470031_INSPECTIONS_20171231

NQRTH CAROLINA
Department of Environmental Qual

ype ui v Isu: V c,umpuance n1specuuu v Uperauun Kirview v ou-ucture r.valuauuu v I ec11111c"I namnotauce
Reason for Visit: ® Routine 0 Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: j jr�� Arrival Time: Departure Time:173T a2qcounty: NbAV4— Region: !V
Farm Name: "�'� Owner Email:
Owner Name: _ 4:22Z - _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone: e
Integrator:
Certification Number: (gQ�
Certification Number:
Latitude: Longitude:
!� +I
�:
,{I. .
ul ., I
; , � I
al, hl [,I I,
, [p, , • ,IY,�I�{�€,,,, „I,I
,�I.I i,
, � i
�, ,•,lii:^r+l I,:�
�+'
-:1-� { II I!, , I {,; .{.
[gll[II I , ,[[I,[ 1.Alll ,I I
# I:i: a ,:.:Ill II• llilil III,I..IIIi ll
I� t
Desi Ins Currents,
I.. � , ,, ,
� 1• ��lialrlli[+ul+,,�111
,,[,
I,i ff
I,�•I.f'
,,
1 .
p x ,1 ..,,) •.nl {1 {i
# ..: �,14
!I. , i 11 i ill . 4 , Il li 1111,E
I. i �pl Ui;I; �1iro1.: [ , ,.
1 i,l�� I Desi n 1, Current,..I
{� [ p # •.k 4I 1, � � �, ,, I�
`"I� € I,,,I,In, , �::•s
upll
1 i^I,r ,
, 3 3 ,I, Ij
i�ll�,li I I l
� u�ll
��.,� �I[
{:.€»€ -t {" -, ,,, -..ro, A"lY ry III
{dig,
1�i�!1,3 9;1 �g I , I[
i, . ,,•[ 1 .Desi n
�,:; ,,;il! � l �� , .g
� I
-..�:. ._ 131 ..I
I llllll. {41:f
Current
31 1.
I .
14
�i;;.��l;�,l
;,
, ,1 .,
• ;;, I ,�,,,
4;Sw>Ine,,,' 41
J,: ,,,
,113II I
Capacity P,9p. �,
k
it j
�y.;
�: .
,�
! Wet Poultry Capacity�Ll Pop , , i.
� J; II:�
��{lil.i„I{[a.�:.lEllr11111111111iE1,.l„r,.
,":l
fir _Cattle
c
! 1;, ,;..,#s1:,,..111�1•
1� 1, , Capacity.
�1€��, 1 1,
� ,
i :,; �„I€1�
1!a
�UF,#1.:, , ? �:.>,}.11,i�3�ll.,i�i.l,11�llu�l ,.�1�:Jfil3.ui.r�113#lute.
€.en,•4-..- 1, �II11411
iS�4
,. ,(� � :., , •;,1,1.
.:,. ,,,
„ ,t . ,
Wean Finish
�a:•
La
ll�
Dair Cow
I
to
er�^r
I#,1
Non -La er
DairyCalf
j•,41
Wean to Feeder
I#'
� I
ip
Feeder to Finish
pro[
I
#+IIIH
I �IIl
�
! r11
�� � li I��Ii �i�I��
DairyHeifer
arrow to Wean
-7
"°'
,�1
#��I!dfi
Al1
� �
�Desi�n11�Current �,
�t 1111 III � ^ � 9 ! i ��w�l i
s
Dr Cow
Farrow to Feeder
10"'
#
#i�,I�;rD
1Poult
:�,ln
;Ca uci ,:cif IPa li l it
I
Non -Dairy
P
i
I
Beef Stocker
'ff[jtl
Farrow to Finish
E1€1
La ers
t
Gilts
Boars
�'
I
ii" ^
Non -Layers
Pullets
{
!
Beef Feeder
�Ir�lg
I ' I
Beef Brood Cow INNIII �I
illotl
,� €, �, R41 1 [h
!#Ill 'la€.1 l„Ili q
I �
eril ,.{, al
.,il 1.h,y1,,EF 1; i
I I i ,; . I llI I Il I
I i. 1..
Iv ��'
•.,
Turke sI
Turke I oultsll
4�,
I!I'
�'
�' �� �
Other
N r0' I
1, 0� 1,
� N 1 , I. 1j•
r�
I
Other
Discharees and Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes T No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [Y3 NA ❑ NI?
A Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [q NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
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?
�Z
Page 1 of 3
❑Yes
❑No
q]NA
❑NE
❑Yes
lip No
❑NA
❑NE
❑Yes
NNo
❑NA
[]NE
21412015 Continued

5
Facilit Number: 1- Date of In ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1PNo
❑ NA
❑ NE
a. Ifyes, 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):-----lr�--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�No
❑ NA
❑ NE
waste management or closure plan?
T6
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
1P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E� 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
[g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffiers, 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 y No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Fleavy 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 'Wind Dr ❑ Application Outside of Approved Area
12. CropT e s : % %�% 44Z r `- ",n U 5,.W
13. Soil Type(s): L~
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
$ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4-No
❑ 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
Ea No
❑ 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 ❑ Maps ❑ I.ease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E0 No
❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[)9>No
❑ NA ❑ NE
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection- 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [t No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [P 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 ng No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C 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
[3 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
q No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
43 No
❑ NA
❑ NE
33. Did the Rev iewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E� No
0 NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name: KelkA Phone: 3
Reviewer/Inspector Signature: Date: fX
Page 3 of 3 21A 01 S

•� • Division of Water Quality '
11 Facility Number ®- © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 4V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: fa Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IO Arrival Time: p; DO Departure Timer, County: a Region:
Farm Name: �i✓`+� Owner Email:
Owner Name: - -- _�C Phone:
Mailing Address:
Physical Address:
Facility Contact: *� V" 00
Onsite Representative: u
Certified Operator: W
Title: Phone: _;;�"�
✓i"y �.
Integrator: , 1"/te S
Certification Number:
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
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
El E L
ayer
Discharees and Stream Imnacts
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes TP No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No IM NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No F NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: '
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
EP No ❑ NA [ ] NE
❑ No NA ❑ NE
Structure 6
❑ Yes �3 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes '"pqd No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes �D 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 ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ip 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
[V No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑Yes
[PNo
❑NA
ONE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
rp 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 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412015 Continued

fFacilit Nu ber: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
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.
T
T
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
[P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Co ffients�; r`efe"r fo `-'ues'tioir #, : E t- lain aii 'YES answers'`and/,ara;an ,additional recainmendittions or' an other comments'*;
re:.r 1.u: iY' �rp9w} i�opt �u9� u :.; a pJ +::[ s y .:t, :_, :;, YID
Use drAwings of facility'to betterr" explain situatlons;(use addltional a es: as:ne.cessary) . 4> •"
p
G L4� AvL G - 0 u) 9,
C5LL) qio-62N-N04►
Reviewer/Inspector Name:
Reviewer/Inspector Sign
Page 3 of 3
N
Phone:
910 _y33-33fb
Date: !03 /
21412015

I
Division of Water Quality - 41
Facility Number - © O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: �7' Departure Time: a = � County: dxRegion:F2
Farm Name: ? t9oy/lL l Owner Email:
Owner Name: "Rill
Mailing Address:
Physical Address:
Phone:
Facility Contact: �Cf WOo Title: Phone:
Onsite Representative: t Integrator: irne_5 /;444
Certified Operator: U Certification Number: ! 60
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine. Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Impacts
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Non -La
Pullets
Poults
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
[]Yes
[V No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[]Yes
[]No
( NA
T
❑ 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JE]pNo
❑ NA
❑ NE
of the State other than from a discharge?
0
Page 1 of 3 21412011 Continued

Racilig Number: - Date of Inspection: 7
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 [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier; r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2,6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
.g 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 allo ❑ 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 r [] Evidence of Wind ift C❑ Application Outside of Approved Area
12. Crop Type(s): ( La
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
No
❑ NA
❑ NE
❑ Yes
(]
N No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [8 No ❑ NA ❑ NE
❑ Yes [�j 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 ® No
[3 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2?,No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
it
1/412011 Continued

Facility Number: -5=1 Ds ection: J7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
14 No
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[�g No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
� No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[jiNA ❑ NE
Other Issues
29, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Zb 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
E�JDNo
❑ 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
[n No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question ''#):; Explain any YES,answers and/or.aiq additional recommendations or,any other comments. ,
Uie' drawings,of;facillO. to w better explain situations. (use additional'pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2.�dd _
Date: 1 12
21412011

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 ReferralEmergency 0 Other 0 Denied Access
Date of Visit: g Arrival Time: 0T Q Departure Time:®, County: fiDl'If
.
Farm Name: 1 +� �6--m Owner Email:
Owner Name: fz�&aed cvPhone:
Mailing Address:
Physical Address:
Facility Contact: _z" WMW Title:
H
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:71�`7 J`�,•n, £ -�C
Certification Number: 7/ QC,>17
Certification Number:
Longitude:
{rd ' rk Y ill 11:L
3'i F3 iy rk{��� ' -
Desirtn� Current' Design Currentbba h �t f Dcsign l:urrent
Swine Capacity Pop Wet Poultry, Capacity fiPop",{Cattle gg C p city Pop.
"AmBY0MINNdw
can to Finish La er ,r; Dairy Cow
Wean to Feeder Non -La er I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean ri 17 n 1717 0 Design Current Dry Cow
Farrow to Feeder Dr. P,ault'. F Ca aci Po P. Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other1111111
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?
L\,3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
°age 1 of 3
/
❑ Yes P
No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes []No
❑ Yes ❑ No
❑ Yes fZj No
❑ Yes No
[ZPNA ❑ NE
LF NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
21417011 Continued

Facility Number: 4 7- jDate of Inspection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes : W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No [S NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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?
T
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 ;D 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 Acce table Crop Window rr ❑//E+vide-�nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � ?F.{'At r.tp a (.},rzt! s �PLrS .Y.�) �� 6,4—h
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [ ] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes PS No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes � No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste TranTsfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ( No ❑ NA ❑ NE
Page 2 of 3 T 21412011 Continued

Facility Number: Z77 - 3t 7 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 to provide documentation of an actively certified operator in charge? [:]Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes;No
No
❑ NA
❑ NE
Comments.(refer to question#): Explain any YES answers and/or any additional recommendations or any other comments:`:
Use. drawings of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q ry `C13 3 -3 ?CV
Date: Flr4 }3
21412011

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t) V
nArrival Time: Departure Time: rOE;`JR� County: PoKla Region: MO
Farm Name: P8r F M Owner Email:
Owner Name: _Icy �, wood Phone:
Mailing Address:
Physical Address:
Facility Contact: QI G�Ulaj _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
tt
M
Latitude:
Phone:
Integrator: 1--Yh'%� SM 4 "rYr",-_T- C
Certification Number: `Iq C01 1
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
[Layer
Non -La er I
Design
Cap city
Current
Pop..
..
11,
Design Current
Cattie Capaclty Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
13. P.auitr.
Layers
esign
Ca aelt
Current
P,q
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
L
Pullets
Beef Brood Cow
Other
Other I
Turke s
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?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
�NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
` Page 1 of 3 2141201.1 Continued
1 ,=

ti
Facilit Number: - Date of Inspection: col 101tt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No NA
❑ NE
Structure 1 Structly� Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1�/ y�/�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 7
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require []Yes O No - [DNA ❑ 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 MNo ❑ 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): C'p� ( F P-4-M� C3YAS5 Id"GS � ; ��^ �+tn aW,
13. Soil Type(s): ._.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jP No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes TO No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
❑ Yes P No ❑ NA ❑ NE
❑ Yes nNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [�PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

b.
Facility Number: Date of inspection: l!
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes §3 No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes P 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 �p No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [j No
��ff
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE:
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes M 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 FM No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. �>
❑ Yes [� No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other comments
Use drawings'of facility to better explain situations (use additional pages as necessary),
Reviewer/Inspector Name: TA Pt' Lw��
Phone:
Reviewer/Inspector Signature: Q�(/t J ,,,�.�Q - _
Date:
6 I'D
Page 3 of 3
21412011

Facility Number
�
Division of Water Quality
Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 l0 /O Arrival Time: Departure Time: f� l County: O
t
Farm Name: Q c R poi rf m Owner Email:
Owner Name: + 'CT W Wwd Phone:
Mailing Address:
Physical Address:
Facility Contact: },,K. C Atha Title: �
Onsite Representative:�.rLzrdv)cJ
Certified Operator: Rt 6l� d C, Wood
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Region: )RzQ„_,,,
Phone No:
Integrator: �0e�..�
Operator Certification Number: 99oo�T
Back-up Certification Number:
Latitude: = o = g = Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I Non -Layer
Other
❑ Other
Dry Poultry
Design
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I Application Field [I Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Current
Cattle Capacity Population
❑ Dairy Cow
Number
❑ Dairy Calf
❑ Dairy Heifer
❑ Dr Cow
❑ Non -Dairy
I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (]f 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?
of Structures:
❑ Yes Jp1Vo ❑ NA ❑ NE
[]Yes
Page
[:]No
�I NA
❑ NE
❑ Yes
❑ No
[NA
❑ NE
❑ Yes
❑ No
Pn NA
❑ NE
❑ Yes
�9
El NA
❑ NE
El Yes
p,No
LJ No
❑ NA
❑ NE
I of 3 12/28104 Continued

Facifity Number: — ?j Date of Inspection o n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tg No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes In No ❑ NA ❑ NE
P
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes No [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) IP
9. Does any part of the waste management system other than the waste structures require ❑ Yes [71 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1PNo ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) G_d�_Ctb
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rQNo
❑ NA
❑ NE
15,
Does the receiving crop and/or land application site need improvement'?
❑ Yes
1� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
1P No
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
�_ q': Rfi)` ilk �
t (el a .q.. ) .E p. � yp ES answers !an any iecom y ..V,-
;Comments refer to j yt tts or an �otlier�comments
4 S,m.:,:,. ,estiom.#X, laln 8II Ya.[:r;:a.:,:. a �mendatia„
cUse'drawings:;of facility to�better.ex lam situation si (use additional a esxas net essary:): a 3 .; n � ,
�Inr i � 'e.i �rR: I:k ti ,i,,�,G;, 1.% .�'d, ,�,. �.�4 � '�, �,fi r al ..� i�,.. i6,"� {Y� refs :' >' p:. � �`s ��r2 .fi A"r'.: .rie ' �i: �� .'.w;�, ���s i ��05
L
Reviewer/Inspector Name :.tFF h ,;�', .F k% i� ,' t�::' �..� 5.
Phone: 9�p` ,� �3300
Reviewer/inspector Signature: Date: a
1) c 2 12128164 Continued

TI
! Facility Number: — 3 Date of Inspection D D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ER 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. ❑ WDP ❑ Checklists ❑ Design [I Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EWNo ❑ 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
T No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
IR Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�5NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ 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)
r
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
(4 No
❑ NA
❑ NE
cat
stl�-! Ste' n0 Co► I��
5l uL`qP �Gc✓�p�., ! S � �.�u✓r'C.u�
. J /
CC/ Olaf s, .
.�- zoo a
F�..1/s lm� iw y
•, r
Page 3 of 3
Ili
12128104

31a
W.Dtviston of Wate.r.Quality
d+;UCllity'NUlribet' y D Divlsioniof SoiE acid Water. Conservation
r s t Q Other Agency Ej
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1$ O Arrival Time: Departure Time: i County: R�
Farm Name: �4 IR PoTk i--70A Owner Email:
Owner Name: Q T" Phone:
Mailing Address:
Physical Address:
Facility Contact: RidllkL WQQL Title: Phone No:
Onsite Representative: R f Chkd,— _ wood, Integrator: _&0fA -Sml`f h
Region: PQ
Certified Operator: RULML WOOL Operator Certification Number: 290Q17
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 6 = Longitude: = o ='
=
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
k
Number of Structures: K
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 ofthe State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Fachity Number: 4 — 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?
nStru�cture 1 Structure 2 Structure 3 Structure 4
Identifier: Nb— _W v_
❑ Yes t2 No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA [I NE
Structure 6
Spillway?:
Designed Freeboard (in): �^
Observed Freeboard (in): c
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ER No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes tjj 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 El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tR 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 CR No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? I f yes, check the appropriate box below. EFYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding [JSl-lydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 1 W/o 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) Coada 1 liA7t ida PVive . S& 61
13. Soil type(s) l Or
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Eyes ❑ No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V No
❑ NA
[:]NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
tRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages As necessary):
Reviewer/Inspector Name S Of A/ GIM Phone:91D iffi;110X33V
Reviewer/Inspector Signature: Date:
v 12128104 Continued

' 4 Fagility Number: 41 -100Date of Inspection
Reattired 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
t'No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® 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
N NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[B No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR 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
IgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
❑ NA
❑ NE
Additional Comments and/or Drawings:-, '
9, d)e_ V00Ile t)e )fay i, yet, He ie on a vhrde 0� Matt
119
h9 ,s,de,
I5, �dege i►' e-Q•Odf ►vh'O-e needy so„Av-,P--Kif yea•
j l , R'e t od , S 6 o w fly &a ,lic ovegoaj b u� o-t- p ,v ovg� Jaod , P I1°B� eh et k k j
of) `tea j o' J, jcu 0,i an ov.+_-'a Al OV J'
Pla., rnr 1`U u� i 0, 4 S tic � / e+�e,`t-. r� ed,- a fR ac �I �°vaq_
01sl d Tow b�' sf+�
�' 1,�ePs74lI beiowso 1o[�de�],
lfl�j- gilds look Ir�r jood-
ue ma d I M') pffM f+ retie► j -fo Pgje°� by
/ --'
12128104

VW I1#re a,sone
Z C bad ran
�fea
V,.A*Pe .�
grow
Sowd
-�134(08 — lf'q
C4 (c loraa' a 1 Ia (o'
13,, 034 %allc�
`aIkf
Hrd relic Look.
CPm F
Call<[s�
sslw 7
Nowt ova lug

Facility No. Farm Name )'Ggct (-XvyCA4 Date
Permit COC 01C NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design Current FB Drops
i I M' Ln4•a-
La oon
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
a
Sludge Survey Date
Sludge Depth ft &
Liquid Trt• Zone ft
!r Gl3d�ri1•►.!�. f ri s►�7J
Calibration Da-
! - . .
----�--�
Soil Test Date
Crop Yield
120 min Inspections
pH Fields
Wettable Acres
Weather Codes
Lime Needed
WUP
Transfer Sheets,
Lime Applied
Weekly Freeboard
RAIN GAUGE
Cu Zn
Rainfall >1"
Dead box or incinerator
Needs P
1 in Inspections
Waste Analysis Date
- 60 Da
* 60 Da
N Amt Ib/1000 Gal
H
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump

acility iVo. Farm Name
rmit COC
J,4 P, P -k Date
OIC_ NPDES (Rainbreaker PLAT Annual Cert)
FB Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt, Zone ft
Soil Test Date Crop Yield 120 min Inspections
pH Fields Wettable Acres Weather Codes
Lime Needed WUP Transfer Sheets
Lime Applied Weekly Freeboard RAIN GAUGE
Cu Zn Rainfall >1" Dead box or incinerator
Needs P 1 in Inspections
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib11000 Gal
H
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 144 sjp j Date last WUP at farm
FRO or Farm Records FQ D
Lagoon #
Top Dike 4:�
Stop Pump IP
Start Pump 40.3
solr
App. Hardware SW
—

x Division of Water Quality
Facility Number. 3 2 Q Division of Soil and Water Conservation
Q Other Aaeney
Type of Visit Q) Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 114 0 Arrival Time: ® Departure Time: � County. -Nib �- Region:
Farm Name: 4,, , _ AOY 1Lni—N ___- Owner Email:
Owner Name: �T r`' ay w �� Phone:
Mailing Address:
Physical Address:
Facility Contact: G Title:. Phone No:
Onsite Representative:-V�Ci_Y �� integrator: t
Certified Operator: lam-► Crd `�� Operator Certitica on Number: 7
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Latitude:
0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
Dry Poultry
Pullets
Puults
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)
Longitude: = ° = ' 0
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifev
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stoeket
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: l _l ill
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 RNo ❑ NA ❑ NE
❑Yes
El No 4NA
❑NE
❑ Yes
❑ No -N,NA
❑ NE
❑ Yes
❑ No XNA
❑ NE
❑ Yes
W No ❑ NA
❑ NE
❑ Yes
® No ❑ NA
❑ NE
12128104 Continued

Facility Numher: —3 r
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?
El NA [I NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
❑ Yes 110 No
❑ Yes jNbNo
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? %Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )U No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlleation
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. Cl Yes f 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 Rare Soil
❑ Outside of Acceptable Crop
n
p Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &mom- t"' dM G ►r 0 1-115
13. Soil type(s) \]rlYtlpp�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes DANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes JN'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes J3�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes j� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes —KNo
❑ NA
❑ NE
Comments (refer to question #E): Explain any YES'auswers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name C4+1V J1 " 9'�Il! Phone: r! 4/53 a
Reviewer/Inspector Signature: Date: r
12128104 Continue

Facility Numbe 7 -� Date of Inspection afi�s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropiate box. ❑ WOp ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. >Yes ❑ No ❑ NA ❑ NE
El7�'*
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
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
M NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ 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
zNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�;NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: f 1 l
11 1 uS vkve. ( xx&--C� Q_L-1 1r . w 1 ►n l0 0 ob 0 �/
W � b,ra�4% on +fie ; Y" Z-C>'
OCL I 4-4 54e )/I, , 1, 6ar C
S S-4 So-.) -�.t s��-i'mj JA-L ; L"P e
12/28/04

Facility No. 4 Time In �� Time Out Date 3 !q /OV2
Aaarmm Name }� �Q V Vy,— Integrator _Q+L
Owner I % zwL ✓ � a Site Rep
OperatorNo. SR 00� ,
Back-up No. -
COC Circle: or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow -- Finish
Fee
Gilts 1 Boars
arrow — Wean-2
Others
FREEBOARD: Design
Observe
Crop Yield
Rain Gauge,,,,
Soil Test CP Wettable Acres
Weekly Freoar ir _kbob
SpraylF ebo d 0op
Weather Codes
Daily Rainfall
120 min Inspections
Waste Analysis: q-7-37.
Date Nitrogen (N)
o.-r�
b -7 0,33
�,4j�
Sludge Survey
Calibration/GPM- 1
Waste Transfers
Rain Breaker o—
PLAT
-in Inspections
ftw
Date Nitrogen (N)
t a?:P02 I -if 0.9�-'
Pull/Field Soil Crop Pan IWindow

f Division of Water Quality �'� F i J
N;acility Number O Division of Soil and Water Conservation
D Other Agency VIA
Type of Visit A,Compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit 14 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a1 Q, Arrival Time: ® Departure Time: County:
Farm Name: k ice-- Pdrk— P:bLfrr" Owner Email:
Owner Name: L d. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:CL
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Numlter:
ao'3IZ
Back-up Certification Number:
o {� i�
Latitude: = 1 = Longitude: = Q = 1
Design Current Design Current
'Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La et
❑ Feeder to Finish
Farrow to Wean 7i0 ISUK
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifet
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters ofthe State'? (If yes, notify DWQ)
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 �lo ❑ NA ❑ NE
❑ Yes
❑ No �NA
❑ NE
❑ Yes
❑ No JMNA
❑ NE
❑ No 'd5 NA
❑ NE
❑ Yes
❑ Yes
(� No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 42 —D Date of Inspection
s
t Waste Collection & Treatment
,
&No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: `Q Cl�rl
Spillway?:
F
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Nio ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2No ❑ 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�jNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
�EF'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
tbNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
%V 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 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
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes
2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
$a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
PONo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VNo
❑ 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):
aIcA -5�1y%0 baA-p cz� m A cr/
►,-CX4 t'-CXSraH .
Reviewer/Inspector Name WA Phone" -AA(") '' 600
Reviewer/Inspector Signature: Date: c��
121,2Rin C.'nntinued

f . Fadility Number: --3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K 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 N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No A 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
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
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
I,;; �No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspeetor 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:
AM
i n S i VTfoveDl
T
12128104

Facility No. Time In [_mac Time Out Date
Farm Name _lrti'Y4� Integrator p E
Owner � C c� Site Rep ti=�
Operator �� No. oZ��
Back-up No.
COC ✓ Circle: Genera or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed, Finish
Gilts / Boars
rrow — Wean
'O
Others
FREEBOARD: Desi n
nudge ."13urve"V
Crop Yield
Rain Gauge
Soil Test 19 tt,
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
`Observed �DL
C.9libration!GPM
Waste Transfers q==--
PLAT
Daily Rainfall
RRc Ta -)_ r
920 min nspectiods _
Waste Analysis:
Date Nitrogen (N)
'� a o•3t,
S
Rain Breaker ---
Wettable Acres �
1-in Inspections
Date Nitrogen (N)
2r_ o�p t
Oro -
I
I`� )L
0
n �� L

M
Type of Visit Coroutine
nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: rJ.
{D Arrival Time: a Departure Time: � County: {V �� __ Regio
4�
Farm Name: �Q� L_--W lip _ Owner Email:
Owner Name: "� d_ Phone:
Mailing Address: �S 1 1r,�,�P��I.YL
Physical Address: ,- (�,�
Facility Contact:_R L.V iLfd Title:3 Phone No:
Onsite Representative; Integrator:
Certified Operator: �`-'_ _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder I
❑ Feeder to Finish
Farrow to Wean r79 O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ - — — — - - 1
Back-up Certification Number:
= 0 =
=!1 =0=i =n
Latitude: Longitude:
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkex Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non- Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 ElNA ElNE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
;Io
❑ NA
❑ NE
❑ Yes
�JoNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 031 Date of inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:_ - C old * I 61d * 2-
Spillway?:
Designed Freeboard (in): tt c rl Yjo r ;n
Observed Freeboard (in): -c� ai 3.21)
.,t1
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?
El Ye"I Vo [I NA El NE
❑ Yes ❑ No 'RNA ❑ NE
Structure 5 Structure 6
❑ Yes ANo ❑ NA ❑ NE
❑ Ycs �kNo [:)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 �KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes �No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) M
9. Does any part of the waste management system other than the waste structures require ❑ Yes old No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'fXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4 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 Win
dow
Evidence off Wind
,,Drift j ❑l Application Outside of Area
12. Crop h'pe(s) armit4(-L . s ! Lt ` 1 (l nl n i J V.Y 7,62d
13. Soil type(s) ( a h i "�n-r-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o El NA El NE
15. Does the receiving crop and/or land application site need improvement`? El Yes tlo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 7p� 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 N7No ❑ NA ❑ NE
Comments (refer to question,#). Explain any YES answers. and/or any recommendations ar,any other comments.1'i*rk`o k'�
;Use drawmgs'tif.fticilityto betterexplain`situations. (use additional pages as necessary):
h.
►-�a . 0�1, ruc�urc *-Z, iy INACTIVE boV no4 C165-ed .
'
j tS 2ftr_It 101ctc-4ve ,
IvQ�d I V v e I rear k-0-' : r o Id #,
leucl records or, A FJ 3 S-�rUcjures .
Yrivs-�' Kup ix�ee_Ut,�
M 05A h a "e- W4'5` 0- a GAS 1 S t"' �� �.. (DO t__ T �a / rh pi n. au�
Reviewer/Inspector Name j e �C ( N Phone:
Reviewerllnspector Signature: Date: ELL
% 200
Page 2 of 3 121281041 Continued

Facility Number — a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? 4yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
X NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [:]No
kNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes [—]No
XNA
❑ 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 lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes '%No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 'fZtNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office ofemergency situations as required by
❑ Yes AM
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes ` p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes-%lo
❑ NA
❑ NE
19. C wetn4 CoC nA r �� a✓o� Io- . 4l�
&- f t la/lAq , Pau ;vl recoh . Qciv{'s,( arrlU, 40
O�'-a i )'\ T q u c� (" sa)n Q5 ?055; Wf) Urren'l, Co C .
3 7 . S�o lG e WA ;0,yM" 15S ves L rt a Mi—
�Ca,, Pdemz .
NOTE- kx�,4 ana/ w 1 A ''n (_P�
45 L''SLv$SQd , ca ,,6, ��cY1 SUrVP,y/ (on 0.�+i+r�
tA he%rtfIo-
12128104

Facility Number 4 9 �' � � Date 1 `t Time IN Out
Owner CSC'] _ . .
Farm Name :� © Y L f
No.
C.O.C. NPDS
R Design Current Design Current
qY ` 0
`O 1
0
Wean to Finish Wean to Feeder
Feeder to Finish ow to We 77W5
Farrow to Feeder a ow I_Sfi
Gilts - Boars
Other
Soil types
�1
Crop Types Pan % Window 31 1 - R so
Soil Test" Plat -�-'
Designed Freeboard Z L a Observed Freeboard
Rain gauge Rain breaker__� Daily Rainfall V Waste Transfers ---'-
Calibration of spray equipment —
Sludge Survey Crop Yield
G/P.M.
V
120 Minute inspections
1 in. Rain inspections Weather code Weekly Freeboard
Pumping time J
Waste Analysis % & Monthz/0-10 LOS-
S

c)21 & 'P"-" -C J S_ ��11
L�a)-q) 021�Or2!
419
�s 02 -5lt r I
( 0 �) � v - SlIk"19
M,,
4,1
J. w1 s
Ka
.. `tlh`J i � W -2.

t
M
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of' Visit: Time: 01
10 Not OiDerational 0 Below Threshold
O Permitted ❑Certified `0 Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: k �. V �or f� Fay,..- County: �� !� 'r_ R C
Owner Name: u,g 3 qp�� ��__ Phone No: ' `/ ��r
NI ailing Address: dui' 10 b elele e_ ICG�f Ilcf C A) W N e cy P3 � i- ^
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0' 0
. .: .
.,
`.Design, Current
pesign Current Design, Current
Sw•fne .
Ga acity i 1'o Matron
jpoult "
r� .
Ca' achy `Po ulation Cattle Ca achy r`'061wition
Wean to Feeder
�i ❑ Layer
❑ Dairv�
❑ Feeder to Finish
❑ Non -Laver ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
;
r
Total Design Cslipaci6
❑ Gilts
❑ Boars'
1 '
Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area i
�'
�'�Holdifig; I
Ponds LSol3d�Traps'�"
�y}
•;�,
No Li uid Waste Mana ement S stem
l
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon [,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, notiA, DWQ)
2. Is there evidence of past discharge from any pan 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 Colle-yrtion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches): a Cri
05103101
Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

• Facility Number: -- 3 ( 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 46 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?
B. 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?
I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
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 Lgsues
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.
Field Covv ❑ Final Notes
Reviewer for N ` /Inspec Name =f' a _:� . i .. r .c`i ?'T 14 ��' h I.lw' L.. i l Iw �.'"
ReviewerAkspector Signature: Date; . ' —f d r�
12112103 Continued

11�'a�rfr!•�s:1,E;€a:a,�}"s.�?%�:,is:,3;..'f'tfsr?�:.,iz'a;5;tfi k.s..��i<�i�u�al:'?dts�'�-...iz°�!R"2�f!ui•�fi»,#..r�a:.r: .. v. ...�.�i., .. ... :3 ��.. .z.. z - ..,"'mot €'F a<.r%�c,.., u<.n: 'd:.l.�r1'�z �"' ....E1
Type of Visit ® Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up C) Emergency Notification O Other ❑ Denied Access
Date of Visit: Fi_l= Tirne:
Facility• lumber
Not Operational 0 Below Threshold
® Permitted ® Certified 13Conditionalh' Certified M Registered Date Last Operated or Above Threshold:
Farm Name: __ IZ 4- County: _ . f Olco 7 _
Owner Name. A04 4- tz"r, 6-1YL l-1 d OeL Phone No: 1 O 1 A>
Mailing Address: '40S1 '4L'C&,uL" si - _- &Cx-J:ccct_ /1- C
Facility Contact: _ g, u d_ 10 oA Title:
Onsite Representative: 9— Iw L.j o'D QC
Certified Operator: 0A
Location of Farm:
Phone No:
Integrator: 6-cat� Kw\i% F J"'( L'r
Operator Certification number: ab31Q.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • i . Longitude • 0 ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Po uladon
❑ Wean to Feeder ❑ Laver EEI
Dairy
❑ Feeder to Finish ❑ Non -Layer Non -Dairy
® Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ La oon Area ❑ S ray Field Area
:Holding Ponds / Solid Traps JE3 No Liquid Waste Management Svstetrt
Discharges S Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Laeoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharee is observed, did it reach Water of the State? (if yes, notify D WQ)
c. If discharee is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .�..r
05103101
❑ Yes 5 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [RNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes} No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes UNo
12. Crop type a ex-m L' ej o. — 4-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
®No
16. is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IV No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[�a No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
?I No
�
deficiencies iwere noted during this visit. You will receive no further correspondence .,,...
No violations or d — — about this visit.
v-1iuJiv! Uunrrnueu

Facility Number: + 7 - 3 Date of Inspection ° 3
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?
05103101
❑ Yes ❑ No
❑ Yes ER No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes] No
❑ Yes ❑ No

t y A K'❑ Division of Soil and Water Conservation ❑ Other AgencyE
O Division of Water Quality
f
10
,
Routine 0 Complaint 0 Follow-up of DNVO inspection 0 Follow-up (if DS%VC review 0 Other
Date of Inspection l//-L4
Facility Number
Time of Inspection 3 % 24 hr. (hh:mm)
Registered 13 Certified 13 Applied for Permit © Permitted 113 Not Operational. Date Last Operated ...........................
FarmName:.... '. ...., a.r.k.,..F�.r..fl!!................................................................ County: .... 11f"ke....................................... .......................
Owner Name:...!`......' �!fi...4.1" ,......1 .. Phone No: .................. ...............I.....................
....'............................................... ......�1..71 = 71T5'
Facility Contact:...., f.Cr.! tl ..... ... Title: (�!-�, -Q,..� Phone No:
Mailing Address:....... I ...... ,.......................... ..................... ....t.......��..� .� Y �............,............,..�g37G.........
Onsite Representative:,,92..(;+ .,-d.... and ... lntegrator:....�.T!1. .....Sn;).t �....S, !' s..
.....................................................
Certified Operator:...... 1.0 ................!!0 .....
Operator Certification Number :............,............................
Locution of Farm:
c
"e
Latitude 6 « Longitude ' 4 "
Design urrenu 4_ J' x, Design Currents k Design,,- Current s
Swmee Capacity Papulatton Poultry a Capdeity Population cattle dCapacity Pgpulahon
h.. : .
❑ Wean to Feeder ❑ Layer m ❑DairyIE
❑ Feeder to Finish ❑ Non -Lay r y' ❑ Non Dairy
Farrow to Wean 7
Farrow to Feeder
❑ Other,
F x ,y .
❑ Farrow to Finish Tatal Design Capacity; 7 D
❑ Gilts; s
❑ soars Total'SSLW "605
1A ,.
; umtier of Lagoons% Holding Ponds ❑Subsurface Drains Present ❑ [ pgnon Area ❑Spray field Area z<
;.
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
2. Is any discharge observed from any part of the operation?
❑ Yes
0N0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. lfdischarge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypassa. lagoon .rystem? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
VNo
7/25/97
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes fNo
Structures _(Lagoons.Holding_Ponds, _Flush Pits, etc._)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier-
................................... .. ......... ..................,.................................z....................................I................................................... I.............................
Freeboard ft
10. Is seepage observed from any of the structures? ❑ Yes ( No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes 'O1 No
12. Do any of the structures need maintenancelimprove ment? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
qyes
❑ No
Waste Anolication
*0
14.
Is there physical evidence of over application?
❑ Yes
(If in excess of WQMP, or runoff ente .ng waters of the State, notify DWQ)
15.
Crop N'Lt1A.cL
eC
type A....................... ..... ..... i�.�................... .��...........................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18.
Does the receiving crop need improvement?
❑ YesNo
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For
e ified or Permi ted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
R.
lvo.violationsor deficiencies werenotedduririg this" visit.:You'will r&e' i'veitoltiriher
:. ctirres*idence about this'vis.it:
IT.
old lq jee,
w,11 be elooJ eart w�e►_ neLo lajwr, 't5 Comp
j3,
Mo keys 4-b
6e- in54oJ+J 61
1Z/31.
NVJ �dleee_k
rS W4Y-Kt� dti
L'cr�r7rcAC�'ror� iS "Tq!'IYt.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: /f�j(,,,u U : J*dA , Date: // —/ y —