780047_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: it Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ' TLC Arrival Ti Departure Time: County:
Farm Name: / " V S >dGsJ caner Email:
Owner Name: B '' i �r1Z i5 Phone:
Mailing Address:
Physical Address:
Facility Contact: 61�4_0
U
Onsite Representative:
Certified Operator: P�
Back-up Operator:
Location of Farm:
Title:
/1 Region: 900
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
- - � Design' Current
Swine_ 4Capactty_ -Pop.
Wet Poultry
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
Non -La er
D . 1?oult":
Layers
`"a
Design
@a aci
Current
P,o ,
DairyHeifer
Farrow to Wean
0
Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
A.,Turkey
Other
Turkeys
Poults
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system'? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �q No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑Yes [::]No NA ❑NE
[:]Yes [:]No
[] Yes 4M No
❑ Yes 6No
�O] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
10
21412015 Continued

F'acui dumber: - U1 113ate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EP NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r -
Spillway?:
Designed Freeboard (in):
s1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
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 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): l aQf�p
Li I�t' 04a 0,,), �"
�l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes
[P 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?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[T No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ 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 ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lE~acili umber: - Date of Ins ection:
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 C] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
F] No
❑ NA
[] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M 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 concem?
❑ Yes
jQ{ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
r
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
"Tfifi"
❑ 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
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4Yo
Phone: ?60
Date:
21412015

ype of v isa: ® Uompuance inspection %j uperanon xevrew V Structure r vamatnon V s ecnmcat Assistance
Reason for Visit: . Routine O Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j//p//y Arrival Time: E� Departure Time: Qr County: &bl�&Q/Region:
Farm Name: fi oWaO !9 S� o, J 011 Owner Email:
Owner Name: ,ram, Phone:
Mailing Address:
Physical Address:
Facility Contact: •40 Title: Phone:
Onsite Representative: Integrator: SM+—M4I�D
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design` .Current Desiga Current
Swine Capacty P.op. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop -
Wean to Finish
a er
Da Cow
Wean to Feeder
ITNIon-Layer_1
Da' Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
2.00
-
Zip Design
Dr Pou Ca aci
Current
P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Stocker
Beef Feeder
Gilts
Boars
Beef Brood C­
nii
Other
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)? _
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 �5 No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes �No
[:]Yes f� No
❑NA ❑NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

10 41
EMcility Rumber: /', 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 P9 NA ❑ NE
Strueture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P 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 environm ptal 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 F
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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes M No ❑ NA
❑ 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 WinS,Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes M No
❑ Yes �No
�] Yes y No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
[RNo
T�
[3 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
No
1P
❑ NA
❑ NE
❑ WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412015 Continued

Fheility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes `P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T 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 5 No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes 1P
No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1� 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 [P No ❑ NA ❑ NE
Comments {refektotquestion ##): Explain any YES answers-andlor any additional recommendations or any oth_ er,'comments.
Use'drawings of ia'cility to better explain situailons"(use additional pages as necessary).
w,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U �` 3� "3 !o[
Date: 9) kbk
21412015

Ii ype or visit: a c:ompnance inspection v vperanon xeview V btructure Evaivanon LJ i ecnmew Assistance
Reason for Visit: i♦ Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
p Arrival Time: /b ,' pQ.� Departure Time: O�- County: _._ Region: �
/a=
Farm Name: �s� ',C S Owner Email:
Owner Name: Brucc 17 S '�" �t"r►t S Phone:
Mailing Address:
Physical Address:
Facility Contact: j{ Title: Phone:
r
Onsite Representative: Integrator: r vti
Certified Operator: Certification Number: 179S3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current `
Design
Current
Design
Current
Swine
Capacity Pop., Wet Poaltry
Capacity
Pop.
Cattle Capacity
Pop.
an toFinish
La er
Da' Cow
an to Feeder
F
Non -La er
EE]
Da' Calf
Da' Heifer
der to Finish
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D P,oul
Layers
Ca aci.
P,o ,
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turke s
- TMKCY Points
NJOther
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: 0 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes 0 No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes 0 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3
21412014 Continued

}
Facili Number: 20 -17 1 jDate 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EP 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
M 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
J�j No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MI 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 Wind Drift ❑ Application Outside of Approved Area
l
12. Crop Type(s): &A r rVa, ,5i,,,. L
-
13. Soil Type(s): Ngc,4 AL
14. Do the receiving cr ps differ irom those designated in the CAWMP?
❑ Yes
V) No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C6 No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[n No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
® No
T
❑ 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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [::]Yes 09 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Eg No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

FaciliNumber: 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
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
any_: YES answ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes (E2 No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
0 NE
❑ Yes
P No
[DNA
❑ NE
*z
Phone:
Date:
21412014

f ype of visit: jF Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (D Routine 0 Complaint 0 Follow-up C) Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 0 County: Region:
Farm Name: ���dIQQ� Owner Email:
Owner Name: b co t"4f Phone:
Mailing Address:
Physical Address:
Facility Contact: Gev"_� Title:
u
Onsite Representative:
Certified Operator: + �S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
integrator: r aq
Certification Number:
Certification Number:
Longitude:
rent
Design Current ::R , Design Curo
Design Cnrrea#
Swine m Capacity Pop. Wet Poultry apacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
iry Cow
Wean to Feeder
Non -Layer
iry Calf
Feeder to Finish
airy Heifer
Farrow to Wean
1.t7 D b
Des.ign
Current
Dry Cow
D oa aci
P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
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)
❑ Yes No ❑ NA ❑ NE
[-]Yes [:]No
❑ Yes ❑ No
�NA ❑NE
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 E� No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection: 2
•
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:
0No [DNA ❑NE
❑ No �8 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [] Yes [5+ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ( No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes �No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KF� 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 WW* d Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � t (.J•'*4 �5 (21" ), � _ C"Z -..ice
13. Soil Type(s):
14. Do the receiving crops"differ fronv*bse designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes FkQJ No ❑ NA ❑ NE
❑ Yes E0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[P 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 El 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 El Waste Analysis ❑ Soil Analysis ❑ Waste Tra fers
❑ 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 ® 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 21412011 Continued

Facility Number: 126 - T2 Date of Inspection: aly
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes `ice 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 �j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [)a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes h 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
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: ! ��
Date: 7
21412011

Type of Visit: • Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: 4P Routine O Complaint () Follow-up O Referral O Emergency (D Other C) Denied Access
Date of Visit: j3� Arrival Time: 50 a, Departure Time: t2 i County: PSjO45 fiW Region: /`-M
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (q-&-o Title: Phone:
u
Onsite Representative: Integrator: /4jkA_N
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design- Current
Wet Poultry @specify Pop.
Layer
Design
Cattle CapSO
DairyCow
Current
Pop.
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�'
Design Current
D . P,o_ul Ca aci P,o ,
Layers
Da' Heifer
D Caw
Non -Dairy
Beef Stocker
f�0
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other Turkey Poults
Other 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
[P No
[] NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
C ] NA
❑ NE
❑ Yes [:]No
[—]Yes EP No
[—]Yes [�JNo
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

fi'acili 'Number: jDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�]a No ❑ NA ❑ NE
❑ No RNA ❑ NE
Structure 6
❑ Yes T No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1] No ❑ NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [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 Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): GaS C-",.L— �1rG
13. Soil Type(s): e.
14. Do the receiving crops differ firthose designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
�["
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
MP 20. Does the facility fail to have all components of the CAWreadily available? if yes, check
❑ Yes
CNo
❑ 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 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 ONE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

FaciliNumber: -Y 1 7 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes N 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[!R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V No
❑ NA
❑ NE
Comments (refer:twquestion #I): Explain any YES answers and/or any additional recommendations or any other c�_ ts.
Use drawings:of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0
Date: Q19 L
21412011

i ype or visit: t-v c:ompnance inspection V upera[ron xeview U structure t;vatuanon V recnntcat Assistance i
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access 1
Date of Visit: La `a• Arrival Time: Departure Time: ja! County: son
Farm Name: lkA)C_D FAfkMS L►,C Owner Email:
Owner Name: 9 O)pCs TA9,0\6 L.LC. Phone:
Mailing Address:
Physical Address:
Region: FRd
Facility Contact: [ m4wo %(gbnIM4 Title: T1�C1, _ S�D£G Phone:
Onsite Representative: {-� Integrator: MR d
Certified Operator: iRgy V3S1[E jt, Certification Number: 2C15 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current' �=
Design
Current
Design Current
OR
Swine
Capacity Popp Wet,Paultry
Capacity
Pop.
I
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
Farrow to Wean
k'
Design
Current
DairyHeifer
D Cow
Farrow to Feeder
r _._ D -P.out
,Ca aci
$o ,
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
' .
Beef Brood Cow
-
�, v
-
ORKInj Other
Other
Layers
Non -La Layers
Pullets
Turke s
Turkey Puults
Other
Discharees and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gaIlons)?
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 [V No 0 NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
� No
❑ Yes
L No
W NA ❑ NE
14 NA ❑EVE
[gJ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

1 ti
Facility Number: - L4jDate of Inspection: % I X
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: - a _
L No ❑ NA ❑ NE
❑ No � NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): /^
Observed Freeboard (in): 2^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes DQ 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 [4 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 [4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [5Q 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 M No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): Qop,bTAl "'by%nunA G"Ss �NP*`1 ] 5 % 0
13. Soil Type(s): K
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 [4 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [R NA ❑ NE
Page 2 of 3 21412011 Continued

jFacHity Number: jDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CQ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [y) No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a] 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 [Z 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
(M 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
[M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question # ).- Explain any YES answers and/or any additional;recommendations or any other comments.
use .drawin s bf facility to better explain situations use additional pages as necessa'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cttp 3C$-t�sS S
c
Date: ( \;4'A \ a
21412011

type of visit: [Compliance Inspection U operation Review U Ntructure Evaluation U 'Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: O O I Departure Time: County: &4ffw
ow -
Farm Name: Owner Email:
Owner Name: Rli;." F�z f Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: drl
` I M Title: Phone:
Onsite Representative: L Integrator: M_JV
Certified Operator: LAA �4 �G-w`. xgts Certification Number: --�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�D stga Currentmok
Pye
rent
apact�Pop: Cai#le Capacity Pop.
Finish
La er Dai Cow
Feeder
Non -Layer airy Calf
o Finish
o Weans
UFarTowo Feeder
-
`T a
DesignCurrent
D , P�oul
Ca actty PoNon-Dairyo
La ers
airy Heifer
D Cow
Finish
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes
❑ No
[3 NA
❑ NE
❑ Yes
❑ No
[Rf A
❑ NE
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?
Page 1 of 3
[] Yes [:]No L'J'''r' ❑ NE
❑ Yes [2'lNo ❑ NA ❑ NE
❑ Yes Fa<o ❑ NA ❑ NE
21412011 Continued

FacUity Number: 77- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes Cj" o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 4 T"KA ❑ NE
S7ce 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 LIDS o ❑ 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 Per o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Er<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes g o " ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,__,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I� 2110 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving cropsVitTer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffj 1"o
❑ NA
❑ NE
❑ Yes
io
❑ NA
❑ NE
❑ Yes
Ej<o
❑ NA
❑ NE
❑ Yes (�No
❑ Yes KKO
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ 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 ell-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspecti;NoOIE]
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
to
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
L'T"'o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 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
E2'<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[:]No
❑ NA [ <E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CJ N' o
❑ 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 IlQ 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 gto ❑ 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
L1'9'o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
rj;�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
�N o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
E].? o�
❑ NA
❑ NE
Comments (referzto question.#): Explain any YES answers and/or any additional recommendationor:any otbercomments.
_; recommendationsfor
Use diawtn sof facile to better explain situations use additional pages as necessary)
CQIA-e, 12,1 Z. I/ Z.45
`ZAD ll ,
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: //D -05(33
Date: �Z4
4,2011

e
type of visit 0 Compliance inspection U Operation Review () Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: ) :08 Departure Time: `CO 1-�
County: a1 Region: ;Q0 _
Farm Name: CD f' S if ULC Owner Email:
Owner Name: I 0 CO wtS, LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: G""v knh2&3Title:
Onsite Representative:
Certified Operator: i" . ( (tap" ��15
Back-up Operator:
Phone No:
Integrator:�T�nf�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = = « Longitude: 0 o = t = 4f
Design Current
Swine Capacity Population
Design Current
V�'et Poultry Capacity Population
IN
Design Current
Cattle C•apac%ty Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
ElWean to Feeder
❑ Non -Layer
❑ Dairy Calf
ElFeeder to Finish
Farrow to Wean t2w 7 Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
El Boars Boars ❑ Pullets
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures: t ' J
Discharp_es & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P§ No ❑ NA ❑ NE
❑ Yes
❑ No
CANA
❑ NE
❑ Yes
❑ No
�j NA
❑ NE
CO)NA
❑ NE
❑ Yes
❑ No
❑Yes
MNo
❑NA
El NE
❑ Yes
bTNo
❑ NA
❑ NE
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?
❑ Yes
I No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway7:
Designed Freeboard (in): N
Observed Freeboard (in): 46
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes]
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ® 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 P No ❑ NA ❑ NE
maintenance/improvement?
I i . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Fel No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Eviden f Wind Drift ❑ Application Outside of Area
12. Crop type(s) li•putCS l/[_G1,, `�N��Q1-S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E.No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: pj r &0 Date:
Page 2 of 3
1212RI04 Continued

Facility Number: 76— Date of Inspection / !D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 55 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Dd No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes r 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
JP No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
D9 No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes
F1 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE _
El Yes
19No
El NA
El NE
❑ Yes R1 No ❑ NA ❑ NE
❑ Yes 1B No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Page 3 of 3 12128104

�11LLS �Nl-e.:-c.� S_,y_ ZGt'`1 iC2•
Q15i'vision of Water Quality
Facility Number �%� 7 O Division of Soil and Water Conservation
O Other Agency
Type of Visit
o
Inspection
0 Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
,om��pliance
CTKoutine Q complaint
Q Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of visit: j1-67' Dq Arrival Time: 9'/3Departure Time: County:
Farm Name: f �i'f d G$ Gav Owner Email:
Owner Name: !�>ud e / fty/d✓ Phnnp:
Mailing Address:
Physical Address:
ROLSSe^J Region: )C:40
Facility Contact: — � � •��94^J �r,�tY Title: r �- ' Phone
No: p
On site Representative: U &ek«- �� r��>� _ Integrator: U L2la ,gy�;�I
Certified Operator: Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 [= Longitude: = ° = ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Law can to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 1200 90
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity:. Population
❑ Dai Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©1
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?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
B NS�A
❑ NE
El Yes
[]No
2<A
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,g'lq-o ❑ NA ❑ NE
12128104 Continued

Facility Number: 7 — 44- Date of inspection -r77'O
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 E 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 �o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ����
6. Are there structures on -site which are not properly addressed and/or managed El9t1 o Yes ❑ 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 L'_TNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ 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 ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B< ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s) Bel'mtt-C M-7_) � 17 �i.1 60 S. )
13.
Soil type(s) A)aB 44 kc./-w J :�EC> 1, AZ S
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R<o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
3 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[a o
❑ 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
E3No
❑ NA
❑ NE
1 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):
C.ovc�S
Reviewer/Inspector Name c l: ;ZeV Phone: 9/0,
Reviewer/Inspector Signature: c,c,/ r �� Date: 5-07—.7 DO G/
12128104 Continued

Facility Number: 7B — 447Date of Inspection S D7-D
Required Records & Documents /
19. Did the facility fait to have Certificate of Coverage & Permit readily available? ❑ Yes B 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
❑ 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 [:1 Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(3fvoo
El NA
El NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
[, o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 o-
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
�[2
L-I o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,��
LJ No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El o ❑ 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
�,
L3'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
�o ❑ 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
O/No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

IblkS �e.4�d. q/o!/0 8
Facility Number
Q Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit ,Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ( Routine O Comp#aint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: .3 -07 Arrival Time: Si/J�/tiilvf Departure Time: �/ County: ROIC-SDN Region: OE71"4
Farm Name:" 817 D/fE S �y�l ,�1JJUC Owner Email:
Owner Name: �Q.t o �G �. �y� T7� Phone:
Mailing Address: — �� 7 f i,�/a� $, �"J /Q� /�G Z 93YO
Physical Address: _ ! .�G�� L Saar! _
Facility Contact: �G�, v���.'/ Title: Phone No:
Onsite Representative: l� a N� �- _�Uea"�, Integrator:I If
Certified Operator: R4 1, Operator Certification Number: 19113
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑' ❑ " Longitude: ❑ ° = ` 0 «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FJ'No ❑ NA ❑ NE
❑ Yes
❑ No
ff"NA
❑ NE
❑ Yes
❑ No
209A
❑ NE
❑ Yes
❑l No
[INNA
❑ NE
❑ Yes
E No
❑DNA
❑ NE
❑ Yes
❑ No
LYJ IAA
❑ NE
12128104 Continued

Facility Number: 7S— -71 Date of Inspection - 7�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo El NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No UTNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
N
Observed Freeboard (in): _ 27 , ,/
5. Are there any immediate threats to the integrity of any of the structures observed? ElEJ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [FNo ❑ 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 El Yes hJ' No ❑ NA ❑ NE
maintenance or improvement?
Waste AnnllCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes T No ❑ NA ❑ NE
maintenance/improvement?
]1_ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Cl 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 ❑ Application Outside of Area
12. Crop type(s) &S, G,
13. Soil type(s) A/0lt L y _
_
14. Do the receiving crops differ from those designated in the CAWMP?
ElLJ Yes
,� /
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
U]"'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
�P<NNo
El No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).
Reviewerllnspector Name Phone• YlO, 0�33-3300
Reviewer/Inspector Signature: Date: 3-07 - ZOO
IfZ1Zd1U4 Lominueu

. V
Facility Number: 7 oo — '] Date of Inspection 3 7 O
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LI 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
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
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
MINA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
,(}��',,//No
NNo
El NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,LK
L� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes `i rNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
Z 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
El Yes
/
O 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
L7 No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
3 o
❑ NA ❑ NE
Additional Comments and/or Drawings:.
AL
Page 3 of 3 12128104

a1M.� vlr�l��
V Division of Water Quality
Facility Number % g 7 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: A?0d 9rS4- J Region: 17—'eV
Farm Name: �% d e_S Owner Email:
Owner Name: Gtfa j e_ =au% _ JRQ N �E'f _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: kla44I, b,,;UQ!gAJ Title: JGe- � 5; Phone No:
Onsite Representative. ti Dw4Gn1 Integrator: �ts�-D� 1J�G✓/✓ ___
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [�o 0, = Longitude: =0 01 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
- ❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non-L�
Pullets
Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design .Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Qd No ❑ NA ❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[$ No
❑ Yes
[;0 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

Facility Number: -7 Date of Inspection 3-z3-ab
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes � No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z4.5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q' 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 MNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /[/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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [M 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 ❑ Application Outside of Area
12. Crop type(s) 6S . �iitCel� e;rr"kt/ (/�d V t vS e
13. Soil type(s) 1.404
11 J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V) 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
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ELK Phone: / %33 -3330
Reviewer/Inspector Signature: Date: 3 -Z 3 1200
12128104 continued

Facility Number: -7 — % 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 appropiate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
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
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ 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
Of No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
UNo
❑ 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
J9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ D� O Arrival Time: Departure Time: County: � Region:
Farm Name: _7e ✓,l ceS Owner Email:
Owner Name: , �ii%Q.d e 7 -1.QLo- Z�-iyv— Phone:
Mailing Address:
Physical Address: ��//
Facility Contact: lea VVI. L1W. A.1 Title: "Z;�4 Phone No:
Onsite Representative: Integrator: W&tA4 �yaz.I�✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e E__1 I =1 Longitude: = o = ' FT
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
La e
Fallonn--r—Layer
❑ DairyCow
❑ Wean to Feeder
❑ DairyCalf
El Feeder to Finish
IliM
Dairy Heifer
Rg Farrow to Wean 12too I -ZOO❑
.El
Dry Poultry•
Dry Cow
El Farrow to Feeder
El I a ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets '
❑ Beef Brood Cowl
-
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
IEJ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
0 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[� No
❑ 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
[;gNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

+ Facility Number: '7 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Cj
Spillway?:
Designed Freeboard (in):
'ForObserved Freeboard (in): .0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 91 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 V 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 f' [�1No ❑ 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 R No ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ 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 [INA
❑ NE
17.
Does the facility lack adequate acreage for land application?
ElL Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Comments (refer to question ft Explain any -YES answers and/or any recommendations or any other cornments
t
.Use drawings,of-facility to better explain situations.. (use additional pages as necessary.):
Reviewer/Inspector Name f /�J/C, /� �S v— - I phone: f0 33 3300
Reviewer/Inspector Signature: Date: $—O`� Z �D

Facility Number: — /�! ] Date of Inspection �� 8
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (7 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 [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RE No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
to 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
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IVNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;9 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
AdditionalComments and/or Drawings:` f s
Page 3 of 3 12128104

Type of Visit *'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I( Arrival Time: y:. �C.okCSQ YC- Region:
Q > OQ Departure Time: County: g
Farm Name: 84-r dQ S_ FarlyC Owner Email:
Owner Name: Phone:
Mailing Address: r Z - i Ri rmo-,'+-f
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: eAxl N. hn Integrator: , vr-p �v _ 6 Lt,_ _
Certified Operator: 2t �- R r1 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 n = i =s Longitude: = o = I = ll
Design Current
awme t.apactty roputatton
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean p BO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream lm acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dix Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
III
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 N No ❑ NA ❑ NE
❑ Yes
❑ No
P9 NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
& NA
❑ NE
❑ Yes
❑ No
❑ Yes
[;ZNo
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
12128104 Continued

FaSility Number: — i� Date of Inspection EZ T_d�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
DNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
eilr0
Designed Freeboard (in): ILI -
Observed Freeboard (in): W
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.)
Y
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
Ej?No
❑ NA
❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
52 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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 f Wind Drifl ❑ Application Outside of Area
t?'10 , 3as� �- ,I ( SO
12. Crop type(s) v r S{/t t—a ;
13. Soil type(s) MA L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [)a 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 154 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [�kNo ❑ NA ❑ NE
Reviewer/Inspector Name o Phone: 0 5-
Reviewer/Inspector Signature: Date: V9_ 2L _&k7_'7
12128104 Continued

Facility Number: Date of Inspection I Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LA No ❑ NA Cl NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp' ❑ Checklistfi ❑ Design- ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EZ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis I❑ 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 U,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B 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
54No
❑ 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
KNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F•No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D(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
4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9q No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
gyNo
❑ NA
❑ NE
AddthonalCotiinaents'andlo%Drawings i
Z l _ P h%&Se u pd "4 G rcr •� i shot 4 yr _ cap i-tf'_ G wre. +
Zl. le4 a.!{ 1r��r� eVe....-'� �►1S��t
12128104

(Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: jbI7G Ill Time:
Facility Number
O Not rational O Below Threshold
® Permitted ® Certified Q Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: Zza Imo% ate c Fa N r. + Ne- County: %1 a 6 es Cs" Fi-a
Owner Name: L✓- Pc / 7 �c �IQT -- r-• "Phone No: �S �a� G " 9-� -7
MailmgAddress:..__97.F7 W/i. Ac dagize
Facility Contact: Phone No:
Onsite Representative: _ -VICL Integrator: _ •ch id _-• , v__
Certified Operator. _ e_ r t Operator Certification Number.•
Location of Farm:
Swine ❑ Poultry ❑ cattle ❑ Horse Latitude �' �� �� Longitude �• ��
,Design nCmrent
_' .=iks
Carreat - ]lg� Cnrrmt
Swine 'Po.._
•on. ?Ponl�y .
:Po lion, .Cattle
Wean to Feeder
Layer
iff Dairy
Feeder to Finish
Non -Layer
Non -Dairy
Farrow to Wean a a a
Farrow to Feeder
- Other I
Farrow to Finish
- T�Ded��,.Y -
Gilts
-
Bows`Total
SSI:W
Number Of Lagoons4
1,
Discharees & Stream impacts
I . Is any discharge observed from any part of the operation? ❑ Yes W No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [I Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? H / a
d" Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 18 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure .5 Structure 5
Identifier:
Freeboard (inches):
12112103 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 1�1 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
Yes ®No
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? ❑ 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 ❑ Yes I] No
elevation markings?
Waste Aaalication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Croptype _ ,C7C.-wac.sQ�_ !� Strsa /� gyro-: OS ..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVNIP)? ❑ 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
I6. Is there a lack of adequate waste application equipment? [I Yes jf] No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1� No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the tune of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Q No
Air Quality representative immediately.

Facility Number: 70 Date of Inspection /e G
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes IP No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.) ❑ Yes V No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [V No
28. Does facility require a follow-up visit by same agency? ❑ Yes [3 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E9 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35) ❑ Yes m No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

rya -'se '�C _..._�`- -- •-W.-.-�Miw�.v.:....-. _ ....r.
Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ®Routine o Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit:
TiMC: L 0 l
{ Facility lumber
ro lot Operational 0 Below Threshold
Permitted ® Certified
0 Conditionally Certified
0 Registered
Date Last Operated or Above Threshold.
Farm Name:
County: /�QkeS� {26
Owner Name:
r tq& cd.
A!"
Phone No: G /. ' - .2 •
Bailing Address: _ �5
�� }_ ltll„ �t Pc--nci
%evil
l-i" LIL-11+ n1 G 2x_; 40
Facilit" Contact: IZGTRL±t_—
Title:
Phone No:
Onsite Representative:
Integrator: Ge"-,i•c (I s
Certified Operator: Ar,
1
Operator Certification Number: -
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �' �•
Design Current
Swine Canacitt Ponnlation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
/ , CC;
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I I I ID Dairy L I --d
❑ Non -Laver I I IQ Non-Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I 1 I ILJ Subsurface Drait
Holding Ponds / SoCtd Traps 1 10 No Liquid Waste
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ar: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar_e 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)
❑ Yes
1RNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes W No
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 33
05IV3101 Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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?
❑ Yes Q No
❑ Yes [51 No
❑ Yes Y No
❑ Yes P No
❑ Yes P3 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [)O No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Wo
12. Crop type �'rv+! (�tn O'S .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes T 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
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,�No
Ll3 No
Reauired 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?
ONO
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
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
V No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Up No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
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
0 No
0 No-dolations or deficiencies were noted: during this visit. You will receive no further correspondence about this visit.
sag` : question ) it . _ (
nsv�ers And/or yg Lother: o m nt
y
i1 a drawtn�s otfacility u�to better glean sttttaho sa use addibonala as necessarV)n�
pages
p
� ❑ Field Copy Notes
-' _ •
Reviewer/Inspector Name-- e:-.
Reviewer/Inspector Signature: r - Date: / 03
05103101 Continued

Facility Number: — Date of Inspection �l
Odor I&M
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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?
O5103101
❑ Yes Q No
❑ Yes] No
❑ Yes © No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes [51 No
❑ Yes (@ No

Type of Visit * Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Date of Visit:/� Time: 9 �a
Facility Number 7 J
Not erational Below Threshold
® Permitted IN Certified 0 Conditionailf Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: A6eAr/ County:
Owner Name: ___ /, ,,F i 74 ,7 Phone No: (_ P�6� �� ��7,7
Mailing Address: —J�7 _t�o.,�e� �CD,4d/ �+�� �i9/.Pod �� .2 ef
Facility Contact: — ZZ11 ! Title: Phone No:
Onsite Representative- 6 L_ t_��// _ _ _ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 Longitude `
Design - Current Design Current, Design"-. Current
:Skive .Po-Cacpopulation Mile- Ca acity-ltmnCa actf Population
❑ Wean to Feeder ❑ Laye r Da'
El Feeder to Finish ❑ Non-LaverL airy —
® Farrow to Wean /zeo
❑ Farrow to Feeder ❑ Other
Farrow to Finish ❑ Total'. esigw capadt� , .
❑ Gilts � �� ."
❑ Boars :Total sm
Num!iF of:Laguons = = ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdeng Ponds l Solid.Traps ❑ No Lig uid WasteManagement System
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 gallmin?
d. Does discharge bypass a lagoon system? (If ves. 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 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ,E`No
❑ Yes JUNo
❑ Yes ;ONo
❑ Yes RrNo
❑ Yes No
❑ Yes ® No
❑ Yes 0.No
Structure 6
Continued

Facility Number: 7 — eZj
Date of Inspection 0
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?
❑ Yes PU No
❑ Yes K'No
❑ Yes WNo
❑ Yes F No
❑ Yes FNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes F No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IgNo
12, Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CR No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes r�n No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes PSNo
15. Does the receiving crop need improvement? ❑ Yes "nNo
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps etc.) ❑ Yes ;KNo
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 5d No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JK No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes R 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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to gnesizon #) " Exphtixi any YES;attswers andlor any re mmendattoas or,.a other comments. -
_
Use drawings of facility tti:better. ezplamsituattori,?(use pa additions! ges as necessary) 0 Fieid Canv ❑Final Notes
_ �- -- -
Reviewer/Inspector Name A
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: % — X/ Date of lnspectinn �d
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28, Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes No
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
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.) ❑ Yes SrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 5TNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes qi No
Additional Commentvaiid/or Drawings:.-, - -- -.
05103101

I?iv�ston of .Water Qiahty
Division of SOB."a Water Conservation
O Uther Agency. _
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Em Date of Visit: ®'rime. E= Printed on: 10/26/2000
Q Not —operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold
Farm Name: ......��.i. ...... .%'L. .....i� ....... r .5 ...ZC. County:...... Qfi?�SCL?.r.........................................
It
Owner Name: ��� r.... 1....... �o�'.... .. ... ... Phone No:.......... .Z -..� f�...................................
Facility Contact: .....+t . . ... LJ r... / ... Title: Phone No ty....>(J'!`:er........................... :...................
r_ � DJ ��//
Mailing Address: i R.7 ................. ....M1U t......... .... ... rM� dYt ....r.Y•..c............. Z .l.. '....
Onsite Representative: yE ................ ........ Integrator:- .....................Rr�. ...............................
# . ...........................
Certified Operator:.,&. . IC .Vri Operator Certification Number: ..
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C =i Longitude • 4 44
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Po ulation
FDairy
Non -Dairy
Total Design Capacity Z oa
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Ficld ❑ Other
a. II'discharge is observed, was tltc convcyancc man-made?
b. If discharge is observed, slid it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flaw in gal/min?
d_ Dees discharge bypass a lagoon systent? (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 Structure 4 Structure 5
Id ent i fie..r:.................................................................
Freeboard (inches): 31
5/00
r
❑ Yes ONO
❑ Yes 9kN0
❑ Yes Wo
❑ Yes ANo
❑ Yes tNo
o
❑ Yes
❑ Yes *No
Structure 6
Continued on back

r
Facility Number: Date of Inspection j Printed on: 1 0/26/2000
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 11 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 maintenancelimprovement?
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? , ❑ Excesfive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type llprm (.4 lye3. 1 iCL,-4 /. Sol . k rzn Ir
13. Do the receiving crops differ with those desi(n�ted in the Certified Animal Waste Management Plan (CAWMP)?
14_ a) Does the facility Iack adequate acreage for land application?
b) Does the facility need a wettable acre determination`?
c) This facility is pended for a wettable acre determination`?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
: io•yioiatiOris:o , defciendieg •were noted• du-rttig phis.visit; • Yob'Win4'ee0iye do ful, th&.-.'-.
.
comes ridence: abaut this visit ........... ....
'C&ii&hti (refei to question #). Explain any YES answers and/or any. kecotnmeiudations or.
Use'drawings of facility to better explain situations. (use additional.pages-as necessary)-
9
❑ Yes gro
ElYes j�No
❑ Yes )LTNo
❑ Yes o
❑ Yes tNo
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes )KNo
❑ Yes KNo
❑ Yes ANo
❑ Yes KNo
❑ Yes kNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ANo
❑ Yes �rNo
❑ Yes �No
❑ Yes " NO
IV
Reviewer/Inspector Name
Reviewer/inspector Signature: Date: 7—' "0� S/OlJ

r
Facility Number: 27Date of Inspection Printed on.• 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
ArNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
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-)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
1RrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
I'Additional-Comments-andforDra
r'q
J
5100

Division of Soil and WaterConscrvaaon :Operation Review
`vision of Soil and-_Water,Conservation :Com Nance echon
r _ Division of Water_ Qtiahty Comphance Inspection _ -
"JY
1 ll
Other 4� FnC O FYat10n+RCVICW
W,�.,. _,
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
APermitted 0 Certified 0 Conditionally Certified 0 Registered 10 Not Operational Date Last Operated:
Farm Name: ..... -� -....... �'/'1' E'.. - ! ` i, r-W C.ount►':........�dl�e�Q} �.....................................
•� w ~
Ij-........ .....................
Owner Name:...''.........G.... ..1ir/Lj
. !� I .. ..................... f Z - G� z
W�`�f Phone No: (( /
FacilityContact: .... . I Ti . Phone No:.....
Mailing Address: ..... /.. ! 11Y.. � ..a /.... .S.r..... r-.....l...l!...�.................... �.`....�.....Q..
S .............. t �'?.Q7.
Onsite Representative:. �ilf y�,Pi� ........ Integrator...._ !1l..t'�% 5..........................
......................................... ...................... ....
JQ .
/ f� ....
Certified Operator:.... ct�rr l Operator Certification Number:
Location of Farm:
Latitude •�' •� Longitude �• �' �"
Deli Current = R: x _- °Deli - Design _ gn F `Current Design Current
_Point ' - _
-.. Ca acity Population _ iY -'Ca '-Capacity- Population Cattle Capacity :Population
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ eeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish - - TOW Desigh Capacity
❑ Boars Totai ssLW
-_ Number of Lagaans= - 3 ❑ Subsurface Drains Present ❑ Lagoon Area
HolcLng-Ponds / Solid Tiaps ; ❑ No Liquid Waste Management System
Discharges & 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 inan-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)
Spray Field Area
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 5
Identifier: �/I II
Freeboard(inches): ............. .......................................................... ........-.-........................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
[:]Yes ANo
❑ Yes A No
❑ Yes IM No
❑ Yes No
❑ Yes No
❑ Yes 1 No
❑ Yes No
Structure 6
❑ Yes KNo
Continued on back
K1f►dtSM

Facility Number:7yy — Date o1'laspection I/—/-LAt'
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
,.No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
® No
/`�
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
)kNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
K No
es
11. Is there evidence o ver applica 'on? ❑ Excive Ponding ❑ PAN
El Yes
KNo
12. Crop type /1J �'►r (1 r�
13. Do the receiving crops differ with those desig at in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9[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
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
j No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
\\
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,ja 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
PNo
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 �m No
co710 yiolatftjns of at?ticiecies were poted dirt°itn0 #his:visir: • Y:ou will-teoiye iid fu4 th+si
rresnandence aba�ut this visit.::..:::::..::::::::::::::::::..... :
-- — _. �., S —mom -r -: a .: _ ., �.,�. r
[fie
drawings of faceltty to better expiarn sttuahons (use additional pages as necessary)
VL Ice fdllk�n -tGzr - -
Reviewer/Inspector Name r
Reviewer/Inspector Signature: , Date: -
7
3/23/99

7
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ❑ Yes ❑ No
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
j 0
❑ Yes11�No
❑ Yes
No
❑ Yes
❑ Yes
�r�
❑ Yes
❑ No

IO Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Other
Pli�-I
Date of Inspection —22 - co
Facility Number -
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: l..-,A ......A LOS. County: .................................... ...........................
Owner Name:......% Phone No:...... L�P..I....J..,?r... ...........................
Facility Contact: ......, Phone No:
Flailing Address:
Onsite Representative: ........... ........ . Integrator:.__... a-ff.-rd/.5 ...............................
Certified Operator: ................................................... ..................................................... Operator Certification Number:..........................................
Location of -Farm:
Latitude �' �� ��� Longitude •
Swine .'�
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Deign' Current Desygn Current
PoultCaery.. C'accy lation
❑ Layer ❑ Dairy
FOJ Non -Layer ❑ Non -Dairy
❑ Others' 4
Total•Design Capaciy Z�
Total SSLW.'L3
Number of Lagootiis� ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area
Iiold�ng Ponds /,SohdFTraps ;;Fr z ❑ No Liquid Waste Management System r rlt
Discharizes & Stream Impacts
l . 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? (Ii-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 5
Identifier: 9 • , 11
--„.I
i
�I
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Mo
Structure 6
Freeboard(inches): ................. ....................... .................... I.............. ...................................
5. Are there any immedia th eats to [h irate ity of any of the structures observed? (iel trees, severe erosion, El Yes ❑ No
3/23/99 - seepage, etc.)
Continued on back

Dwision oF.SojI and Water`Conservat�on = Operatron Re�eew r
4 - - -
= Dwrsion. of Soil and,VVater:Gonservat�on - Corriphance lnspecti
on `
:. .
DwIsion of Water QieaLty,
Coinphance In§pection {
- QtheriAgency Operation=Review �-
-, _ .
Routine 0 Complaint O Follo-w-uE of DWQ ins ection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection _Z
- Time of, Inspection Q,0 30 24 hr. (hh:mm)
Permitted (3 Certified [3 Conditionally Certified [3 Registered 10 Not Operational Date Last Operated:
Farm Namc: ......1 _. '.Yk..... s r' 1eS r G7 C'rv� County: D E' S 0�-�-�
................................................................................ .......................................
Owner Name:.._.. ,-1.......... ............... .. 1... Phone No: 7. Z7.f...................................
Facility Contact: t L�!!� Q Title: Phone No:
g Address: i�A�....................................2�3VV4ailin..Qnsite Re rchentatrvc 6 t� �+� Integrator: ..................... �J D �[ �S
p...:, .. e.......................................................
..-.
Certified Operatnr:....f -C,N•4!"�t �J �'� Operator Certification Number:
...................................................I..............................................................
Location of Farm:
I....... ................................................................... ......... .......................... ........................ ........ ............................................ ........................................ ......................................... I -V
Latitude ' 4 .6 Longitude r ' '°
Design Current
awme t apacrty
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean J z()
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity L p -D
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JFD Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. II'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Identifier:
Freeboard (inches):
Structure l Structure 2
go //
Structure 3 Structure 4 Structure 5
❑ Yes rNo
o
ElYes
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JkNo
Structure h
1 /b/99 Continued on back

4
Facility Number: — (late of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
4 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
(1f any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings'?
❑ Yes WNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes -(No
11. Is there evidence of over application? ❑JPonding ❑ Nitrogen
❑ Yes [No
12. Crop ie.r.V.A.
type ....... Ij4........ {...................................................................................................................................................................
13. Do the receiving crops differ with those desig*hated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes M No
14. Does the facility lack wettable acreage for land application? (footprint)
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes KNo
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 KNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes jf 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 certified operator in responsible charge?
❑Yes No
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes rTrNo
24. Does facility require a follow-up visit by same agency?
❑ Yes &No
........................
No.vialation5:0I: deficiencies .were noted. during .this.visit:. Y.ou will receive nar further receive .
:-Corr-espgndeh4te:about;thisvisit.:.:.:.:.:.:.:.:.:.:.:•:•:•;•:•:•:•;.:.:•;.:-;.:...;. .........-:.:..::
Comments (referto 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):,
IMqq ^r4
er Well iLL21 rt TO ,,eA't
/, c� c Pew � 5 r,n �. � T? 1`+ e,
p� ;s Work, � w� � �
d J:ye 4 ZL J[Oa5TC
A d
Reviewer/Inspector Name
Reviewer/InspectorSignature: Date: Z 2�1_( 1/6/99

0 Division of Soil and Water Conservation ❑ Other Agency
10 Division of Water Quality
O Routine O Complaint O Follow-up of DWQ inspection O Fallow -up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mtn)
© Registered %C--er��tifted p Appplied for Permit E3 Permitted � Not O erational DateLastOperated:
Farm Name: ...............1.—e'A....... #i' �ff. ........f 4rvvl.... �� .... County: ....................... ll�.p.De� f'►................................
Owner Name:.......r�...... Phone No:...............'/✓��...............
Facility Contact: .,,,,,,,,,,,,,blr+,....... eq o ........ Title: Phone No:
I q
Mailing Address:................ :........ �.....I:..&
/........... 1,`��.,.Lg............................ ........�rr...Lug,,....../�Cl..............._C......... ......`�..3...61...
Onsite Representative: ..... -........... �r ll�{.%.1.(. ... .... Integrator:.......�� �r t'bi..�.l .�[��,,c........�
Certified Operator :.............. Ar.c& ....... ,�r'r ........................ Operator Certification Number:...... .....
�..g...(_l ....
Location of Farm:
Latitude • 4 " 4 Longitude • 6 "
:",.k Desrgn = Cut rent"
Design Current.�� Design `, Carrent 3
Svvtne - :Capacity Poptlatson
Poultry: "�Capacrty rPopulation Cattie�� Capacty;,.xPopalation„z
t-
.
4
❑ Layer ❑ Dairy
❑ 1�'on-Layer ' ❑ Non-Dairy
�
R
❑ Other
_Total Design Capacity 00
a ;
2 x x TotaI.SSLW
Nuexber of Lagoons !Holding Ponds
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
z
k,' ❑ No Liquid Waste Management System g
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
apQ
raj
❑ Farrow to Feeder
S
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes )kNo
2. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated Flow in gal/min? N/�
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes 01No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes gNo
ma i n tenanceli mpro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JgNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ANo
7/25197 Continued on back

Facility Numher: %r- 417
8. Are there lagoons or storage ponds on site which need to be properly closed`'
❑ Yes
X\o
" StFurtures (La goons.}ioIding Ponds, Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): q../+........ ........ ........ .................... ................................... ........... .................... ..... ................ ....................
!1
.......... I.........................
10. Is seepage observed from any of the structures?
❑ Yes
XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
OK No
12. Do any of the structures need maintenance/improvement?
❑ Yes
P(No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
X No
Waste Application
14. Is there physical evidence of over application''
❑ Yes
ANo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _ a
�.......Q.�T(..........
1
15. Crop type Gt1C....... .. r.....5,lH1as.IL... .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
XNo
IT Does the facility have a lack of adequate acreage for land application?
❑ Yes
XNo
18. Does the receiving crop need improvement?
❑ Yes
,N No
19. ,Is there a lack of available waste application equipment?
❑ Yes
X No
20. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'.'
❑ Yes
JXNo
22. Does record keeping need improvement? l `
XYes
❑ No
For Certified or Permitted Facilities Only
,
23. Does the facility fail to have a copy of the Animal Waste :Management Platt readily available"
❑ Yes
XNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
0 No.violations or deficiencies were noted during this. visit..You.will receive no further
correspiindenee afiout this visit... . .
'ot�ents'{refer to question , ):."Explain any YES answers andloi and recortimendations or any:o er ctitnments. � °
Jse drawtrigs of facthty to better explain situations. (use additional pages as necessary);
WV
A44- AAJ 4 __'M CO C4"P,
Fazm wzLo wed &a4- as ao ,
4,z- "�/ 4_a,
ko
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
-me- 4Z4 Brkli .
Date:

1� A
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
+O Routine O Complaint O Follow-up of IM'Q insptc.-tion 41 Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 0 24 hr. (hh:mm)
© Registered Certified [3 Applied for Permit 0 Permitted [3 Not Operational Date Last Operated
Farm Name: Iey4.....L.l.r.1AY-5:.... . .krYh......................... County:............. Q.......................................
Owner Name:....... .oj.e ......... ......g .. ........ Phone No: 2. !! .. Z7 7...................................
Facility Contact: ........ B.f:+��� ...... Title: Qi.-!rue. r :; dµ '
Mailing Address: ...... .l..5 7 ....... .F r..i!'1 ok 71 .................... '2U_.( Q
Onsite Representative:...WgJ!� ..... f .C�'4....................................................... Integrator:...L..............................................
Certified Operator;........................................................................... .. Operator Certification Number:..................
Location of Farm:
Latitude a1�L L< Longitude 0` 4 I�{f
Desegn. Current
A
a:: 4'Cumn nrrent§ x
Swore. Capacity„Pitpulahon Poultry FCapacrty P{opulaiion Cat#le Capacity Population
,
. �:
eeder
❑ Layer i ❑ Dairy �Finish
rarrow
❑Non -Layer � ❑ Non-DairyWeanFeeder
10 Others
❑ Farrow to Finish
"' "Total Design Capattty (ZOO
❑ Boars
T lS
- r
Nay eld Area umber of Lagoons / HoldYng Ponds ' � IF—] Drains Present ❑ L ❑ Spr Area
k ❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there anv adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes, ❑ No
❑ Yes ANo
❑ Yes MNo
❑ Yes OQ No
❑ Yes No
❑ Yes P(No
Continued on back

lk
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (LaQoons.Holdine Ponds. Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Yes
l
❑ No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard (ft): ......�P.-J D ..
•..................................
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
❑ Yes
No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
gNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WNW, or runoff ente ng waters of the State, notify DWQ)
15.
Crop type .... . -..........................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ANo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
�qNo
18.
Does the receiving crop need improvement?
❑ Yes
RNo
19.
Is there a lack of available waste application equipment?
❑ Yes
ONO
20.
Does facility require a follow-up visit by same agency?
❑ Yes
PkNo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
6V0
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Oulu
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0, No violations•or deficiencies.were itoted-during this:visit.:.You wi>j ieceive,no furikerr :
eorres'pWidehce about this:visit
rrf c�r� 15 'ass %'k e /g'� rC�u r
9�i -�%aT 11e co�) rrr:cla+e aJG., c�r-5-
6t Y1 5 f ray -}-i c0 +,, allow gCreebQkrj �:(6r— 1 1XgPee j O1'Gi. K-
�' 15 CL 50ca 5i4n K j l A t-,� �I Cnj shoo
I� �Oe ale L"�e 'Cor
J f 7/25197
Reviewer/Inspector Name p ,,�y ...5 r '
p YC�
Reviewer/Inspector Signature: A 0. _, Date:

a
aITeedl [� DSWC Animot"Opefa dhn R v
.. y lew t'
� # ue � zZ�: x �... xy..,t�t� ,yam � r -i - c . raa � '�� t� ✓bze ate* �'+'� �*`�: n "a � ,�- : „ 1 t
' DWQ-An mal Feedlot Operatzon'Site-Inspection '
wMs+�
Routine O Complaint O Follow-up of DWQ inspection O Follow-up ofDSWC review O Other
Facility Number
Date of Inspection �J
7
47
Time of inspection ; db 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered [IApplied for Permit (ex:I.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated :.............—_......_.
Farm Name: e' L ..C3_�.r. Nl►� L' x.... _ ..� . e_
Land Owner Name:��� _ ...LA r .... _.... .._
Facility Conctact:
Title:
Phone No:
Phone No:
Mailing Address: _,�?�,.. ! .._ems .i sZ .� . ........ ..........
_ j
Onsite Representative:.. . _ _.., � G -_ _ Integrator:
Certified Operator: Operator Certification dumber: 26
Location of Farm: 7
. T9 2...n-9
O o. ai a-� it the
Latitude �0 C " Longitude ' 4 �u
Type of Operation and Design Capacity
�az�
Design .- CurreIIt _DUs gnu CpTE Cilrrent p
StiviIIe �s.�
?Ca acE Po ulahoa°ulY..:Cn acety "Po ulatEon�Cg1e�SCa acs :: Pa ulatioo
t ❑ Wean to Feeder 9 La erhZ ❑ Dairy
FI.W❑ Feeder to Finish Non La er I ❑ Non-Da
""t
Ll Farrow to Wean
'�'�s^'�.,w¢c ,� s,-M,,t � � � U
Farrow to Feeder � Tofal:Design Ca #ity� g A
¢ a mN� ,ems,
Farrow to Finish ws�aa 3 �y
" r
t o ",,.j, ,J 1: otaFSS i
�k ❑Other
�db�i5g
nNamber of LagoaEEs lHoldingPonds10 Subsurface Drains Present .
xy„+
}«� ❑ Lagoon Area ;� ❑ Spray Field Area _,
fir, a ,, ,:: ._> r
ne
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes )�No .
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [RrNo
❑ /TNo
Yeso
❑ Yes
Continued on back

Facility Number: _241K—... �...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes ,�No
8. Are there lagoons or storage ponds on site which need to be properly closed?
El Yes �ANo�
Strut ur s (Lagoons and/or lloldintr Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes XNo
Freeboard (ft): Structure i Structure 2 Structure 3 Stricture 4 Structure 5
..._ .. _................ .. _.. .. ... ..
Structure 6
....- _
10. Is seepage observed from any of the structures?
❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 'No
12. Do any of the structures need maintenance/improvement?
❑ Yes XNO
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes `�No
/
Waste Application
14. Is there physical evidence of over application?
❑ Yes ANo
f in excess of WMP, or runoff enteringwaters of the State, notify DW {I
fY Q}
-•J
15. Crop type -._.. �r�"'1.` S�/R"Ile -- - ------- _ -- - - -------- ._._.......... � — — — ...._ ...... ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes 01,No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes ANo
18. Does the receiving crop need improvement?
❑ Yes ANo
19. Is there a lack of available waste application equipment?
❑ Yes ANo
20. Does facility require a follow-up visit by same agency?
❑ Yes ANo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ;Rjqo
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ YesXo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [ O
24. Does record keeping need improvement?
❑ Yes _ To
n'#1) Ezplam any YES, answers aiidlor any recoti
nngs of facility, to better explain situations: (use additional pages,as i
c{rr. i s r n 5a� sl,r-ye.
Reviewer/Inspector Name
Qr_d k".4UL0,34a u,elf-
ttons'or any .other comments:
J3) n
Reviewer/Inspector Signature:
Date: �1 -
cc. Division of Water Quality, /Dater Qualitjl Section, Facility Assessment Unit 4/30/97

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Wade Taylor
Ten Bridges Farm Inc.
RR I Box 152B
Orrum NC 28369
SUBJECT: Operator In Charge Designation
Facility: Ten Bridges Farm Inc.
Facility ID#: 7847
Robeson County
Dear Mr. Taylor:
`{ Y
®EHNFZ
NECEIVED
NOV 19 1996'
FAY11--- V!LLLF_
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P. ., ctor
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
R.O. Box 27687.C
Raleigh, North Carolina 27611-7687 An Equal Opportunity/Afifirmative Action Employer
Voice 919-715-4100 _ _ 50% recycled/10°,6 post -consumer paper

Site Requires Immediate Attention: NO
Facility No. 7 9 - 4 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Ao9us 12 S , 1995
Time: / 7; 4o
Farm NamelOwner: i eti 3r; J a)cs Nod FAQa, / RQy 8r; 4 _
!Mailing Address: Ri. I doa' / �L9 8 F4;r Ma.v f NG -z,73"
County: Kobeson►
Integrator: Coarr-otls Foaas :7'Nc-. Phone:
On Site Representative: _ Ra ,-; Phone: C9/OJ (028 - 9277
Physical Address/Location: 11 sR Z4-55 N,.►- Ash o% wot
Type of Operation: Swine Poultry Cattle
Design Capacity: /2-00 ""14umber of Animals on Site: 1197
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 µ ° Z m ' 3,f Longitude: -79 ° 10 , 13 "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes No Actual Freeboard: 3 Ft. Co Inches
Was any seepage observed from the oon(s)? Yes orC9 Was any erosion observed? Yes or(1
Is adequate land available for spray? QL4or No Is the cover crop adequate? V or No
Crop(s) being utilized: Coasa.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? ( ar No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or N�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(s)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? �or No
Additional Comments:
R' C Reyej5 _
Inspector Naive
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Wade Taylor
Ten Bridges Farm Inc.
RR I Box 152B
Orrum NC 28369
Farm Number: 78 - 47
Dear Wade Taylor:
C) E N F1
February 13, 1998
RECEIVE
FEB 16 1998
FAY TiEVILLE
REG. OFFICE
You are hereby notified that Ten Bridges Farm Inc., in accordance with G.S. 143-215.1OC, must
apply for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your
farm has sixty (60) days- to submit the attached application and all supporting documentation. In
accordance with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section
19(c)(2), any owner or operator who fails to submit an application by the date specified
by the Department SHALL NOT OPERATE the animal waste systern after the specified
date. Your application must be returned within sixty (60) days of receipt of this letter. Failure to submit
the application as required may also subject your facility to a civil penalty and other enforcement actions
for each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package. The
signed original application, one copy of the signed application, two copies of a general location map, and
two copies of the Certified Animal Waste Management Plan must be returned to complete the application
package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Katharine Keaton at [phone]
extension 533 or Jeffery Brown with the Fayetteville Regional Office at [phone].
Sincerely,
te A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Fayetteville Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% posi-consumer paper