway?:
Designed Freeboard (in): a Q1 3 3 .
Observed Freeboard (in): _ �Qr_
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 El 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 4RNo ❑ 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 JXNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aimlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes [R' Jo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 1yNo
❑ Yes ���N,, o
❑ NA ❑ NE
El NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes PNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes IffNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes _�g No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: p
Reviewer/Inspector Signature: Date: r�LJne_ D
12/28/04 Continued

Facilityimber�] ��
N{, � Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t?No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DTA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in); a- CD -9
Observed Freeboard (in): pZ
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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [, No ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 No ❑ NA ❑ 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 > 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
❑ 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
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector NamePhone:
Reviewer/Inspector Signature: Date: -_Tyne D '_& ']
12/28/04 Continued

Ficility Number: D — p Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 00 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design F-1 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Iwo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo [:INA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
55 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�4No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes(
No
[INA
[:1 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
IMNo
❑ 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
No
IANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:AL
�
j C 1- ! 2:-,c-
N��te tam �R3i j avV I 4 ` Z)Q,vr f I e �� T� 001o5 kom, C: nC lf) �L
bvt4 �O O Nb Im(svE 0.ni wal L''x1s e -�o %
0, v e fW4 sol c.�-,a` (�� 5
rweda2C .
UVI
12/28/04

�Q
Facility fVa D CD� Time In Time Out Date
Farm Name Integrator
Owner Site Rep
Operator No.
Back-up
COC Circle: General or114D�
C
Desitin Current
Design Current
ed
Farrow —Feed
ish
Farrow — Finish
ee inish
Gilts ! Boars
acro Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Waste Transfers
Rain Gauged -
Soil Test
PLAT
Weekly Freeboard
Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Observed
Calibration!GPIM
Waste Transfers
Rain Breaker
Wettable Acres"'
1 -in Inspections l O— It q.;
12- I -1-S
Iy
Date Nitrogen (N)
I7,a
lCk-20
CL
��S

4
I
Type of Visit m�ollance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 D County:
Farm Name: %l;ri" fl rs .5i �eS . /—/!4 1,7" /r J�+�,ur �So�s- Owner Email:
r3L� elrn cf-.44+ en o FQ� --
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:^
Certified Operator: 7—e-p�
Back-up Operator: /��h P u $1
Region: ft—
K D
Phone No/:
Integrator:
Operator Certification Number: eE 5
Back-up Certification Number: Ze
Location of Farm: Latitude: 0 e =' =" Longitude: 0 ° = i =
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
JQ No
❑ NA
Design
Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finishxg
❑ Yes
RNo
❑ Layer
❑ NE
❑ Dai Cow
C` Wean to Feeder
D D
1.31 O D
❑ Non -Layer
El Dairy Calf
Feeder to Finish
ODD
pD0
❑ Dairy Heifer
Farrow to Wean
3 Dc
3 D
Dry Poultry
❑ PqT Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
[:1Layers
El Beef Stacker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Soars
El Pullets
[I Beef Brood Cow
❑ Turkeys
I0 Turkey Poults
loll e
❑ Other
❑ Other
Number of Structures: /®
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
JQ No
❑ NA
❑ NE
❑ Yes
tK No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: dw Date of Inspection fr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,F� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ,l No ❑ NA ❑ NE
slmetnre4l S4raftare2— StmetmT-3 - Stfueiui-e 4-
Strtretnre-5-
Identifier: I' 0? -3 9�-f1.9& L&5 /
17V1f/VV0 Mtn-•.
Spillway?: A 0 �y�— , rs v
rrL-An;__ /I0 1QQ
Designed Freeboard (in): 1�9 p 3 % 07O o90 202 <3.2, 302 3D
33 69
Observed Freeboard (in): (/ HD �� �y L�
�� 67 f
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 [Z 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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes JRNo ❑ 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 DINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes CKNo ❑ 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) e-ln.
13. Soil type(s) ,
14. Do the receiving crops differ from those designated in the CAWMP7
❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,LNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes EL No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes VNo El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes KNo ❑ 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 Phone:9/P=1IrIS 330
Reviewer/Inspector Signature: Date: / 0_jL-2p 0491
Page 2 OJ -3 12/28/04 Continued

Facility Number:j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No [INA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 54 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z1 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[4No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D ,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[a 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
IR 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
49 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
Pq No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

W,
IType of Visit 6-6—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit' 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:, D o Departure Time: ® county L d' -d . Region:
Farm Name:�.yt'e__s La22:�' 0 Z �,�c Owner Email:
Owner Name: (� U T,d f✓yr1 s L L G Phone: , 1
Mailing Address: D I ox. 25`9
Physical Address: _ 6�s
Facility Contact: Aflrr / i�A cl h fJt Title:
Onsite Representative:
Certified Operator: J! y. -e— .
Back-up Operator:
Location of Farm:
Swine
0
Latitude: E]
Phone No:
Integrator: %?41.tr A %31'i►
Operator Certification Number:Z
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
M ❑ La er
b D ` ❑ Non -Layer
® Wean to Finish
17
Wean to Feeder
❑ NE
® Feeder to Finish
d D D
Farrow to Wean
.3 D
❑ Farrow to Feeder
KNo
❑ Farrow to Finish
❑ NE
❑ Gilts
54 No
❑ Boars
❑ NE
Other
❑ Other - I
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
u =0=,
Longitude:
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ 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?
❑ Yes ENo ❑ NA [:INE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:Q2Date of Inspection 1W-15-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ®.No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /fir]-1� S,�9_tOi/1 �' �gr}�D Pad 7 � � / �i JL3
Spillway?: VV
Designed Freeboard (in); ry 3 3� _ �?o' VD -/3l 30,...0 r,79 t.QX
Observed Freeboard (in): 3S- 0V7 di __3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
,4 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
Q No
❑ NA EINE
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
g No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5,No
[INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
%No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes
�No
[DNA ❑NE
maintenance/improvement'?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
[KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs [I Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of AcceptableCrop Window ElEvidence of Wind Drifl C1 Application Outside of Area
12. Crop type(s) &,enj/I a %rAa r- I5�wa 116rta -, A- /%%�D / u�t Afoy 1 gLA4__r_ a -/-�
/
Can f
13. Soil type(s) a ZP_e2� 1; G ke &_0 ZZU 1W t? kits /Plf lCe /40f /
c r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
A -No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
CKNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
R,No
❑ NA ❑ NE
° :fix io SiiMtIfaY i9
Comments (refer, to q'uestioo #) Explaln any YES.,answersiand/or:-any+recom$mendayt�io,ns_ organ. other comments. )
U ��Use drawings or cillty to better.explpin siivations .(use,addltional pageyys„u T,s1neeess�a�ry)
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/28/04
Continued

Facility Number: 42,y -7Vp3l Date of Inspection—D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 59 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 5? No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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?
ElYes
(&.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
P 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
P No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
KNo
❑ NA
❑ NE
Additlanal Cornments and/or Drawings: �'
r..
�"j U�— ;��ey-j
12/28/04

Facilih• Number Date of Visit: J� Qt' Time:
d.3
hot O erational Below Threshold
ENPermitted M Certified 13Conditionalh• Certified 0 Registered bate Last Operated or Above Threshold:
a
Farm Name: �+Ics Count•: a��n
Owner Name: %� u � ��=js--tbL j rs- Phone No:
Mailing Address: I
Facility Contact:_ �a i'+ ON i Z 1 C Title: Phone No: �r
Onsite Representative: �a�C Ve C,,t;1,, Integrator: / 400'/7�x -- l7f-dGJh
Certified Operator: _ ��h4 bc1 �r �' Operator Certification Number: ��dw l
Location of Farm:
EV Swine ❑ Poultry ❑ Cattle [] Horse Latitude • 4 0 K Longitude �• �I �u
Design Current
Swine ronorifv Pnnniminn
® Wean to Feeder Q
Feeder to Finish 6O 17.t
Farrow to Wean ao
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acity Population
❑ Laver I I JE) Dairy I
❑ Non -Laver ❑ Non -Dairy
1[:] -Other -
Total
OtherTotal Design Capacity
Total SSLW
Number of Lagoons ® .. .❑ Subsurface Drains Present ❑ La ooh Area ❑ S res Field Area
:Holding Ponds /Solid Traps 0 ❑ No Li uid Waste Mana ement System
Discharges 8 Strealn Impacts
1. Is any discharge observed from any part of the operation?
El Yes ( No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen�ed, 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? N /A
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 8 T� a ent
4. Is storage capacity (freeboard plus storm storage) less than adequate? B2"Spillwav ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i�L3 / 3 y�G , 7 $+��p Io
Freeboard (inches): �31 •� �� J` •• .sfo 33 9 5V ,S"CN XV
05/03/01 Continued

Facility *mber: 9 — a03
Date of Inspection 1 /o 0► 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A lication
10. Are there any buffers that need maintemmoe/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (7eeAla .50" �GC/1f, "h ecf' i^o4.g4',& r, ig) SCa e3S
❑ Yes [Z No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes [N No
❑ Yes 3 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 1p 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 LSr] No
Odor bssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes JS 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 0 No
Air Quality representative immediately.
@�Dd�',KTk Y:aja�;"g 2j°j 4 " �"$,�'.„r��:6],..,s:t��S"S$�?EB�2i -�"}1 9dEt%R>kd;H?��k88S""'3di374.�tB'jaYysi��?�s;C��.yt&yk��tYS'4�.:Cri`�'8"S„d6� �„f"Jy..'3yY;�`��.G{y��y�� E,°i @k7, a ixJ ;}@k9? €6�dp� �8&�$y� `�,�.; E��iY�.7tysg,�y. � 2. g:< „p .•t��°✓ _ . t' .i
tYB.I�Ye oii'1I Y MGMNa6, 'a € W o ''yi�rVW N�N YYYtiiP Y�>s Y�trVom IWYi
33' 4:” p .t
3r3� ina] N.s�oa:?t�es d
Field Copy Final
OPY❑
! ?11k�� u? .
:.kL
yikc,”t-Q 6
1
3.PIGCG CSI b jCdS d S LA -pa
G _S.
I0- oL"oL4.
i-],
'r C SGGcQC d�- .
Reviewerans ector Name st E s !b : 5tt : I,n�' g� e��€,y¢,§��g�$$, ° ¢ N.� r' � ' �l ,dq : .. e
�;.. > �.. �€���{€i.'�
p r x,@€• � F��E .i ,b:i9a,rara;4t!t�.q, �.:A`z�§.w"d:'s��i7a.�&Y�.':�.�6 . .�8:�°id#:L
Reviewer/Inspector Signature: as- Date: ads
17112/03 � Continued

acillty umber: 2 —,2,931 Date of Inspection
Required Records & Documents
-J
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
2-14
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W , cher , de3ig<m'W, etc.)
El Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application []6m§ea 04vwte Aawysir, ❑ ztpling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
S -No
25. Did the facility fail to have a activeIy certified operator in charge?
❑ Yes
©filo
26. 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
la'No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
Z. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EMO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
MKe's
❑ No
31. • If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑filo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[moo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
01TO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 2No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes I TNo
❑ Stocking Forth zm ❑ Rainfall ❑ in
❑ No violations or deficiencies were noted during this visit. You will receive no farther correspondence about this visit.
-J
A,
IV I
12112103

i
Division of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090203 Facility Status: Active
Permit: AWS090203
❑ Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine County:
Bladen Region:
Fayetteville
Date of Visit: 03/24/2017 Entry Time: 11:00 am Exit Time: 1:00 pm Incident #
Farm Name: Mr. Holmes Sites #1 - #14, #1 7, #18, Blueberry Sow, Bladen ,Ar
Owner Email:
Owner: Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: 2313 Mr Holmes Farm Rd
Garland NC 28441
Facility Status: Compliant Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm: Latitude:
34° 49' 09" Longitude:
78° 32' 41"
From the intersections of NC 242 and SR 1002 in Ammon, go 2.0 miles north on NC 242
to farm entrance on right
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Robert T Young
Operator Certification Number:
18461
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons
Phone : [phone]
On -site representative Michael Ammons
Phone : [phone]
Primary Inspector: Robert Marble
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
Lagoons:
2042 = 33"
2004 = 47"
3092 = 44"
3088 = 51 "
3090 = 56"
4205 = 55"
3084 = 35"
3086 = 40"
3082 = 54"
3081 = 51"
3096 = 66"
3093 = 69"
page: 1

t
Permit: AWS090203 Owner - Facility : Murphy -Brown LLC Facility Number: 090203
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Swine
Design Capacity
Current promotions
❑ Swine - Farrow to Wean
3,350
Swine - Feeder to Finish
64,680
Swine - Wean to Feeder
10,600
Total Design Capacity:
Total SSLW:
78,630
10,500,350
page: 2

Permit: AWS090203 Owner - Facility : Murphy -Brown LLC Facility Number: 090203
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
20.00
Lagoon
10&11
32.00
Lagoon
12&13
32.00
Lagoon
14
30.00
Lagoon
17&18
32.00
Lagoon
19 & 20
Lagoon
19&20
33.00
Lagoon
2&3
31.00
Lagoon
4&5
20.00
Lagoon
6&7
32.00
Lagoon
8&9
32.00
Lagoon
AMON
29.00
Lagoon
BLUEBERRY
Lagoon
HOLMES 1
Lagoon
HOLMES 10&11
Lagoon
HOLMES 12&13
Lagoon
HOLMES 14
Lagoon
HOLMES 17&18
Lagoon
HOLMES 2&3
Lagoon
HOLMES 4&5
Lagoon
HOLMES 6&7
Lagoon
HOLMES 8&9
Lagoon
NURSERY
08/23/05
page: 3

Permit: AWS090203 Owner - Facility i Murphy -Brown LLC Facility Number 090203
Inspection Date 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
E ❑
❑
Discharge originated at
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ E
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ N
❑
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)
❑
1:10
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
E ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
N ❑
❑
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
❑
E ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ E ❑ ❑
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 4

Permit: AWS090203 Owner - Facility . Murphy -Brown LLC Facility Number
090203
Inspection Date 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes No Na Ne
Crop Type 1
Coastal Bermuda Grass
(Hay. Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Butters fine sand, 0 to 2/u
slopes
Soil Type 2
Centenary sand
Soil Type 3
Foreston loamy sand
Soil Type 4
Ocilla loamy sand
Soil Type 5
Norfolk loamy fine sand.
0
to 2% slopes
Soil Type 6
Leon sand, 0 to 3 /o slopes
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ 0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 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?
❑ 0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ E ❑
❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ N ❑
❑
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?
❑
page 5

Permit AWS090203 Owner - Facility : Murphy -Brown LLC Facility Number:
090203
Inspection Date 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit
Routine
Records and Documents
Yes
No Na Ne
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
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?
❑
N ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26 Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑
❑
27 Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Na Ne
28 Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29 At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(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 ❑ E ❑ ❑
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? ❑ N ❑ ❑
page 6

1V.\ m
ivision of Water Resource
Facility Number - FTZ5L 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: Orlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: FT Departure Time: County: (Aar -'1
Farm Name: j Vrct�( Owner Email:
Owner Name: �t\6[ �� r ��1� ��`�J Phone:
Mailing Address:
Physical Address:
Region. r=770
Facility Contact: _C.�i S ij3rx� wL[' Title: Phone:
Onsite Representative: � Integrator:
My -S
Certified Operator: i iltl, f �E Certification Number: 22— die 1(
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
[D"No'
❑ NA
❑ NE
❑ Yes
❑ No
[EJ A
0 NE
❑ Yes
[:]No
[] NA
❑ NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWR) ❑ Yes ❑ No ❑'INA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3'�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E§No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: T - F_ 0"1- Date of Inspection: MN
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg-Nv- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [4] -NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
[v]'Ro
Identifier:
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Spillway?:
[f No
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r� !r
Observed Freeboard (in): s Z
❑ NA
❑ NE
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.)
17. Does the facility lack adequate acreage for land application?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes Q No ❑ NA
❑ NE
waste management or closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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 LJ 'No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ['SNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
Cn—No
9. Does any part of the waste management system other than the waste structures require
❑ Yes [ 1Ro ❑ NA
D NE
maintenance or improvement?
Q No
❑ NA
Waste Application
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [D -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 ❑ Meavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare 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
[v]'Ro
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2 -<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P -Mo
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Cn—No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ED Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes F/-J"qo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

FacilitX.Number: - "L Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes[B<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ 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 ['�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D-blo ❑ 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 [Q�Na ❑ NA D NE
❑ Yes E go_ ❑ NA ❑ NE
❑ Yes [3-M- ❑ NA ❑ NE
❑ Yes [3 -No ❑ NA ❑ NE
❑ Yes
[B -155—
B'' 5
❑ NA
❑ NE
❑ Yes
[f] No
❑ NA
❑ NE
[:]Yes
2ITo-
❑ NA
❑ NE
Comments (refer to question #):: Explain any YES answers,and/or `any additional recommendations or any other comments F`
Use drawings of facility to better explain situations; use additional agessa`
g y ( S,I1 geSSar
Reviewer/inspector Name:
Reviewer/Inspector Signatu[
Page 3 of 3
1t0� ,� oy 4 is
Phone:(&~ 4'� 3 -33.3
Date: p
2/4/2015