630006_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental QuA

� nAAk
�i
'� WDlvi"sion of Water Resources
Facility Number - Division of Saii and Water Conservation
Q Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: M oo&# -
Farm Name: �(-` t�. Owner Email:
Owner Name: 1 ' PU y'ys Phone:
Mailing Address:
Physical Address:
Facility Contact: 76_ !^27 e f oD-y Title:
Onsite Representative:
u
Certified Operator: C*-a,L.J.'iS"
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:i
Integrator: 6 C' pcc,u S _
Certification Number: 9g'7 0,
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
I Dry Cow
Farrow to Feeder
1246D.r.
Paultr:
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Poults
11
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
® 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Fhcili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
}
I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J�j 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
4Z;9 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
5 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?
i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Eviden
ce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): QS-W &" S � 7�
13. Soil Type(s):.�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes T5]o No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1] 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 b No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

r ciiity Number: Date 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
0 Yes
5!3allo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge`?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
O] No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
Reviewer/Inspector Name:
Reviewer/Inspector Signature: (FdC(GC�'�
- 4
Page 3 of 3
❑Yes
�No
❑NA
ONE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes P No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q,V -47/33 _33�
Date: 01 Y1( e
21412015

' Dlvission of Water Resources
Facility Number - Division of Soil snd Water Conservation
O Q ther Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 l Arrival Time: Departure Time: County: m4rga
L
Farm Name: 'T`"�� t` Owner Email:
<77
Owner Name: Cj- i' �' I` S L-LWLx 5 C Phone:
Mailing Address:
Physical Address:
Facility Contact: Tpr y 14nO rP Title: Phone:
kl
Onsite Representative:
Certified Operator: ,
Back-up Operator:
Location of Farm:
14
Latitude:
Region: AA52
Integrator: ALL Pu-"-A 3
Certification Number: l 7 -7o {
Certification Number:
Longitude:
Design
Current
�
Desil;n
Current
Design'
S��wi�`ne _
C��asspacity
Pop.
Wet Poultry
Capacity
Pnp.
Cattle
Capacity
?Fap�
®A�R�
APAi' �I�QI
I
G:iren�m�l�,� P
Wean to Finish
Layer
Dairy Cow
}
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I Z00
D . P,oult .
Ca aci
Ro
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
y
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
9R9®ay196r�I
11�i+a'iJ�fl'�Cf6YiQi
Other
Discharaes and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[F 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 DWR)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �_ 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / ,3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[PNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
' Crop Window /' �❑ Evidence
of Wiind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C_IZ5` (�1'w�� a �'YP& L,� 1.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis- ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fitcili IVltmber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �_K6No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [P10
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 [5ZPNo
T
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency?
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ['j No ❑ NA ❑ NE
❑ Yes [�)No ❑ NA ❑ NE
❑ Yes glNo
❑ Yes �] No
❑ Yes No
❑ Yes i� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: [phone]o
Date: �5
21412015

RUA- gllg
Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: 2Yo0 Departure Time: ti I', County:
Farm Name: --�—It ZIA Owner Email:
r
Owner Name: ��� PoYV t C 7 Phone:
Mailing Address:
Physical Address:
Facility Contact: o ►L Title:
Onsite Representative: t4
Certified Operator: a�) W'LSOtj
Back-up Operator:
Location of Farm:
Latitude:
Region: t?
Phone: Integrator; ►)L Pv'�_r,'S
Certification Number: R 17QC
Certification Number:
Longitude:
Design Current
D`e"sign Current
Design Eurrent
Swine Capacity Pop.
Wet Poultry Cap city P p
Cattle Capacity Pap. !:
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er I
.0
Dairy Calf
Feeder to Finish'Ia
• • : i {
I
rty
�Desi n
fL1V � I r „Nu � � ��M �
]l . I'odltr ,i�$ ,„Ga aclt
Layers
Non -Layers
.111l,"
Current
'P!�
PU 3
ht.
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
lZ
(
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Beef Feeder
Al
Boars
!' �;
Pullets
Beef Brood Cow
q
Other
Turkeys
Tur ey Poults
�e �
Other
r�
Other�li$
�.���[�*:��.
:.
M+sllew3rA9!sa'-iWrn4�rs:.onw :onoamu6�!!
Discharmes 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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
E� NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
[]Yes []No
[:]Yes No
❑ Yes No
[� NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

, .+
Facility Number: Date of Inspection:
LP
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�3 No ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in
Observed Freeboard (in}: y 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Y =f No ❑ N . ❑ 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
[D No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[j] 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): GS 6�SM_�1
13. Soil Type(s):
14, Do the receiving crops di fer frl those designated in the CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack ofproperly 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 Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

....
Facility Number: 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. 7'
❑ 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 V3No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes [)—j No ❑ NA ❑ NE
❑ Yes [� No [] NA [] NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
(5 No
❑ NA
❑ NE
❑ Yes
[jg No
❑ NA
❑ NE
Phone: 10- s3 3Tcro
Date:
21412014

Division of Water Quality
Facility Number - O Division of still and Water Conservation
O Other Agency
Type of Visit: 4D Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �(� Arrival Time: o O t7 Departure Time: l f : ntJ County: Moo kpz
Farm Name: �i�a`lT i"yi�o(1� 2 T Owner Email:
Owner Name: —[- i'w. ✓�_S Phone:
Mailing Address:
Physical Address:
Facility Contact: Mys Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: /V(f A-'-"kI-
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
RLayer
Non-Layer
Design Current
Dry Poultry Canaeity Pnn_
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region: ,0
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Datty
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
§D NA
❑ NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
jA NA
❑ NE
❑NA
ONE
❑ NA
❑ NE
Page I of 3 21412011 Continued

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

Facili Number: - Date of Inspection: 'Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
In 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?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
CP 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
rM 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 t0questlon ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings offacility'to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature: \AM
A4""
Page 3 of 3
Phone: q/0~��— 37dO
Date: 6 Sy /
21412011

4 0 Division of Water Quality
Facility Number l� - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 48 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4# Routine 0 Com laint 0 Follow-ue 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 1 ; Arrival Time: �Q7 Departure Time: 2; County: / Region: �O
Farm Name: P61 f r1 CA_ a i_�9VL... Owner Email:
Owner Name: A) 6 Q� WY i wA D�c_ Phone:
Mailing Address:
Physical Address:
Facility Contact: LV-t-e Title:
Onsite Representative: 14
Certified Operator: PA
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
)CpFarrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Phone:
Integrator: dk&'T� Yti�
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non-L
Pullets
Turkey Poults
Other
Dischart•es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current...
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑Yes
❑No
Z]NA
❑NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No [] NA ❑ NE
0
Page 1 of 3 21412011 Continued

acili ,Number: Date of Inspection: Zq
Waste Collection & Treatment I IF
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑No �NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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? 0
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 n NE
maintenance or improvement'?
Waste Ani ication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [IJ'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C&tq&,/ &-�ffdt��r�f a II & fbtp6441
13. Soil Type(s):pJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reguired 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
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑Waste TratTtsfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
4
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

acilit Number: Ds ection: Z`t
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes EP 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
2$. 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
E� 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
`P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments'(refer to question #}: Explain any YES answers and/or.any additional recommendations or any- other:comments:,
`necessary).
Use drawin�s,of-facility to better explain: situations (use additional paaes as
' .'.
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 7o0
Date:
2141201.1

Type of Visit: 40 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1/g Departure Time: County: IW40& Region:
[ �!
Farm Name:
Owner Name: (T �' ✓t S C r
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Aolone Title: Phone:
Onsite Representative: Integrator: jm� p[,✓V(?
Certified Operator:
Back-up Operator:
4
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design
Currents Design Current
Swipe Capacity Pop. Wet Poultry Capacity
Pope Cattie�pp Capacity Pop.
�x
SK 1 Ft
WN�Ixai lid ?CUFF '.. _
t Dairy Cow
Wean to Finish
"
Layer
Wean to Feeder
Dairy Calf
r Dai Heifer
Currents Dry Cow
Non La er
I
Feeder to Finishell
�Designt
t
Farrow to Wean
Farrow to Feeder
D .P,oulfCa
aci
PoU Non -Dairy
Farrow to Finish
La ers
* Beef Stocker
- Beef Feeder
Gilts
Non -Layers
Pullets
Turkeys
Boars
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
bgNA
❑NE
❑ Yes [P No
❑ NA
❑ NE
❑ Yes )p No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

pacility Dumber: - Date of Inspection: ?�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A
No ❑ NA ❑ NE
❑ No ® NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 10(0[J
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 to 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 9� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes�� j No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 1P
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/ Evidenge of Wind Drift ❑ Application Outside of Approved Area
l2. Crop Types};n G-5S Cda_L7)1 4e 9„
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
M No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
"No
[DNA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
❑ Yes Eq No ❑ NA ❑ NE
❑ Yes IF No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `� No
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes It No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 63-6 Date of Inspection:
24.�Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes k9 No
❑ Yes ❑ No
❑NA ❑NE
NA ❑ NE
❑ Yes MfNo ❑ NA ❑ NE
❑ Yes t1l No ❑ NA ❑ NE
❑Yes f]No ❑NA ❑NE
❑Yes [PNo ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes} No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes No ❑ NA ❑ NE
%34, Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
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). { ti
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l0 � � 7 ,-2
Phone:
Date: 44' 7_1
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r � Departure Time: County: Region: Z
Farm Name: `✓`
Owner Name: %Ptit.y ��� 6?3r- V11 9 ')�'C.'
Mailing Address:
Owner Email:
Phone:
Physical Address:
C
Facility Contact: %0,1.1 tt�__ Title: Phone:
1/ +
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: ��. rP __1(t$ T
Certification Number: `i-
Certification Number:
Location of Farm: Latitude: Longitude:
Desi n
g
Swine Capacity
c
Current
I. ,
Pop.
'Ik
CC Desi IRRnt°;Currentl ' y
oTrj4�Hb fkl��4
Wet Poultr Ca aci PoI
guy
yei p;
L -
RN5 1
Cattle
Design
Capacity
Current
Pop.
an
I. s as r, see ,
La er
Wean to Finish
Dairy Cow
Wean to Feeder
I INon-Layer IDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D P.oult . Ca aci P.o
Non -Dairy
Farrow to Finish
La ers
Nan -La ers
Beef Stocker
Gilts
= Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthcr
—Turkey Pouets
Other
Other
Discharees and Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
`M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
UNZnj NA
❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes
❑ No
O 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)
❑ Yes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
MNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

I
Facili Number: - Date of Inspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E4No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ;S NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 179 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
MNo
❑ 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
[n 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 Approved
Area
12. Crop Type(s): &" C-,Mss-
13. Soil Type(s):
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rt"I 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 21412011 Continued

'Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'trNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�JNo C] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes `� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes KMNo ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
❑ Yes FOl No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes.79 0 No
❑ Yes q] No
❑ Yes [D No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question}: Explain any YES answers and/or any additional recommendations or any other comments?-,��
Use drawings otfacility to better explain situations (use additional Popes as necessary
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

If U•
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: I of e.n� 6- Departure Time: a'�iAp County:
t r
'e Yc" m Owner Email:
Owner Name: 11zPatv,15 &!-& �YI_L� Phone:
Mailing Address:
Physical Address: �/�
Facility Contact: / Q64 /r100 e- Title:
Onsite Representative: f1
Certified Operator: "" me -
Back -up Operator:
Region:
PhoneNo:
Integrator: — 416_1 Aolt_11 1.5_-
Operator Certification Number: �$3p
Rack -up Certification Number:
Location of Farm: Latitude: = o = 1 = i1 Longitude: ❑ ° = I = 46
j
Desigu Current
Swurrent
ine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
El Farrow to Finish
Gilts
EBoars
Other
Wet Poultry
❑ Layer
❑ Non -La er
Dr:y Poultry
❑ La ers
Pullets
❑ Turkeys
❑ Turkey Poults
Design Current
Capacity Population
�e-
Cattle pulation
❑ Dairy Cow
❑ DairyCalf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Other El Other
Discharges & Stream Impacts
Is any discharge observed from any part ofthe operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E4 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
[33NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —
Date of Inspection C
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
Idenliffer: 1 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �q No ❑ NA ❑ NE
❑ Yes 40 7 ❑ NE
Structure 5 Structure 6
❑ NE
❑ Yes
F, No
❑ NA
❑ Yes
LJ No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(�_ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or we stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EpNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application`? If yes, check the appropriate box below. [:]Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
[]PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) N*,&,a 5r ke 6v�
13.
Soil type(s)�ji' }
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
Cl NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
r _�' No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18,
is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
-comments (refer to question #): Explain any YES answers. and/or any recommendations or any other comments,
Use drawings of facility to better explain, situ ations.; (use additional pages as necessary):
77
Reviewer/inspector Name 1' — — — — ---_ -_ ---- v. Phone: /0 0D
Reviewer/inspector Signature: �L Date: ILI 6110
Page 2 of"3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes [§No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g ElMaps ElOther
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
El NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
&I No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[h 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
IgNo
❑ 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
F)No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
6 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
42 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additionai'Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number 2 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection Q Operation Review Q structure Evaluation Q Technical Assistance
Reason for Visit "P-Routine O Complaint Q Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ; f)0 fi Departure'Time: 5*00 PH I County: '-1ar'-.
Farm Name: Al 014 e (01 Owner Email:
Owner Name: 1Y v Phone:
Mailing Address:
Region: MO
Physical Address: Facility Contact: 12i rf u Do-e. _ _ _ Title: Phone No:
Onsite Representative: rOAPQ- acne _ Integrator: ry r E:A(,Mi
Certified Operator: e Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ c ❑ 1 = Longitude: = ° ❑ , ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
1❑ La er
E] Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ D Cow
❑ Non -Dairy
❑ 13ccf Stocker
❑ Beef Fcedcr
❑ Beef Brood Cow
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)?
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
52 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 63 Date of Inspection
r
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?
Struchrre I Structure 2 Structure 3 Structure 4
❑ Yes ERNo ❑ NA ❑ NE
❑ Ycs ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes TgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [5; No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
®'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste stntctures require ❑ Yes
Cg No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes
[3No
❑ NA ❑ NE
maintenance/improvement'?
11, Is there evidence of incorrect application? if yes, check the appropriate box below. Ryes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding CgHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into
Bare Soil
❑ Outside of ❑ Evidence of Wind Drill ❑ Application Outside of Area
Crop Window�
/Acceptable
j
12. Crop type(s) -(1QTA �r j_ 1
J
0v
13. Soil type(s) r",k"Ic
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
BNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes
N No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ON
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ 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):
ReviewerAns ector Name Phone: 0 y33-33(XjX33
p �UAV-�C f�N6f� _ 9I
Reviewer/inspector Signature: Date: H&A30
12/28/1)4 Continued

Facility Number: 63Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes 0 No ❑ NA ❑ NE
20, Does the facility fail to have all components ofthe CAWMP readily available'? If yes, check ❑ Yes 15f No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, Yes ❑ No ❑ NA ❑ NE
❑ Waste Appiication ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 2tCrop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit'?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative 'immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
.Comments andl. r Dr,awin .Is Additional,_ .
❑ Yes
;R No
❑ NA
❑ N E
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
aYes
❑ No
❑ NA
❑ NE
❑ Yes
51No
❑ NA
❑ NE
❑ Yes
❑ No
RNA
❑ NF
❑ Yes 1�9 No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes Lrl No ❑ NA ❑ NE
❑Yes ZNo ❑NA ONE,
F1l -The-small -(�,e(L ktd_as19t M-hl&0-11Cove last (06"t 10140), -T_ �>° d L
s � ��o �I' �'a'%e Dn- �-�,���, PAV was s,4-i 1 b-ero+. i;Mr s
Q 1, Hai record r were n of ke�7i�
as1151 4je SlIme n0-cQ-,- a0o8
No 140* cow C ro t 300F aoo4. kojefa ,,� d ai , ��-r�,'� �Pr, v pieq, ,ref 1 I
a-�ha�
, �(
Page 3 of 3 12128104

Facility No. 3~Op Farm Name %)2;4-e - Date
Permit -1"' COC T)Al OIC ✓ NPDES {Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
. _
MUMS©
, top,�t
�-------
Soil Test Date a i rLd �18a
pH Fields 57-1
Lime Needed
Lime Applied
Cu
Needs P
Crop Yield w
Wettable Acres v
WUP -�
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
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 Q CrD�s���
Lagoon # i-f�►� Qv�t'Q�d ri: �r�o��!>f e-, SMollg
Top Dike
Stop Pump TrRe 7
Start Pump

4 . "N'
.,Division of Water Quality N 3'31
Facility Number D O Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access ,Q�n�
Date of Visit: �- d Arrival Time: Departure Tinter County: �� Region: !—"I�
Farm Name: 1' Z'dQtFat ry _
Owner Name: Nr C� �lr Y t.5 Kaf'ros / Oc _
Mailing Address:
Owner Email:
Phone:
Physical Address: Cal r / �-7r
Facility Contact: a r Title: Phone No: r IO aqS ,- / 7
OnsiteRepresentative: ��Y integrator: [—Lr S
Certified Operator: Operator Certification Number: ` 9
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
,Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Hack -up Certification Humber:
Latitude: = 6 0 « Longitude: 0" = ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation`?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D 'Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters ofthe State? (If yes, notify [)WQ)
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 pan of the operation?
I
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No
'FCINA
❑ NE
❑ Yes ❑ No
.DNA
❑ NE
,MNA
❑ NE
❑ Yes ❑ No
❑ Yes ANo
❑ NA
❑ NE
❑ Yes ;)A No
❑ NA
❑ NE
12128104 Continued

e
Facility Number: (p3_ D(o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �§No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes V No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes 'gNo El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.) ��/��/ ```"`
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ 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? kYes *No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[)9 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ I-leavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > I W/o or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Windd Drift ElApplication Outside of Area
12. Crop type(s) fail: Ml
uck - a)"Yt. G Ir
13. Soil type(s) F0. 1) ti V a, Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
JANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes
[M No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
4� No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment'? ❑ Yes
&No
❑ NA ❑ NE
Comments (refer to question #):' Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
► wol 4j e d t,-o ss ove., f,�
Reviewer/Inspector Name CH RUST ivy' 64> Al A/ Phone9/0 %.3 3900
Reviewer/Inspector Signature: `'�'t�� Date: ETZ3 2—cm
12128104 Continued

Facility Number: (8 — 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 PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
93 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P�LNo
❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediateiy
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
%No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�A No
❑ NA
❑ NE
E
12/28104

Facility No. G, 3 — G (0 Time In Time Out
Farm Name }��G 1�� �(_�
Owner C P r ✓rn_�
Operator F
Back-up
Date
Integrator _ C'" U fy 11 .$.
Site Re
No. I 1 3 p
No.
COC Circle: Genera or NPDES
Design
Current
Desi n
Current
Wean — Feed
Farrow —Feed
Wean — Finish
F arrow — finish
Feed — Finish
Gilts 1 Boars
Farrow —Wean
Others
FREEBOARD: Design ` Observed
Sludge Survey Calibration/GPM 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall
�/y�1-in Inspections
Spray/Freeboard Drop 1' ` ! -,'� � ' h
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
51 3 I 3
Pull/Field
Soil
Crop
Pan
Window
aL.
,-C r
5

7- Division of Water Quality �?j._,1It list
Facility NWmDivision of soil and Water Conservation
0 he gencll=
Type of Visit �&Zompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: DepartureTime: oZ U County:
Oy
Farm Name: �1� Owner Email:
Owner Name: 1 U�1 V C �(]t Y �(YlS Phone: _
Mailing Address:
Physical Address:
Facility Contact: 1 UTI
Onsite Representative: lf�
Certified Operator:
Back-up Operator:
F
Title: L f
Region:
hone No: I 1 d Q 1_) -7 77
Integ for lklry J 5
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n =' = Longitude: = o ❑ i 0 «
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
ulation
Cattle Capacity Popa.
a.
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I JE] Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ DEY Cow
Farrow to Feeder Z
❑ Layers
❑ Non-Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
on -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey POL11tS
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
A
❑NE
b. Did the discharge reach waters ofthe State? (if yes, notify DWQ)
ElYes
❑ NoA
rN
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
—�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
*A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
)%No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)Phlo
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: -- oil 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 St ture 2 Structure 3 Structure 4
Identifier: (—.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No MNA ❑ NE
Structure 5 Structure 6
❑ Yes �do ❑ NA ❑ NE
❑ Yes N:�o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Wes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ANo ❑ 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 ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JF&o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes_1�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WindrD�r�itl ❑ Application Outside of Area
12.
Crop type(s) &M, fn U-4 ! C�'l ✓ U!
13.
Soil type(s)p� V�
_
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
:Comments (refer to question #): Explain. any YES answers and/or any recommendations or any other comments.
,19se drawings of facility.;to better explainsituations. (useadditional pages as necessary):
CQ CA, Cn �'� reu � � n cox re �-�-� o�
Reviewer/Inspector Name ST - -- -_� ---- Phone: 3 L�
Reviewer/Inspector Signature: 1 Date: 7L7Q)
Page 2 of 3 12128104 Continued

F'acilitF Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "Po ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 11,210 ❑ NA ❑ NE
❑
the appropriate box. // "
❑ WUP Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �IO ❑ 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 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
es
No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
es
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�fo
❑ 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
§aNo
❑ 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
MNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�FNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
S) uj Su f - ba Wa Y- e4ed -) 1loq.
7onr.. -k VP0 - (d4, 01(' �
Y7'tip P -rib, v'Jv� mr, + (��Opr, , CL�a �, (� �D� Lt/C
Page 3 of'3 12128104

Facility No. 0_�o � Time In 11 Time Out Date
1l,,
Q d." it Integrator �-�-�1� 1 S Farm Name tom! b � t � �
Owner
Operator _ >_Q i_
Back-up
COC
Site Rep
No.
No.
Circle: General or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — F
Wean — Finish
a -- FInish
Feed — Finish
Gilts 1 Boars
Farrow —Wean
Others
Design
Sludge Surve r
Crop Yield
Rain Gauge
Soil Test V` PLAT
Observed
Calibration/GPM 1 a�
Waste Transfers
Rain Breaker
Weekly Freeboard _ Daily Rainfall _ i
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
c9 :3
Wettable Acres
1-in Inspections -
Date Nitrogen (N)
6 !t
Pull/Field
Soil
Crop
Pan
Window
r
L5
�1,h
t tl
/01
00

Type of Visit (5-co-mpliance 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: 1� Arrival 'timela—I'DO-1 Departure Time: 3 County: t+�
Farm Name: �p c te rtn� Owner Entail:
17
Owner Name: _ _ f� . ��^ f t-t. N` lit S Phone: _
Mailing Address:
Physical Address:
Facility Contact: _Dn Title:
Onsite Representative:!.
Certified Operator: 7
Back-up Operator:
Location of Farm:
Swine
Region: i G
Phone No:
IL—_ `
Integrator: �u+'✓i s
Operator Certification Number:
Baek-up Certification Number:
Latitude: = 1 Longitude: = 0 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-LaVet
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
ER Farrow to Feeder
Id(o
%
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance ratan -made'?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beei'Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: ELI
b. Did the discharge reach waters of the State'? (If ycs, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (li'yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes ®No ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
L14
[I NA
❑ NE
❑ NA
❑ NE
❑ Yes
EX No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes 2INo ❑ NA ❑ NE
12128104 Continued

Facility Number: — 01�o Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
Cl 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.
❑ WEJP ❑Checklists El 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
SNO
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2SNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ 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
10 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
r cxi.•S.. a ua rt'i 4 �y�n 3� {' WZAFi{�igi>
Adq'ditlopal .gMn en anW D,rnwlllgs. k
, 'rs,. 'w{'r�`
12128104

Facility Number: b3— C) Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. Il'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: 1 V
Spillway?:
Designed freeboard (in): �.
Observed Freeboard (in): % 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed ❑ Yes jai 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 91 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes No ❑ NA ❑ NE
(Not applicable to rooi'ed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) b->' Yvt,tlt_J,R ft'
13.
Soil type(s) r el B �Q
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZLNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Callo
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination': ❑ Yes
E No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L&No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason tar Visit ©Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
[)ale of Visit: 9' Id'OSI Time: : �S
Facility Number 3 (e
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold : ......................
FarmName: ............... . ��ty.Q..... K,!. .......................................................... County:.... mao.�;.....................I.................F!E',c....
Owner Name:....... s...�r:...................14-
A.t.1!' j .............................. Phone No..........9 � ..1..9..� ......--JR.-:02.7..............
Mailing Address:. X2 H............ P............ �,tr�i�?i.�..t.7.... A ..C. �73.xS
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative:......... �.!Jf'4..h.r.......... .rE;::..t.»............................................ Integrator: ......... N.,(; ........ .....................................
Certified Operator:........................................................,.............................................. Operator Certification Number:
Location of Farm:
[M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 '4 Longitude • 6 77-7-711,
Design Currenf
Swine Eanac. »Ponulatian
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
© Farrow to Feeder
J
❑ Farrow to Finish
❑ Gilts
❑ Boars
'' Design :.Current i-Design 'Current
Ca ,. aci =Po 'uladon Cattle : Ciia�i . Population
:r ❑ Dairy
Layer ❑ Non -Dairy
;r
Total: Des1gn. C>eiPk4 —
ToW, SS W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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 2 Structure 3 Structure 4 Structure 5
Identifier: ....4r �........... ......... Ab w 4A2................................................................................................................ .......
Freeboard (inches): S _
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
12112103 Continued

Facility Number: 43— ,L Date of Inspection 17 - /a-
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
l I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reouired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments irefervto'question #)' Eiphtin any,YES Fnshers and/or any recommendatians,or anv'other 6rri nents: s; . .
Use drawings of facility to better explain situation. (use additionai pagesas necessary g; Field Cory ❑ Final Notes
V 7...
S +e" ." 4 n o o r. CA
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

�—�--- �� Dote of N,isit: 3 04 Time: d . a
10 Facility• lumber _L (o,i I� CP—�
Not Operational 0 Below Threshold
® Permitted ® Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: Qi tlr �-_Ci r� County: jf_AVQre'_
Owner Name: J1I %. 10L rJi L , Pajam.0 Phone'So: _ �,oil _!ZA� R - a'5 I
Mailing Address: __ :1 4:�-I' "nCi
Facility' Contact: Title: Phone No:
OnsiteRepresentative: Integrator: Pt1rv,�s
Certified Operator: __ L._i G;Lc, Operator Certification Number: J(f_?o L-
Location of Farm:
19Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude i Longitude a I
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca achy Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Laver I I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver I I ILI Non-Dain
❑ Farrow to Wean
® Farrow to Feeder Other
farrow
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JLJ Subsurface Drains PresenLJILJ Lagoon Area 1LJ S rriv Field Area 1
Holding Ponds / Solid Traps No Liquid Waste Management System
Discharggs S Stream lmnacts
I. Is any discharge observed from any pan of the operation? ❑Yes No
Discharge oricinated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Rater of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
2, is there evidence of past discharge from any pan of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste ColIggfign & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 J Continued

Facilitp Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes N No
❑ Yes (0 No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings:
A.
05103101

n
Facility Number: — 4
Date of Inspection 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 1�3 No
❑ Yes No
❑ Yes No
❑ Yes ❑'No
❑Yes PNo
❑ Yes No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12, Crop type --- f3cr,r.t -6,G _ =6 9i L ,, , 6 1 S , , _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M 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
M No
19.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
Q'] No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ic/ 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
;ZNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[ No
(iel discharge, freeboard probiems, over application)
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
NNo
25.
Were any additional problems noted which cause noncompliance ofthe Certified AWMP?
❑ Yes
(4 No
[� No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
�,, F• .�. 0 Sri +•=F -'+ N t�� ifi�� ,itt xxQIN�
{ to question „. ; , .rP L,., :,n;w ran of ` o
ya` 4cr�cummcnts �N^17, P
Use drawn a fac.ilito betterx laiiatfona {use"addltianala eyes ag
of necegsary)nslnry�t
g• a A. p p g ❑❑Notes"s
H,,
Reviewer/Inspector Name d �..,a'" 7� a ^` • .',r ,p,�1��,�a'�; �� �,� .a)v, '. �� tuii!� d��ui��l '.J � lu;l "4, ,�iie�
Reviewer/Inspector Signature: Date: 3 6
05103101 Continued

Site Requires Immediate Attention:
Facility No. G 3 - l�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: AJ
Mailing Addr ss: So
County:
Integrator
On Site
Physical
DATE: 7- zo , 1995
Time: /O-'ZS --/� : s-1
Phone:
Representative:,Z:Wlamo _r�,;;evtS Phone: ?/O -
Address/Location: GAx7 0 t- r - P :% *A Gd r a/max vW �/� oS' .g.✓v see/z7s
Type of Operation: Swine � Poultry Cattle
Design Capacity:1Za,0_Aj - �2 -j�e t Number of Animals on Site: - zao_ fir✓ __
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' Longitude: ° ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft.f_.�Inches
Was any seepage observed from the lagoon(s)? Yes or 1�Was any erosion observed? �or No
Is adequate land available for spray? es r No Is the cover crop adequate? Ye or No
Crop(s) being utilized: s S
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? es or No
100 Feet from Wells? �or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o&V
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (vol es of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments:rdou.✓i� C���rZ �/dyc� f"S7i}BLl�.5��7 o/v �,,e�
A/1EA� '2F L%d.J S�aP�S
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.