430001_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Facility Contact: JAwn Title: Phone:
Onsite Representative: Integrator:
Certified Operator: _Awe Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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Dairy Heifer
Farrow to Wean
D.,T'Qult`
Design
Ca aci
Current.
Pa ,
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
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Turkey Puults
Other
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Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
00 NA ❑ NE
it NA ❑ NE
NA
❑ NE
❑.NA
❑ NE
❑ NA
[] NE
Page 1 of 3 21412015 Continued

Facility Number: - al I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No L] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ N E
(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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
LP No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑Yes
1�No
❑NA
❑NE
❑ Yes
rD No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi I Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ SIudgc Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - 0 Date of Inspection: ! � tO
j 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1� No ❑ NA ❑ NE
'1 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes rV
! No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Fell
mtliients' refer o' rtertiair':#. s}Ex' lain ani'°'FY S answers »<nd/aran Iudd€tionslErecait'm6ndatlans or;a'n other comments '=1 l ( tE ip!lflIl,Fla.: lll,...,,!;,rawings'bflfacilityi,to betteir€.explala sltuations�(use'addltiofinC ges as3nccessa i 4''�!
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Reviewer/Inspector Name: ir%r Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

17
Division of Water Resources ..
�scillty Number - 0 Division of Sail and Water Conservation
0 Other Agency
of Visit: 1s Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Techn
m for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emereency 0 Other
Date of Visit: Arrival Time: eparture Time: +og►l County:
Farm Name: K S ' zt W1 Owner Email:
Owner Name: TQ Phone:
Mailing Address:
Physical Address:
Facility Contact: I c IA4 g MA Title:
Onsite Representative: N
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
0 Denied Access
4✓ra. U7 Region: %J2()
Phone:
Integrator: pYY'S'r gre
Certification Number;
Certification Number:
Longitude:
Design
Current
Design urrentl gn Current
Swine Capacity
Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pap.
Wean to Finish
Layer I Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Qp
Design C►urrent
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Ek PoultG Ca aci P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
�qNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acilityrlumber: I jDate of Inspection: u ' 4 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 [�bNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in}:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
MNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate publle health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &a 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 Accepta
ble Cr indow Evidence of Wind 'ft ❑ Appl' atio Outside of Approv d Area
12. Cro T e s : a A>7r
©,9 f r 6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r'41 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P1 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes A No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes 7No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes fUbNo
—
❑ Yes t5� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

aciii Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
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
M No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
§2 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
§4)No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 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
Ct I C) - 62y-�/o41
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A.-Ly (p Phone: �--�
4U96 Date:
412 15

Type of Visit: ,A ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit: Qn opl�utine 0 Complaint Q Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: , ounty: IVV6& Region:
Farm Name: �j Owner Email:
Owner Name:�1$.S_ e{_lj�(' Phone:
Mailing Address:
Physical Address:
Facility Contact: C+ �� " Vim(~ Title: QC Phone:
Onsite Representative: _-- Integrator: 00
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
1111iDesign Current
Design
Current
Swine
Capacit Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity
Pop.
Wean to Finish
lam
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
€ Feeder to Finish
Dairy licifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, F;oultr, Ca aci P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
t. Is discharge from
any observed any part of the operation?
❑ Yes
[go o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
—VA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
..
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
V<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[?No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
❑ NA
❑ NE
of the State other than from a discharge?
UP,
Page I of 3
21412015 Continued

Facili Number: � Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [GoKo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r'1I0 ❑ 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
I-'_T<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ErT*4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E 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
E�-Qo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L2Ao
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Rio
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Approved
Area
12. Crop Type(s): &�6'z i 'f"
13. Soil Type(s): �j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;�Xo
❑ NA
❑ NE
16• Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q,JOK
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j],Xo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-11-o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g-<oo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3].PdS
❑ 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 �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking; ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [j;A<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No -{P,11rA ❑ NE
Page 2 of 3 21412015 Continued

Facili Dumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JtTo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2lo ❑ 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?
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:
❑ Yes 2Ef<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA - 1;.R2
❑Yes Lilo ❑NA ❑NE
❑ Yes =0 ❑ NA ❑ NE
[]Yes e'lQo ❑ NA ❑ NE
[]Yes E-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes K3-Ko ❑ NA ❑ NE
Reviewer/Inspector Name:
Phone: ?/90 ` A3 "'3—BW
Reviewer/Inspector

Divisi n of Water Quality
Facility Number -' O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 7Routine
pliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Az
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:Owner Email:
Owner Name: :d -ylA t° G'GJ yo- V` Phone:
Mailing Address:
Physical Address:
Facility Contact: lKts I CO" Title: Phone:
Onsite Representative: L/ Integrator:. [ ` L /
ssCt3
Certified Operator: � Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
k I +Non-Layer
a er
3
ury rouirry
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. 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)?
Design Current
Cattle Capacity Pop,
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [3 1`'o ❑ NA ❑ NE
[:]Yes
❑ No
ErNA
❑ NE
[:]Yes
❑ No
M,11''
❑ NE
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 Io ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ' No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
��­❑ NA ❑ NE
[:]No [ ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I;J Ro ❑ 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 n<o NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C! o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
To
❑ 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
io _
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[:]No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift ❑ Application Outside of Approved Area
{Wind
12. Crop Type(s): rf� Df! ewj
13, Soil Type(s): 60
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]-Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[1o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
0 Yes
[� No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
L.d N'Z
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E(No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNC ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes to ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

f
Facility Number: Date of Inspection:,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [;F110 ❑ NA ❑ NE
25 pis 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 U9<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes UrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes Flo ❑ NA ❑ NE
/111
❑ Yes E1fd o ❑ NA ❑ NE
❑ Yes 2jeNo ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes VN
❑ NA
❑ Yes ❑ NA
[] NE
❑ NE
❑ NE
Comments (refer to question#): Explain any YES answers and/or: any additional recommendations or any other comments g a
Use drawings.of facility to better explain situations (use additional pages as necessary), m ti P kt�hti
,C3
'- 7G
C.
Reviewcr/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:1&t-r-33-33119
Date: -So, L
21412011

ivision of Water Quality
Facility Number - 0 Division of Sail and Water Conservation
0 Other Agency
Type of Visit: 7Routine
Hance Inspection Operation Review 0Structure Evaluation 0Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other' 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County a�61% RegIonPez
Farm Name: �.cA 4k Owner Email:
Owner Name: �) Gt MPS I l Vgtl\ Phone:
Mailing Address:
Physical Address:
Facility Contact:it Title: 0w�G� Phone: 1 �l
Onsite Representative: Integrator:
Certified Operator: Certification Number: '1-0
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 10 ❑ NA ❑ NE
❑ Yes [ZKo ❑ NA ❑ NE
❑ Yes EZ-Na- ❑ NA ❑ NE
[:]Yes
To
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
[:]Yes
Eg4o
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2-10 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ((p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®.1 ❑ 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
Io7
❑ 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
`;/ o-�
❑ NA
❑ NE
8. Do any of the structures tack adequate markers as required by the permit?
❑ Yes
[2[>o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[ld"1"O
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F.-],No-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F_� ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): '04`'t"_,R&
13. Soil Type(s): 0^ ay
a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E'i<lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Cg-Ko— ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists [] Design [:]maps ❑ Lease Agreements
❑ Yes
[]
❑ NA
❑ NE
❑ Yes
I,115
❑ NA
❑ NE
❑ Yes
[& ND
❑ NA
❑ NE
[] Yes [Z�No ❑ NA ❑ NE
❑ Yes Q'N�o ❑ NA ❑ NE
❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑f .Ko ^ ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3,<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L.t�Koo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
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 �o ❑ 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 [n-??o' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑N,5-- ❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2„Al6_ ❑ NA ❑ NE
❑ Yes Z3..Pe ❑ NA ❑ NE
❑ Yes ❑>i1r' ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V .,Wo ❑ 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? ❑ YesNA ❑ NE
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
21412011

ivision of Water Quality
Ffaefflt'
y Number - 0 Division of Soil and Water Conservation
0 Other Agency 7
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 0 Denied Access
Date of Visit: / / Arrival Time: Departure Time: County: Region: E294
Farm Name: Owner Email:
Owner Name: �jcr7�,i�-$ �,��jr— Phone:
Mailing Address:
Physical Address:
Facility Contact: ./� ES R. Title: 04L4 &_ j-- Phone:
Onsite Representative: ,, integrator: 042"
Certified Operator: �, A? /�2414, � Certification Number: -51Is
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
I kj I Non -La er
Design Current
Dry Poultry Capacity PO .
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 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.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
[:]Yes
[:]No
EDO'NA
❑ NE
[]Yes
[]No
E VA
❑ NE
[:]Yes [:]No
❑ Yes rZ Io
[]Yes 02,IQo
2r'RA ❑ NE
❑NA ❑NE
[3 NA ❑NE
Page I of 3 21412011 Continued

Facility Ngmber: - Q Date of Inspection: /
Waite Coilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [EJ.Kl� ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑✓ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [-lo ❑ 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
ffNo
❑ 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
[�'IVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Duo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): _Z03=4/4 L4W ,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M-Po
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Rql�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
02-'1qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[2 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P <To
❑ 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
fo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
[;Ko
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
6CIA
❑ NE
Page 2 of 3 21412011 Continued

Facility •Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [ff-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes CD-N—o ❑ 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 Q o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes ❑ No r. IAA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E301qo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes fNo ❑ 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 23 lv° ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B<o ❑ NA [] NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ec o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E;I ❑ NA ❑ NE
Comments (refer to question #):Explain any YES, answers and/or any additional: recommendations or_anyjother comments s
Use drawings offaeility to better:explain situations (use additional pages as necessary).,,
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: f1d Z33:— ,3
Date: 11141
214/2 11

Type of Visit: EMompliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: &1f outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: O , County: Region: Fu
r
Farm Name: K� Owner Email.
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �,/}j►'j� ��d/tle:,y„�(` Phone:
Onsite Representative: S Integrator: P. 2! 6
Certified Operator: arjillZ! t Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current Design Current Design Current
Pap. Wet Poultry Capaclty Pop. Cattle Capacity op,
Layer Dai Cow
Wean to Feeder
Non -La er DairyCalf
Feeder to Finish
DairyHeifer
Design Current D Cow
Dr. P,[►ultr, Ca aci P,o , Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
�o o NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3-N%__❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: - Date of Ins ection:
G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Er<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No O'lq'X' ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Frecboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes g3 lqo ❑ 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 LJ '<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I'' 5o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [D*<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to �❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes Cgel o ❑ NA ❑ NE
❑ Yes 2<0 ❑ NA ❑ NE
❑Yes Li!f110 ❑NA ❑NE
❑ Yes t3Io ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ll:�° ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [I Vo ❑ NA ❑ NE
the appropriate box.
❑Wt1P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [E30<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections P
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No LIX#"r' ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: 6K3- Q7 jDate of Inspection:
/
4. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
[f/o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
'
Q'1Va ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Nan -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?
❑ Ycs
'
2'110 ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA
S-Ke
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[]reo❑
NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q<o
❑ 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
52 o
❑ 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
E2 o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/
[E].I�a
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L1111e
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Zj4o_
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES. answers and/or any,Nm dditional eecomendatinns�oriany other comments
Use drawings of facility to better ex lain situations (uqc addtionl. a ex as necesxa ):.: _r
R y p. ply ry
r •
..
`s.. >...`.:
J44447 � � l L/3/ 1Z_Zj ! �•
�-�-
Reviewer/Inspector Name:
Reviewer/]nspector Si
Page 3 of 3
Phone: /6 —^
Date:
/4,2011

Division of Water Quality
FaeMN Number 43 ® Division of Soil and Water Conservation
0 Other Agency
Type of Visit a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit Routine O Complaint Q Follow up O Referral ()Emergency Q Other ❑ Denied Access
Date of Visit: Z '/ 10 Arrival Time: �G M Departure Time: `� County: T7 d E62 5I Region: R
Farm Name: K s 3-- Farm Owner Email:
Owner Name: c Q.h'g, lit r ' K AEI Li.� Phone:
Mailing Address:
Physical Address:
Facility Contact: ' !24VLhf Title:
Onsite Representative: t(
11
Certified Operator:
Back-up Operator:
Phone No:
er-1)
Integrator: res4nar=
Operator Certification Number: �" r 3
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 0 Longitude: 0 o = ` =
td
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►►opacity Population
Cattle C•apaeity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder 1 1-3 1 1
❑ Non -La er I I
Dairy Calf
Feeder to Finish 2
❑ Dairy Heifer
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ El Turkeys
Turke s
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Cow
Other
❑ Other
❑ Turkey Pouets
❑ Other I
Number of 5truetures:
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
�INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
tpNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes.
1P 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?
tt
Page 1 of 3
12128104
Continued

I
Facility Number: Date of Inspection 5 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [RNA Cl NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "2 No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) LP
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �] No ElNA El NE
through a waste management or closure plan? 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 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 [KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 Cro Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) �aj I Shn . Gra.\,� OACWJ
13. Soil type(s) $, LLOZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No El NA El NE
No ❑ NA ❑ NE
�No ❑NA ❑NE
IS No El NA El 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.):. �t
Reviewer/Inspector Name I Phone: 10—Y 3-3300
Reviewer/Inspector Signature: Date: s 2 1f%
Page 2 of 3 12128104 Continued

i
M
Facility Number:13
— Date of Inspection Z O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ 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
l"
'No
`�
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
[INA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
coNo
❑ 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
EP 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
F 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
Ep 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
n No
❑ NA
❑ NE
Page 3 of 3 12128104

z
m a1all
�DS
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit §k Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: laQ Arrival Time: ' j Departure Time: ',Q'j County: JJWRegion: dko
Farm Name: YQ-u- Rim Owner Email:
Owner Name: ,7fraltj P—A01(lell 11� MR4T Arr (Phone: C129-- 636S
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: 4, 11fi
Certified Operator:. Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 i = 45 Longitude: 1:1 0 ❑' ❑ "
uuE 7P
k
,+ k
Swing y
❑ Wean to Finish
Uxkj ..�'�. Z, ': ,�h4.�1 ` is E � "' _. k M
De�sr�gn��Ciirgfre�nt' sDewsinCpurrent�. Design Current
.'�'ui '�`CT�"'"'d k i ;14 J
Capac ty pulat��n �a�M'et Poultry mm ici.ty Popu��la�io�n, �tt�1e ' - Capes ity Population
❑ La er ❑Dai Cow
Wean to Feeder
❑ Non -La er I
DaiEZ Calf
�Feeder to Finish
"' 1D Poultry
i
rjr� El Layers
°`'
,' r
❑
Dairy Heifer
[] Farrow to Wean
❑
D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑
Non -Dairy
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ElYes &-No ❑ NA ElNE
Discharge originated at: ElStructure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ElYes ElNo ElNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ElYes ❑ No ElNA ElNE
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) ElYes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes RNo ElNA [INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes .a -No ❑ NA ElNE
other than from a discharge?
12128104 Continued

` Facility Number: 4'tj — �� Date of Inspection ® 0a I OQr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes GkNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �Q
Observed Freeboard (in): �S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C'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 N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IRNo ❑ 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 CR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5 'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �iNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ FAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) (�OpjjAI DFtM (j [if ay) 13Co /)f
13. Soil type(s)
I
t
14. Do the receiving croi4s differ from those designated in the CAWMP?
❑ Yes
U 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
tR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
WYes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name , '" '�1q� Phone: Q �/y y�
�`.� , K«.. .s F �e�d z,1 C�� ati _ 910 L133- 300 3�33
Reviewer/Inspector Signature: Date: ei
Pann 7 of 7 U 12/2RAM Cnntinued

M
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 51 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ DesignMaps Other
❑ El
21. Does record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[R'NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'j� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IN NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Iallo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose ofdead 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
RNo
❑ 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
kNo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
I . Reel was can aoo8 wi' �.- �a� r r►� -t, or��a 11y , Pr,e� a p + back
'z
r �t sly a reca p b�ca�e, + r t l
trio y'al e or� afibfo ,
�sN &oa�w � r FAX#/` 910 - y s �o-D70-7
l !g+ S.Ak-71 y
GI �
F4 let -,lit Nc as30 )
ev'severLjj rnorf�► er�crs in wwsfe' reca-di b„t way� 1ha, not Avve Ii od, ,
y s� ,&%� now( dVr'� yVPJ4-e a'va is jc a hot Ws w*ewed .
ai"11 Va 90ci.100f 1tyv" wi) )� Coves,
Page 3 of 3 12128104

Facility No. Farm Farm Name „ �'U
Permit _ZCOC `� OIC_
Date 016401
NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
a
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
r
11nil_AA-Al -41f -W.- h'7' lw.. A&&lml-inho e%Q&n
. loll
Soil Test Date �o�g Crop Yield 1 in Inspections
pH Fields � 120 min Inspections
Wettable Acres
Lime Needed �_ W-Q*--- Weather Codes
Lime Applied WUP Transfer Sheets
Cu __%,, Zn ✓ Weekly Freeboard RAIN GAUGE
Needs pp n Rainfall >1"
-ximA 9n. t"-viArAAAt 6, hA4.cn...t(a 5i lr
lain
I
W.
•
.1
�01
UENATI
Verify PHONE NUMBERS and affiliations
Date last WUP FRO )of% Date last WUP at farm
FRO or farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware
i

0
Facility Number [3 0o /
Division of Water Quality
Q Division of.Soil.and Water Conservation
O Other Agency={-
I Type of Visit lI Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I Reason for Visit 9Si Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: * p Arrival Time: ,� Departure Time: �� Countyt
Farm Name: ---y ITT) _. Owner Email:
Owner Name: �0.vrl�s o=r Phone:
Mailing Address:
Physical Address:
Region FZO
Facility Contact: mes 014 lol&K Title: Owncr Phone No:
Onsite Representative: U 0-.1' Integrator: rcg k e
Certified Operator: �Q��'LQS a a ►� Operator Certification Number: c;2 S7 / 3
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
/ dv ❑Non -Layer
❑ Wean to Finish
Wean to Feeder
eeder to Finish
I Z d
I Z Oo
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
ElPullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: = ° = ' =
Design Current
Cattle Capacity Population>
❑
Dairy Cow
El
Dairy Calf
❑
Dairy Heifer
EDiry
Cow
El
Non-Dairy
ElBeef
Stocker
ElBeef
Feeder
ElBeef
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?
0
❑ Yes V3 No ❑ NA ❑ NE
[:]Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/2"4 Continued

Facility Number: —0
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ANo
❑ Yes �d No
Structure 5
❑NA El NE
❑ NA Cl NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '%j 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 Auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KA No ❑ NA El NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JZ 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 CropWindow'' El Evidence of
Wind DriflEl Application Outside of Area
12. Crop type� s) my-dam7� 4 G) , _&-rl C r Qh
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�fNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
OQ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?❑ Yes
;Q 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
10 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 JaJAIMAJPhone: /0 4,32 33Q6
Reviewer/Inspector Signature: Date: z�
12128104 Continued

a
Facility Number: - Date of Inspection IG/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�$No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
II
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
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Doc. m /Wr- idctl ull
1�y P
5-mall C rm'l ri Slow n r I. % tcjl 4 r v_5�ri nU 1
12128104

Facility No. TJ Time In �0�5 Time Out Date
Farm Name K f a �GL✓ rr%_ Integrator
Owner ,Site Rep��p
Operator �ct.rr a� -�. r of Cam. a _ No. cP E 3
Back-up No.
F
COC Circle: Gener or NPDES
c
Desi n
Current
Design
Current
ed
�.
S oa
Farrow — Feed
We - 'sh
Farrow -Finish
Feed - Finis
a
Gilts 1 Boars
Farrow — ea
Others
FREEBOARD: Design I -
Sludge Survey
Crop Yield
Rain Gauge
Soil Test /
Observed 96
Calibration/GPM 0.0 _1
Waste Transfers --- "`'
Rain Breaker
PLAT =6"
Weekly Freeboard Daily Rainfall V—
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
late Nitrogen (N)
W 1 1.
Wettable Acres
1-in Inspections
Date Nitrogen (N)
MIME
MWE
s��--

Facility Number
tip -Division of water Quality
Division of Soil and Water. Conservation
O Other Agency
(Type of Visit 0 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: , V: 1 Arrival Time: Q Departure Time:
J
Farm Name: '�� rn � Owner Email:
Owner Name:\Qm� 0-� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: _ WY1e.V" _ Phone No:
Onsite Representative: Integrator: r 4
Certified Operator: Operator Certification Num er:
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Region:
Latitude: = o = 1 = {t Longitude: = e = I 0 Jf
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[--]Layer
❑ Non -Layer
Dry Poultry
Non-L.
Pullets
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)
Cattle
Design Current
Capacity Population'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiEX
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104 Continued

0
Hype of Visit 0Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit ®Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: ,s�Qm,a Lai,
Mailing Address: _
Phone:
Physical Address: Facility Contact: 3 G yna _Wag. Title: -C U?'Ct'y- Phone No:
Onsite Representative: uo Integrator:
Certified Operator: Operator Certification Num er:
Back-up Operator:
Back-up Certification Number:
eg�on:
r 4�
Location of Farm: Latitude: = e ❑ I = « Longitude: = ° ❑' = 11
Des Curr` Desgn
\ '�Cp"
Current f� Design Currenh
sulation
fuo_
Wet Pooultry ,,Capacity
Popular a Cattle
Wean to Finish
❑ La er
=❑ Dai Cow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish °k
`��' `�
�. ❑ Dairy Heifei
El Farrow to Wean
Caw
Discharges & Stream lmnacts
1, is any discharge observed from any part of the operation? [I Yes El No [I NA El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes ❑ No ❑ NA El NE
b. Did the discharge reach waters of the State? If yes, notify DWQ) El Yes El No [I NA [I NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes ❑ No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes El No A El NE
other than from a discharge'?
^• 12128104 Continued
e
�:, i. .... . .:...:.. ��:. .... -_. .... Yer :. r. ♦1:'re -.. �..: .... h.�..s. e; •-Vl..n _.. -, - �:::_' .. ., .., r s. :. -_ ... .. . .. .. ri. i ... _ .... ._ -w. .... ... .... .. _ ,.a _ .-�. .
2. Is there evidence of a past discharge from any part of the operation? El Yes ❑ No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes El No A El NE
other than from a discharge'?
^• 12128104 Continued
e
�:, i. .... . .:...:.. ��:. .... -_. .... Yer :. r. ♦1:'re -.. �..: .... h.�..s. e; •-Vl..n _.. -, - �:::_' .. ., .., r s. :. -_ ... .. . .. .. ri. i ... _ .... ._ -w. .... ... .... .. _ ,.a _ .-�. .

Facility Number: — QO Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ief large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
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 [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
t5. 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 ft Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name j I Phone: Ct 0 3
Reviewer/inspector Signature: Date: X191J�
Page 2 of 3 - 12128104 Continued

r 4'
Facility Number: Date of Inspection O
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ic/ 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:
12Q
Page 3 of 3 12128104

Facility Number: Date of inspection
Required Records & Documents 1
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 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 I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑}NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ 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? r
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[:1 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
12Q
V a�
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[I Yes El No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE -
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 3 of 3 12128104

(Type of Visit 10 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit $ Routine () Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a a % Arrival Time: 13 (SD Departure Time: County:
Farm Name: �K&,y " r SOwner Email:
Owner Name: 7 1^QX7�_ r—in
kkof Phone:
Mailing Address: q
Physical Address:
Facility Contact: i Title:
Onsite Representative.
Certified Operator:
Back-up Operator:
Integrator:
Region: r_7L
Phone No: 5 1) S UM 4� (A
U ^�
Operator Certification Number: of
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = 11 Longitude: = o = i 0 11
Design UN ta
Swine Capacity Population
NjLe;si—onGulrent Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
can to Feeder
O D
110 Non -Layer
❑ Daia Calf
eeder to Finish
❑ Farrow to Wean
0
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
ElNon-Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & 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
�9 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
l—
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
5LNA
❑ 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
M No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:713 —oo Date of Inspection a� D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: I
Spillway?:
Designed Freeboard (in):
/r
Observed Freeboard (in): 02
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes ❑ No 4N NA ❑ NE
Structure 5 Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes T;L%o ❑ 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 VNo ❑ NA ❑ NE
S. Do any of the stuetures lack adequate markers as required by the permit? ❑ Yes tWo ❑ 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 v No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ElNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t)�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
XrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
q No
❑ NA
❑ NE,
Comments (refer to question #): Explain any YES answers and/or any recommendationsor:any other comments
4:
Use drawings of facility to better explain situations. (use additional pages as necessary):
r e � bA,rc Spo+s u n e.rn 6czn, /6r,�wL-%_j aid 4� , s ee�
m 0ch 46 PuV_ro � .
Reviewer/inspector Name /A/E N l0 I Phone: :_J �`� 3 1 JOD
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes hNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
b2 No
❑ NA
❑ 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
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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)
l(
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
NA No
❑ NA
❑ NE
Additional Comments and/or Drawings:
N reed -�o Iced C v_rren4 s%LAd�e s uviY�`�,�W;44 -
I e-co'rd S r VA n,) a � QeAJ, ca�',zr, dle- I / 0 7.
Page 3 of 3 12a8/04

Facility No. Time I n Time Out"; Date
t;6
01 Farm Name �� ryt Integrator T`
Owner r�.sassc � � i v,4. O1 Uh,ny Site Rep
Operator No.
Back-up No.
COC
Circle: General or NPDES
Design
Current
Design
Current
can — Feed
Farrow— Feed
We —
4
Farrow — Finish
teed — Fin!
Gilts 1 Boars
PMTuw--Wdan
Others
FREEBOA • Desi n bserved
Sludge Survey - Calibratidn/GPOL/ob1
Crop Y' Waste Transfers
Rain Gauge Ftaln Breaker
Soil Test ✓ PLAT V/ Wettable Acres
Weekly Freeboard , v Daily Rainfall 1-in Inspection
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
�#�O!u
3
MOW14011% WI—Mi.
r
-- if
�r

1 . _.- -:
— - - ----- f ion of Water Quality
aCil�iy NUlmb°elr — — enc
p Division of Soil and Water Conservation
Q Other Agy
Type of Visit 0-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vislt O Routlne O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 3D-D(v Arrival Time: ; a a Departure Time: zo ;.YZ) I County: 606a12"'11141_ Region: v
Farm Name: K 4'U Owner Email:
Owner Name: T-O+7 C. i }LS c t'� � kT / ' "4L /)&Gc& V rI Phone:V If
Mailing Address:
Physical Address: - -
Facility Contact: 901-;J:-s %r%tsx r Title: Phone
No:
Onsite Representative:Y �%%G;r J r1 Integrator: f % &1 � -G
AV
Certified Operator:. ;Gels /4&,._sirv— _ _- Operator Certification Number:
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
0 Longitude: 0° 06
l I N
Design Current Design Current Design. Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity. Population `
❑ Wean to Finish
Wean to Feeder
GjAvo
C3-.Feedcr to Finish
CJ
' (00 p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giits
❑ Boars
.Other
❑ Other
f ❑ Layer
❑ Non -La er
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
iNNo
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
12128104 Continued

Facility Number: ITS -- O 1 Date of Inspection �ro
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: it
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [R No ❑ NA ❑ NE
❑ Yes [�,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? CR-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) J�r-r �.sr.ey �c5r� S S'i�a. f,� C3 roar w /7�i
13. Soil type(s) T az N O B
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?
❑ lies
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"[]
Yes
EN No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
0 lir5��v�A"i� p-^-
6,-,m col
Retiewerllnspector Name ;..{ rY✓ xa Phone: � y� -��3a-
Reviewer/inspector Signature: Date: /-3D -- lvOyb
I fN fiW VT ly VI$#off" L"

Facility Number: q0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 91No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 5-Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP [I Checklists MDesign El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
49 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;M No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
k1 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
El NA
El 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
EZNo
❑ 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
Genera! 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
4F_No
❑ NA
ElNE
Adonal ,dmmenh-and/or;prawln°gs ,fi F �'r :r
�Gt�raUin9 QQi)n� i r`. Oef 690a,'V IIiCG�S �`D�o� SiYJuGf 6��;� /l,b�ar-
`}"An vU 'i vJew `FD r" b r-e,- it d- Cn of s i S,p 7
61,5C 11 Y i.(j %h Y�j 1!/'Yp� p LC�J!/J �t! 1413
3
12128104

1
Date of Visit: p O Tune: _ 00
Facility Number
0 Not Operational 0 Below Threshold
© Permitted 13 Certified 0 Conditionally Certified 13 Registered DateLast Operated or Above Threshold: ... ............
»..»».
Farm Name: County: ».» . tkk.�r»..............».» .»» .......
Owner Name: p
...!R.k!'+�.�.....1��`,�S.e!�..».»»...�,al,�!�.f�.fp.....�......».».»........... Phone No:».»...»�10...........��.�.».».»».�.�.`.�..,�....... »,
Mailing Address:.......... Q�?... ....� N'...........L .............. _..._ !. i � !'i .!n ..r ...»N L_............2.} ELfk
FacilityContact: ..».. _ .» » ............»» »._...... ___.»_».».» Title:.._.». __..__. _ . w__ . ___.. _.. Phone No:
Onsite Representative:
Certified Operator : ................. »...............................
Location of Farm:
Integrator:
Operator Certification Number: ....... ».......... ......................
❑ Swine ❑ Poultry ❑ cattle j] Horse Latitude • ' 64 Longitude • ° 69
Desrgn, ,i.Cnrriit"t�
Cttrrent j Deign Current
<
SwinCat e-,
Po +
e
illation «"Mopiition
'El Wean to Feeder
❑Layer
,
❑Dairy
'
Feeiier to Finish
❑ Non -Layer
k
" ❑Non -Dairy I};
Farrow to wean
❑ Other
Farrow to Feeder
Farrow to Finish
Dgn° Capacittp
v
t
Gilts
Bows
r
) To!tg(isi LI 'n
Nmnberof Ir,stg1oons ` r °P
r
�° I�Fi£
1.
Discharges & stream Imc►acts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Freeboard(inches); ...»....... � . �. _.........»....»».........»_..»...............»...»._..._....... ».»...»».»»..»......».»... ..»...._........_......._.._ ......_.»...._.»...._.»»...
12112103 Continued

Faciitp'Number: ej3— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or C Yes ❑ No
closure plan?
(Ii any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ' ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
ii'"'!Mrl�S�E�jii'Y39-Y' iJipt� k'., ar •F'�i: u:>fiuP41 •..• '8l�f➢Ir�kG31<'.71R �.fiiaiiLE
r.Cab meats (refer�to qq. , 0n,#} ExpleinF�tny 1,LS answers and/or any r ecmm�ieneiatio�,ar'any at cr oomaiepfs. k �
i a k -�.G'� "a� �;l. - tEl3'.';ikrit Ir 'iFtkf° a iell:H4. "1! d!l�fl.:,.� ..'�f "N41 ":ariYdJli#3Hi➢s,.'Y'.3�i't{gi9"+;ac`�tS.a"xr�..c. �HEd=�Usezdrawing iofil`aciLtykta�betteracplaia sitnstions. (ose aeiditiotaialipagas as necssary}`:Field Copy ❑ Finalyi , i"r�1
No &P e_ a-K s 4-e . �o �c�oa�x (eve( left .
w
Reviewer/� mpector Name i >„ ,� i '- ? r ,� i i {: p ` �� � ?i
IYnSp � 1 , kc r g.&3� ., „. E:fErt k: § asi din»3 �iit �i .' ? g
Reviewer/Inspector Signature: Date:
awsf�v✓ a.wFsap�sars

Faciiih• Number
Date of Visit: Time: '. G 0
ro Not Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 12egistered Date Last Operated or Above Threshold:
Farm Name: _ _ !G . a' j-, C-"e'n� County: rrtietf r—�a
Owner Name: Wl G _ M.--a u C� _ Phone No:
N1ailing Address: _- 4,-�-,(, .b,i , 'f 0 ci , R or, cL �L 111' A) LG� _—„ 21T__ 644
Facility Contact: T vv, cc VIA" W c r Title:
Onsite Representative: r�4 M n GS VAG.G [t t .T
Certified Operator: - c w e,� McgG u rr
Location of Farm:
Phone No:
Integrator:{`e—S•-G.Ce
Operator Certification Dumber: 1554. I
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 09 ON Longitude I it
Design Current
Swine ianari4v Pnnntatinn
Wean to Feeder
Feeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca ackv Population
❑ Layer I I❑ Dairy
❑ Non -Layer 1. 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Q r_• ❑ Subsurface Drains Present ❑ La oon Area S rov'Field Area
.`. Holding Ponds / Solid Traps r
Q ❑ h o Liquid Waste Mana ement System
Discharges & Stream Imnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lat=_oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes [M No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ER No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [R No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101
Continued

Facility Number: — I Date of Inspection
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?
S, Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes LNo
❑ Yes [M No
❑ Yes No
❑ Yes No
❑ Yes � No
❑ Yes No
❑ Yes No
12. Crop type 44-t,��.ti 4-- ,C, ,. , 6-i A,d-n © tS .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes [--]No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
[:]Yes
M No
16.
is there a lack of adequate waste application equipment?
❑ Yes
P No
Renuired
Records& Doc ments
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
2) No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[R No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[)a No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(3 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
CgNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
UJ/U.V Uf 4 U0711"U r"

Facility Number: :J3 — ) Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes [ , No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
09103101

•
State of Nc3rth Carollna
Department of Environment,
Health and Natural Resources • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor Jonathan B. Howes, Secretary � E H N
Andrew McCall, Regional Manager
DIVISSION OF ENVIRONMENTAL MANAGEMENT
November 29, 1995
Mr, Ray Stanley
Rt. 5, Box 230
Lillington, NC 27546
SUBJECT: Compliance Inspection
Harnett County
Dear Mr. Stanley:
On August 1, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a - copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
In compliance with 15A NCAC 2H, Part .0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
�or
D.T. Jones
Chemist
DTJ/bs
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayeitevllle, North Carolina 28301-SM Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 60% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No. ti 31 -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A& I1 , 1995
Tirne:
Farm Name/Own
Mailing Address:
County:
Integrator:
On Site Representative;
Phone: a 1 C) - �5 I a - 5-"I Z I
Phone: CL �_o - �a 3
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
3
s .�
Design Capacity: 3 �O?J 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 l Foot + 7 inches) Yes or No Actual Freeboard: Inches
Was any seepage observed from the lagoon(s)? Yes or @ Was any erosion observed? Yes org
Is adequate land available for spray? 0 A.or No Is the cover crop adequate?'Gor No
/, _ A
Crop(s) being utilized:
Does the facility meet SCS minimurn setback criteria? 200 Feet from Dwellings?ems or No
100 Feet from Wells? 'e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line. Yes do
Is animal waste dischurged into waters of the state by man-made ditch, flushing system, or other
similar mim-made devices? Yes o6 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)? Oeor No
Additional Comments: _
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

WORTH CAROLIM DEPARTMX NT OF EWntONMENT, BEALTH' 3 HATMAL RMUXMCZS
DIVISION OF EWMONNENTAL XWGEKERT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
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All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed 8ermittee to perform the appropriate
corrections:
Animal 0 ar ti on : FeeCs ep -b fin r` Gbl
Horses, cattle, swine poultry, or sheep
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1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
systam) ]
2. Does this facility meet criteria for
Animal Operation YRE TAA
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a MTXFPM
WASIX NLNAG22M..EUW
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the 5CS minimum
setback Criteria for neighboring houses,
wells, etc?

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AN=10N 113:
i a management
1. Is animal waste stockpiled or lagoon
coastrvction within 100 ft. of a USGS
tap Slue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a MIS Map
Slue Line Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
WT1rIChT10N
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
8. Does the animal waste management at this
farm adhere to Best Management Practices
(SMP) of the approved TTFI ?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
8. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
S�LCTXON�V
gomments

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