770004_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qual

IkA 91111,
Dlvl-sinn of Water Resources
Facllity Number - © O Division of Soil and Water Conservation
© Other 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: Arrival Time:j Departure Time: 9,00tc,t County: ?C f /J P Region: f i -V
Farm Name: �.Q Dze_ Favrn Owner Email:
Owner Name: Tprnw,•.r W �fCC[W`SOy� Phone: '.
Mailing Address:
Physical Address:
Facility Contact: 2=4,j.I ��r`Qw� So �l Title: Phone:
it
Onsite Representative:
Certified Operator: w"`� �/r�r •`Qw+ S,.,
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
iry Cow
Wean to Feeder
`L
' S2
Non -La er
I I
i Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D. , P,oult ,
Ca aci
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OtherF
—FT—ur,key
Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
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 [] No
[:]Yes P No
❑ Yes EP No
XM NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection, 2
Waste Collection & Treatment
4. 1s 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 ❑ No [5 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7U
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 q 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
T�
❑ 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
[DNA
❑ 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 P�pNo
❑ NA
❑ NE
❑ Excessive Ponding [3 Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
�io
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes TP No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E@ No
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? ❑ Yes 1� No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 121412011 Continued

Facili Number: 27 Dy Date of Inspection: 2
7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes T 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 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 Pq No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 1p No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
lComments (refer to question ##): Explain any YES answers, andlor,any additional recommendations or any.other comments:,:. ,!'I
Use,drawings of facility to better explain sitaatlopsluse�additional galzes.as:necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -
Date: g ZS 7
21412011

!'ype of Visit: IP Compliance inspection V Uperation Heview V Structure Evaluation V Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: County: �_d Region: Fg49
Farm Name: &e- /Oze Owner Email:
Owner Name: �,p Mm y Wt%'f gr�SD n Phone:
Mailing Address:
Physical Address:
Facility Contact: VtQ L"/111;Uk50 J Title:
1►
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
it
TyhiMrr ,G✓ir(, �r�so �
Latitude:
Phone:
Integrator: /Iva / '/"Ayo�
Certification Number: S ��
Certification Number: q?" yy
Longitude:
Design Current Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Finish
Layer
DairyCow
F-1
Feeder
Non -La er
DairyCalf
o Finish
Dai Heifer
Design Current D Caw
Dr. P,oultr, Ca acit P,o , Non -Dairy
FrFd
o Wean
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
er
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes P No ❑ NA ❑ NE
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 1�1No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E Vo ❑ NA ❑ NE
of the State other than from a discharge? TT
Page 1 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
No ❑ NA ❑ NE
No P NA ❑ NE
Structure 6
Observed Freeboard (in): �Zu
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 T 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 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes q 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 ❑ Ap
plication Outside
f AA prove Area
U. Crop Type(s): 6r, L(i?�8.,"t�j �� �1 rl !' Aoh"j�r �., K�L�f� ► �i1V A*-
13. Soil Type(s): e*wr',,r4
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes §a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E4No ❑ 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
n No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ 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.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. C] Yes I" No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZ] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
N No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
ReviewerlInspector Name:
ReviewerlInspector
Page 3 of 3
Phone: �1d°t K 33-334;0
Date: i Lm_ I )!.
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up' 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: / a.l Region: D
Farm Name: pe_�_ T&_ Owner Email:
Owner Name: �' ry", A'a,4p+f0 N Phone:
Mailing Address:
Physical Address:
Facility Contact: / i Title:
Onsite Representative: t r
Certified Operator:
L�
I. t
Back-up Operator: fQ ✓k� 141,y/ra#" .faA-
Location of Farm:
Latitude:
Phone:
Integrator: AAAqYA401'jt-J
Certification Number: 931�? f/
Certification Number: 9 0 99 ela
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
an to Finish
Layer
-
DairyCow
an to Feeder 3'S
Non -La er
DairyCalf
to Finish
Dai Heifer
row to Wean
Design Current
D Cow
!Feeder
row to Feeder
row to Finish
Dr, P,oultr. Ca aei P.o
La ers
Non -Dairy
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
'Curke s
Turke Poults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Rg No ❑ NA ❑ NE
❑ Yes [:]No
[—]Yes [:]No
NA ❑ NE
Ug NA ❑ NE
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 Nil 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?
,f
Page 1 of 3 21412014 Conh'n'7i ed

Facility 14umber: Date of Inspection: 7 /
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: I
No ❑ NA ❑ NE
T❑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
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Wn No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste 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
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into
Rare Soil
❑ Outside of Acce table Crop Window ❑ Evidence of Wind Drift❑ Application
Outside of Approved Area
12. Crop Type(s): Grvt � L. lti�i�^► VIL-t r 1 f
t�CrA
(d
13. Soil Type(s): T422", C-(d-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FM No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 7%01 No ❑ NA ❑ NE
v
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No E] 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 M 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 [ZpNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes © No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA [3 NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fgcili Nhmber: Date of Inspection: 3!
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C5 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/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 ®T No ❑ NA ❑ NE
Comments (refer to:giiestion #): Explain .nny ES answer's. and/or any.additional recommendations or�anybther comments.
itiationaUedrawinesoaclitbns{dditlonai`pa es as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes m No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ;D No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
Phone:�I
Date: % ? t
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: tot 1 � Arrival Time: Departure Time: County: MoAIVRegion:
Farm Name: '�'PQe_ RU/ w. Owner Email:
Owner Name: y., �idieSD Phone:
Mailing Address:
Physical Address:
Facility Contact:
r
Title:
Onsite Representative:.r,
Certified Operator:
Sack -up Operator:
Location of Farm:
Phone:
Integrator: BitiG1l1
Certification Number: LEW
Certification Number: qz9'9y�)
Latitude: Longitude:
Dcslgn Current
Design
Current
I I
I I Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
23300
La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
1DrvCow
Farrow to Feeder
©r. PRO Itr,
Ca aci
Ko .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey 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:
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 (gatlons)7
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Qq No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: !d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1p No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
LPM
(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 P No [DNA ❑ 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
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [ No
❑ NA
[] NE
maintenance or improvement? '
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
[3Heavy 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
❑ Applicati n Outside of Approved Area
j❑
6rd �, rf_-
12. Crop TYpe(s): �.D_ " C r),r+tX r, u.�/ '��
ky oxi , i..l "_4 /
/_.,V4'
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ' []Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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 ;0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [go No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No NA ❑ NE
the appropriate box(es) below,
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon ,
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 0] 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 rM No ❑ NA ❑ NE
and report mortality rates that were higher than normal? _
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 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
[R 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
�_%o 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
V] No
❑ NA
❑ NE
Comments (refer4o 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).
r
,S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `f l0 -1/33 -Z,:: 7
Date: 6 2_711V
21412011

(Type of Visit: 49 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: N. Departure Timer County: 10100, JD Region: Ago
Farm Name: t? L)Qc. m Owner Email:
Owner Name: Ork Phone:
Mailing Address:
Physical Address:
Facility Contact: AmaiJq 0.4ia+' 56, Title: Phone:
N 11
Onsite Representative: .0"r'hv Integrator:
Certified Operator: U Certification Number: 9s'99y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
3 5--r2
I
[Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
P P■oultr:
Ca aci
P,a
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
heTurke
Poults
rtr
ther
Other
Discharges and Stream Imnacts
I. Is any discharge observed from any part of the operation?
❑ Yes
7A No
�
❑ NA
❑ NE
Discharge originated at: El Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[P 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)
❑ 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 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
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: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
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?
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
Ej@ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ 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 WindDrift❑ Application Outside of Approved Area /� %�
12. Crop Type(s): [ c_rvt Ll� �..� 1 %�i�� Q.r �-�+h C l`yP "QSS �� , (�W o►�.R�,4f, �,Am* . 64,
13. Soil Type(s): '64,,1 ek-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes T 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?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[] Yes [P No ❑ NA ❑ NE
❑ Yes [4No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [f] No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA [3 NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: rf Z - ZI 7 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑NA ONE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
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)
T
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
[N No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Qg No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other' comments.. ' _
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9l0 —V 2.?-93&''
Date:
21412011

(Type of Visit: O Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit. * Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I1
Date of Visit: yl l ZyT Arrival Time: 00 ; � �ru f Departure Time: p; County: Ricif, � Region:
Farm Name: pe-c. ilk'. - try+ Owner Email:
Owner Name: �rr.� jfi, l`l� ,,+SO►� Phone:
__._r_ _
Mailing Address:
Physical Address:
Facility Contact: 1V�Li�{�fr1 Wl I Uk5or• Title: Phone:
Onsite Representative: fa i � I V, cLWSptr• Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
Layer
C►urrent Design Current
Pvp. Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
'L
5
]Non -Layer I
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design
Dry P,aultr. Ca aci
Current Dry Cow
P,o Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
[� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No
[:]Yes No
[:]Yes No
[�]NA
❑NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 21412011 Continued

I it
acili Number: ri - jDate of Inspection: t411,51
11,
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
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[$ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
C&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
�U No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�jNo
❑ 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
Eq 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?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence ofWindDrift ❑ Application Outside of Approved Area
12. Crop Types}: l�Ytn LLiY'EGfw J 1,�v�i-�y
13. Soil Type(s): zgrjda r(ke
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
E� 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 property operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rect_uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LPJ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�] No
❑ NA
❑ NE
the appropriate box.
❑WUP [:]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

F4cillty Number: get- Date of Inspection: q1 2-5- I L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [R 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 structurc(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 P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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 [a No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes LL,,[No ❑ NA [D 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 JR No E] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or any other comments 4.
gkR �,t
use drawings of facility to better explain situations (use`additional pages as°pecessnry). i 14
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�=+ V 1�►b �j Phone:
f
Date:
21412011

Division of Water Quality
Fb
cility Number ��--� O Division of Soil and Water Conservation
O Other Agency
Type of Visit i Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & Routine Q Complaint O Fallow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: nnArrival Time: 0 k Departure Time: 0 : County: Region: PW
Farm Name: + 1� Owner Email:
i
Owner Name- �n7/'?'7 IQI�?.50.11 _. Phone:
Mailing Address:
Physical Address:
Facility Contact:,,, Title:
Onsite Representative:
C /r ��14'_r 1 _ _
Certified Operator: i W ��n
Back-up Operator:
Location of Farm:
Latitude: n°
Phone No:
Integrator: ,�"_4Wz0i_% p
Operator Certification Number: ----
Back-up Certification Number:
=" Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
El Wean to Finish
KI Wean to Feeder :5r5'1, 4
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other __ J
❑ Non -Layer
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ 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: MD
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 'No ElNA [3NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
;] NA
❑ NE
❑Yes
�No
El NA
❑NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

J
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[PNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
tructure 6
Identifier:
Spillway?:
Designed freeboard (in):
t
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IM No
ElNA
[3NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Y, No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
/► /„ . 1 , . 1 n i %n . % 1
12, Crop type(s)
in
13.
Soil types)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
QPNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
F No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
tt�r�:r d.e.'k '' i•5�, a......t.",.t.' �.,:,f..'�'�"a':._,`"..
?Comments refer to uestinn #)Expiarn;arly�YS unswerandlor any recommendations or any4other comments.,
>Use dri win s of faCilit to lietter ex lain, situations% use'"gdditional `a� er as nc essa'r� 1
{ gs ,Y p i ( �1 P g Y) i. sib K #
�.�4§���s-��_��
.'
A
r
_, s Phone: �7
Reviewer/Inspector Name f��,w? `...
��,,,
Reviewer/inspector Signature: Date: LX
Page 2 of 3 121204 Continued

Facility Number: -- Date of Inspection Z I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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?
❑ Yes §@ No ❑ NA
Yes ❑ No 9:NA
apyes'M No ❑ NA
Yes NA
❑ Yes No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No FK) NA
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ Yes No
❑ Yes (yNo
❑ Yes No
❑ Yes ( No
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑NA El NE
[I NA El NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 3i O Arrival Time: t�t30 Departure Time: p,'�p County: I Region: ►"
Farm Name: '' j -. Owner Email:
Owner Name: O/nM �I 4 M Sots Phone: {3 ! — 4ZIP
Mailing; Address:
Physical Address:
Facility Contact: lamv�� `• ��t _U lj f"It -oTitle•
Onsite Representative:/�"�Y s T""""'� Q ��� f �a+►S6N
Certified Operator: -
Back-up Operator:
Location of Farm:
Latitude: n e
Phone No:
integrator: llrlia.-a -w_
Operator Certification Number:
Back-up Certification Number:
0 Longitude: = ° = ' =
Design Current
Swine Capacity Population
Wet Poultry
Design Current
Capacity Population
Design C•urrcnt
C•attic C•apaeity Population
❑ Wean to Finish
Wean to Feeder
I I
I IC]Layer
µ
❑ Dai Cow
1 35211 3 &0
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
Non -La ers
❑ Pullets
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
I umber of Structures:
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence ofa 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 F No ❑ NA ❑ NE
❑ Yes ❑ No PNA
❑ NE
❑ Yes El No VNA
❑ NE
❑ Yes ❑ No PNA
❑ NE
❑ Yes ENo ElNA
`TNo
❑ NE
ElYes ❑ NA
❑ NE
12128104 Continued

4
Facility Number: IYETI Date of Inspection t7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Q
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 FNo ❑ NA ❑ NE
❑ Yes ❑ No rNA ❑ NE
Structure 5 Structure 6
❑ Yes [1No ❑ NA ❑ NE
❑ Yes '❑q 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 to No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FNo ❑ 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 Acceptab e Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
?, . \ n /! \ i" !I Z-1 A 1
12. Crop type(s)
13MtIG�M
13. Soil type(s) i_.PR
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
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[, No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I[p No
❑ NA
❑ NE
..,.. .. A.if s _§.§ ,,.F�• b`.:I�.,#�f,3%x"�
Continents {refer to yues,666 #)..Explain any YIDS answers and/nr5 any recommendations orrany other comrtt ntsY • t � :h.
,Use drawings of iacilify to.tietter explain situations: (use`adtlitional pages as necessary)
Goinj.
Reviewer/Inspector Name
q
- --- k I Phone:
Reviewer/Inspector Signature:
Date: /
12128104 Continued

...
AL
Facility Number:= Date of Inspection la
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [FNo ❑ 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
CFVo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fo No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
FMNo
❑ 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
ElNA
ElNE
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
[gNo
❑ 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
�gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
40 No
❑ NA
❑ NE
12128104

O Uivision of Water � uality
Facility Number '", O Uivision of Soil and Water Conservation
Agency
Type of Visit 0 Compliance Inspection
Reason for Visit 40 Routine 0 Complaint
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f I Arrival Time: Departure Time; County:
nn----
Farm Name: ��- 6t Q te cis Owner Email:
Owner Name: h Phone: _
Mailing Address:
Physical Address:
Facility Contact: F'OM IH Si i Ar_� _14 pj"//. alh.$&title:
!1
Onsite Representative:
Certified Operator: d G✓.�tl�raMS@N _
Back-up Operator:
R'T-QyfA'0A1D Region: FRO
J
Phone No:
Integrator: _""6ywl. t
Operator Certification Number: 7t5 I T�
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = I[ Longitude: = ° = 1 = 1f
Design
Current
Dcsil Current
Design
Current
Swine Capacity
Population
Wet Poultry CapaciUlation
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑.-Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
on
❑ Dry Cow
❑ Farrow to Feeder
[3Non-Dairy
❑ Farrow to Finish❑
❑ Layers
Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Other
Number of Structures:
10
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[ XNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P 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
RR NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
$,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: q—
Date of Inspection D d�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stricture ]
Identifier:f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
t�
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes J:fNo ❑ NA ❑ NE
❑ Yes ❑ No aNA ❑ NE
Structure 5 Structure 6
[]Yes P No ❑ NA ❑ NE
❑ Yes V 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 ENo ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F11 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 V�LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ' No ❑ NA ❑ NE
maintenance/improvement?
H. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t 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 [I Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) , Cc
15M, "in
13. Soil type(s) Peg
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 55 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes VgNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
5 tads I� D � 1%' SC�� 4y- e4ld OF f+rA 20n9 doh
Reviewer/Inspector Name I Phone: 10 q33'3,�W
Reviewer/Inspector Signature: Date: —
Page 2 of 3 112128104 Continued

1
Facility Number: rj — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 'P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes 'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
qow'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
19 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
09 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
ISNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12128104

r
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit tip Compliance Inspection O Operation Review O Structure Evaluation () Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: G 3 DQ� QD,,ep�arrture Time: County:
Farm Name: .f I C T A( % r✓►uT1� Owner Email:
Owner Name:IR�ah► Phone: _
Mailing Address:
Physical Address:
Region: Aw
Facility Contact:►h►t^Y' a" °�� Wt f t^S itle: Phone No:
Onsite Representative: '�"'^ Q �' ! �QV^`So►1 Integrator: M Lta ""7
i` 8g9g1
Certified Operator: Operator Certification Number:
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
Other
❑ Other
Back-up Certification Number:
Latitude: 0 e = ' Longitude: 0 ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
a� 7 on-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
[nNA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
12128104 Continued

Facility Number: r j
Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ; 7
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 9] No El NA ❑ NE
[]Yes ❑ No & NA ❑ NE
Structure 5 Structure 6
❑ Yes p No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ?2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E9 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 T'No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JS No ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E� 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 Crow Evidenc�� ind Drift ❑ Applicat�o Outside
off Area
12. Crop h Pe(s , —54-W 0 K� '�k�dt t , BT+� �1�r�, �.
S
13.
Soil e s
type(s) ()
ewo r
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
$2 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18.
Is there a lack of property operating waste application equipment?
❑ Yes
fn No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Nu4,1c. , -- Mam49c mej Nan A.erJej 7/r q/o 7,
Reviewer/Inspector Name phone: 110 33e0
Reviewer/Inspector Signature: Date: D$
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 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EK No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KINo
❑ 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
09 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
59 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
DQNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
99 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

r
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit S Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: oR 0 Arrival Time: �Departure Time: (%%Wa7m County:
Farm Name: 81 l rtc6n Fzu-rYl Owner Email:
Owner Name: 1 p yv%yy q W 1 f f a vyl50 m Phone: _
Mailing Address:
Physical Address:
/N 04cl Region: F'1e0
Facility Contact: —ToW ` I Q Vh SOh Title: Phone No:
Onsite Representative: u Integrator:
t1
Certified Operator: Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: [--] o ❑ ' = Longitude: = ° ❑ ' =
Design Current
Design Current
esign Current
D.44
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑Dai Caw
JIN
Wean to Feeder I 355
QO
10 Non -Layer I
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Cow
❑ Turke s
Other11E]
Turkey Poults
10 Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
lip 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
W NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[?PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1P No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection I �J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes QJNA ❑ NE
Structure Structure 6
❑ Yes V� No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ 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 0 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
,,,Window ❑ Evidence of Wind Drift
El Application Out`sidee of Area
12. Crop type(s) l...F.CIS `i�t f�a &), r e 4t qja: T.A SM . G' ©COL .,,...
13.
Soil type(s) a W 1
l PeP)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Pj No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes]
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages.as necessary):
Cer4��4 Oper� -T-riaik e,i I w4S Coy1 o�, I- 30-07.
lam; I t bA i*,, -k-,f o e\ 3 ~8-oi
Gxd 9c&,rjS , tka .rVWml i.l`" ra. ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Pape 2 of_7
Phone: 0 .3
Date: �72WAII
1"8104 Continued

.�6
Facility Number: — Date of Inspection �$ O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ER No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PSNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(31 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N 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
§2 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
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Cl Yes
® No
❑ NA
❑ NE
Additional Commeiits`and/or Drawings:,
Page 3 of 3 12128104

•
Division of Water Quality
Facility Number J�w
_ O Division of Soil and Water Conservation
Q Other Agency
E
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assis=Access
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denie
Date of Visit: �p� Arriiv[a_l Time: iL% Departure Time: O 2 = County: "C Region:
r�
Farm Name: V1 I B4, Faj-W1 Owner Email:
Owner Name: t ArK Frtlt,k rNPhone: CRjo) jf3 [ -q`gb _—
Mailing Address:.-- P©._,0Ox 9 -1 # M o t Lend !y
Physical Address: �730A
Facility Contact: Wt (avK Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: �'7 j r`Q rwt �'�"� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f = Longitude: = ° 0 ` 0 `d
Design Current
DesiRCurrent
Designty
opulation
WetPoultry CapaPopulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
Wean to Feeder
3VX
"' �
❑ Non -La er
❑ Dair Calf
❑ Feeder to Finish
[]_Dairy heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cow
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ 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: ❑ 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
[@ 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
EYNA
❑ 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
X No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: q
Designed Freeboard (in):
Observed Freeboard (in): 3L� &
[:]Yes [PNo ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
Structure 5 Structure 6
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 property addressed and/or managed ❑ Yes MNo ❑ 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? tK Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[� Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) ri a S+^^ t �5 4-e_ frL
13. Soil type(s) p��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[$No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use.additional pages as necessary): ;
I �e s
•
-6(Cef
weer,(
7 SorAe sr --it(( ba^e aµ-ea5 0 L019pwN , rri '�o eS 3rezSS cw4e.- o L,
94aar.
Reviewer/Inspector Name Phone: 70V)Vy_? >
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

l
Facility Number: 9 Date of Inspection
Required records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ 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 N No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
( No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[2 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
[A No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A 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
[3 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
TQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
59 No
❑ NA
❑ NE
f n DAdditional Coiitiitnen s>a dint, avings
tl,
;'
0
12128104

Facility lumber Date of Visit: ti Time:
rO Not Operational 0 Below Threshold
0 Permitted © Certified 0 Conditionally Certified 0 Registered Hate Last Operated or Above Threshold:
Farm Name: + II County: -
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative- integrator: �
Certified Operator: Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude 0 9 " Longitude • �• �«
Design Current Design Current Design Current '
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
Wean to Feeder ❑ Laver I I I[] Dairy
❑ Feeder to Finish 1E1 Non -La er I JC3 Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons + ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Sprnv'F
-Holding Ponds I Solid Traps ❑ No Liquid Waste Management Svstem
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
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 & Jualment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): S
05IV3101
❑ Yes R No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: —4
Date of Inspection L
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any ,stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste An lien anon
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12, Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (__1 No
❑ Yes ❑ No
❑ Yes ❑ No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Regpirr¢ Records-& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ 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.
Comtntnts"„refer to, uestioii # Eif Iilnran YES;6nswers and/or an rcc6i � x
( q ) p y y mmendationsnr any other comments v�
Use,drawings ' -".
of fecilityto better explain situations::(use additional pageaas°necessary): [� Field Copy ❑Final Notes
c h ry
7
Reviewer/inspector Name ter..
Reviewerllnspector Signature: Date: VIC, p
05103101 C Continued

%F vLUC[,
�J`:.�fi'` K
k
ti tiIJf 1
0
Type of Visit & Compliance Inspection
Q Operation Review , Q Lagoon Evaluation
Reason for Visit ®Routine 0 Complaint
Q Follow up Q Emergency Notification
0 Other
❑ Denied Access
Faciiih_ • Number Dale of Visit: Time: 10 ' 3 0
10 Not O erational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold
Farm Dame: _ 8,'li f'Lj_k0h FGrrn County:
Owner Name: L.t It! A 2f ii& 'fsrx __ Phone No: `/ /O yu 4L
Mailing Address: ank 744 _a* G-4 frPi.� AL-C . 2iL.0-L
j.
Facility Contact: Q. ri Q /'r'•rx- Title: Phone No:
Onsite Representative: -sir i�c� - Integrator: ��Ly-oL_i—�C
Certified Operator: ___ at _ 12 ru 0-111— Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 �• �u
Design Carrent
Design Current Design Current
Swine Capacity Population
Poultry Capacity Population Cattle capacity Population
Wean to Feeder
❑Laver Dairy
El Feeder to Finish
❑ Non -Laver Non -Dairy
Fo
❑ Farrow to Wean
ElFarrow to Feeder
El
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
w .; . ❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
.Holding Ponds / Solid Traps �
-
' � ❑ No Liquid Waste Management System rs b�. -- ----------
Discharges 8: Stream ImIlgets
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsem-ed, 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 I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches):
05103101
❑ Yes Q� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ®No
❑ Yes P No
Structure 6
Continued

Facility Number; — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ( No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Q 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 maintenanee/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 Aanlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes � No
12. Crop type 13e1'r,n L �1.4 . L`x'3e-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EZNo
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
F&I No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ieI WUP, checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (ieI irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
IN 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
[5� No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) .
❑ Yes
P'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JR] No
24. Does facility require a follow-up visit by same agency?
❑ Yes
C,No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
L2 No
No viio`l�La�tions or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
SP 5.'I. A-, 1 �: ;n .:: - J V l�#:-
r to
Coutmcnts (refer torqucstfon°#) 1xplaln QnyYFS answers andlorYuny recommendations oir any other comments
Use draw`inis ofcfacllity,to better explain,situatipns. (iii6i ditional pages as necessary)
k Field Copy ❑ Final Notes
rtr Sr5. c^. T.3A�trsul
�r✓�
/'
L /j
011,S
r'ct ile, 4 Gj 5 r) �7K, L hecc4 P,+d
,�J `
Reviewer/Inspector Name
Reviewer/Inspector Signature: Aj L Date: a
05103101 ` Continued

Facility Number: — 4 1 Date of Inslmctinn
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 PQ No
❑ Yes USNo
❑ Yes 2q No
❑ Yes F'� No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/nr Drawings: T
O5103101

IType of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit ® Routine Q Complaint Q Follow up 0 Emergency Notification O Other ❑ Denied Access
Facilitv Number Date (of Visit: t? 1F Time:
1!2Not O er tional 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: tIr P-6-ri n_ _. County:
Owner Name: t L 4rn �'9 II' -01- Phone No: b
Mailing Address: 0 G 27-3 a L
Facility Contact: i2 J%t 166 Title: —y r Phone No:
Onsite Representative: Ct Integrator:
Certified Operator: S= . ?- t Operator Certification Number:
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑Horse Latitude Longitude • 1 �•
Design Current
Design Current Design Current
Swine Capacity Population
Poultry Capacity Population Cattle Capacity Population
® Wean to Feeder
❑ Laver I ❑ Dairy I
❑ Feeder to Finish
❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons r�
❑ Subsurface Drains Present ❑ Lagoon Area S rav Field Area
Holding Ponds / Solid Traps
10 No Liquid Waste Management System
VIscharges d Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
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 .0 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): !j_6.
05103101
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 1,2 No
❑ Yes JZ No
Structure 6
Continued

Facility Number: —
Date of Inspection m C�
5. Arc there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation posts an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop hype l(3 cr m t,, &a_ fb ( Ft, C v-t I
❑ Yes ® No
❑ Yes [� No
❑ Yes [5� No
❑ Yes 91 No
❑ Yes ® No
❑Yes 0No
❑ Yes ro No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
EANo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
C�No
ReQuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
2No
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
N 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 ofdesign?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PINo
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
[;jNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
` '
Comments (refer to question #} Explain any YES answers andlor eny recommeudations orany other comments.
Use drawings of facility, to brttcr. eirplainstttiations {use additional' pages as necessary): ❑Field Copy Final Notes
R
f-i ell CIS tl �� a, c i �, r, t` �- � ,�,,�- P�� �� o . o:
e to q A,
Fi c.(A 9 'G 0v-1r P,-^1 b cl O 8S'
Reviewer/Inspector Name
"r
ReviewerAnspector Signature: Date: !c�
O5103101 / Continued

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