780092_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental quaff

i ype or visit: w t-ompaance inspection U tiperation mevtew U structure Vvatuanon V i ecnntcat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I ZJIICounty: "0IIA
Farm Name: L' fQ A",,- Owner Email:
Owner Name: /zLr/1�s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: LfSG 16
Sack -up Operator:
Title:
Region:_
Phone:
Integrator: .r jcyzj
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design.
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dajg Cow
Wean to Feeder
I
INon-Layer I
I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
"
D P,oul
I Layers
Ca aci
Fre
P,o
Dairy Heifer
I Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
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 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 F No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
®NA ❑NE
NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Rac:U:i]VNumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '�&O) 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: r
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes V
— No
❑ Yes No
DNA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 19No ❑ NA ❑ NE
S. 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 [3NA ❑ NE
maintenance or improvement? 0
Waste Aoolication
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 T 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 A,
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
uesignateu in the v r�L w iwr r
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 [�PNo ❑ NA
❑ Yes rN No ❑ NA
❑ Yes
R9 No
❑ NA
[:]Yes
PNo
❑ NA
❑ Yes
PINo
❑ NA
❑ Yes No
❑ Yes o
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V RainfaiI Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

c' ' Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 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 kNo
❑ 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 the 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 ft 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: q�0--`�T -330D
Date: 4
214.12015

'lype of visit: jP Compliance Inspection V Operation Review U Structure Evaluation U "Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: .-r Departure Time: OO County: "�, "egion: .420
Farm Name: Owner Email:
Owner Name: P ✓6� Ya/s' rn Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 0
Certified Operator: LJ S� ?sGp/LtQ-1
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Den 1urrent Design Current
Capacity op. Wet Poultry Capacity Pop,
Design Current
Cattle Capacity PoP.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
01
Feeder to Finish
22W
17A
D . P.ou1 Ca aci Po
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
a
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other -
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other Other
_Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 1P No ❑ NA ❑ NE
[:]Yes
[:)No
NA
❑ NE
[—]Yes
[—]No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [—]No
❑ Yes No
❑ Yes No
03NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

•k
Facile Number: JDate of Inspection: Gj
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 19 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
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.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes CP No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Y] 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? 10
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 IV No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosph rus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accep Crop Window ❑ Eviden Drift ❑ Application Outside of Approved Area,
12. Crop Type(s):u� t7
13. Soil TYPe(s): /" oI rfV"--1 f Kam► BLS, 01aA"S
14. Do the receiving crops differ from terse 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
le
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
0 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 If 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 N
o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes CP No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Eja�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 MNo ❑ 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
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No . ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [P 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 TT No ❑ NA ❑ NE
Continents (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
Page 3 of 3
Phone: 10- Jf 17 3AV
Date:
21412015

j ype or visit: w t.ompnance inspection v uperanon xeview u Structure Lvaluation V j ecnmcar Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: DI Departure Time: O Z= County: '�V BESbI4J Region: Fi0
Farm Name: FTelej wUXI F4w r^^ Owner Email:
Owner Name: P-8G- _Far s LLL Phone:
Mailing Address:
Physical Address:
Facility Contact: �j-r?,h� VeA,1 rj edt2 Title: Phone:
Onsite Renrecentative: H Integrator• I' [ — em u)r _x
Certified Operator: '�`� ej AAat^
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poaltry Capacity Pop.
Finish La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Feeder
Non -La er
Dairy Calf
o Finish
to Wean
y0
Design Current
Da Heifer
Cow
to Feeder
o Finish
PFarrow
Dr 1'oe Ca aci �o
Layers
Non -Dairy
Beef Stocker
Non -La -Layers
Beef Feeder
$eef Brood CowTurke
Pullets
s
Turke PouIts
'no' —
Discharges
and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑Yes
No
®NA
❑NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

1Facili Number: - Date of Inspect -ion: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
O NA
[_]NE
Structure 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
1p 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
[3 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
�Z] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
I I. 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 Crope�W�indow ❑ Evidence of Wind Drift
Drift/ ❑sA�pplication Outside ofApproved Area
12. Crop Type(s):-ARS�GtI C�'rmuJASS C�". -�t►►�J "" ", 5-Or _ L®`'hr�✓
13, Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
[:]Yes Qg No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
[:]Yes [R No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes fin No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

"'[Facility Number: -9y [Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to property 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)
No ❑ NA ❑ NE
�] No ❑ NA ❑ NE
❑ Yes
f] No
❑ NA
❑ NE
❑ Yes
[Ig No
❑ NA
.❑ NE
[:]Yes
[�] No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes �No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No ❑ NA ❑ NE
® No
❑ NA
❑ NE
[A No
❑ NA
❑ NE
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 necessarv).
Reviewer/inspector Name: ! v iQ, I
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1�rO��33- 130 _
Date: 4i 2 - f
2 (4/20I4

Type of Visit: . Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access JI
Date of Visit: Arrival Time: Departure Time: QZ' County: N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
rt �
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Phone:
Certification Number: 7 ( __17 1 / 7
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet"Poultry . _ Capacity Pop. Cattle Capacity Pop-
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
- De~ sign Current D Cow
Farrow to Feeder
Dry) PmouIt Caaci Po Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
Turkey Poults
Other
Other
Discharges 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)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �5No ❑ NA E] NE
❑ Yes [—]No
❑ Yes [—]No
[�FWA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 09 / NA ❑ NE
Pi
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

a`ty Dumber: f5ate of Inspection: 2�
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F�q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): r�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�g No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
to No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect �nd application? If yes, check the appropriate box below, [:]Yes ® 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 (grog Window ❑ Evidence of Wirid Drift ❑ Application Outside of Approved Axea
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [] No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ NA
❑ NA
❑ NA
❑ NE
❑NE
❑ NE
❑ NE
❑NE
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[] No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1r No [] NA ❑ NE
Pages of 3 21412011 Con need

! 1
f
FA.Jity umber: - [Date -of Inspection:
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 �FNo ❑ 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 Eallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[::]Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [gNo ❑ 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 FZA UP,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 Ej� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �d No ❑ NA ❑ NE
Comments (refer to question ff): 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: 9/ __'K L�U
Date: A
2 4/2011

Type of Visit: 4P Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access —
Date Date of Visit: 7Sj 3 Arrival Time: rG0 Departure Time: 62� p County: 0 Region: rt2D
Farm Name: _ .-�L-�,H,_S T, Owner Email:
Owner Name: j,y�,�� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
0
Title:
��
Certified Operator: �����
Back-up Operator:
Phone:
Integrator:
46"'M
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design
Current
F.,.
Design Current
Swine
Capacity Pop Wet Poultry _capacity Pop
Cattle,
'
Capacity Pop.
Wean to Finish
��� Lamer � � �.
Dai Cow
Wean to Feeder
Non La er
DairyCalf
Feeder to Finish
O ] Zfl - %�
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
v .`,1P,oul s_Ca aci
-
Non -Da -
Farrow to Finish
La ers
Beef Stocker
EEI
Gilts Non -Layers
Beef Feeder
Boars
Pullets
I
1Beef`l3roodCnw
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 Eg No ❑ NA ❑ NE
[:]Yes [:]No
Yes [:]No
[-]Yes
[:]No
Yes
[�] No
Yes
F1 No
]NA ❑NE
®NA ❑NE
®NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FAcility Number: - Date of Inspection: <11Z9
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No [P) 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
W No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[VI No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
tp No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R 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 Win D ❑ Application Outside of Ap roved Area
12. Crop Type(s): Cw,3kM"
� ( . ! �' ` i '✓ _ _'-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in th CAWMP?
❑ Yes
P 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
[yNo
❑ 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 [�5 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 Eff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tp No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IF;cility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fig No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [N 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 CP No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [)a No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EP 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
f�j 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:
T
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
0 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eq 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: ` /0O 437- 3'JQ Z)
Date: 3
21412011

aype ui vtsu. w%-ompuance inspecnon v vperauou mevtew %_j structure rvaivarion V iecunicai Assistance
Reason for Visit: GMoutine O Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: �,'i Arrival Time: io�:4s Departure Time: / . Y ri County: R06
Farm Name: MI_ FFkMW'5 Owner Email:
Owner Name: Q) P,"CL FA-rsu mpoJ Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: i��Cxp K 1` t1�>r q•i Title: `rich . Sp£ C • Phone:
OnsiteRepresentative: SPMF_ Integrator: N\Vftgham( kt2i_n
Certified Operator: kzsx Vke P is n) Certification Number: q 4 S -71-7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Deq tgn Current Design @urrent
Design Current
Swine r� Capacity Pop. Vet Poultry Capaacc t`v mop.
Cattle Capacity Pap.
Wean to Finish La er
Dai Cow
Wean to Feeder
�
Non -La er
I
IDai
Calf
Feeder to Finish
-111 ;;z
-%coo
�, K � � � `'�
Dai Heifer
Farrow to Wean
Dest Current
Cow
Farrow to Feeder
D , Moult . Ca ac1P,o .
Non -Dairy
11
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys Turke s
JEJ
I Beef Brood Co —
f
Turke Poults
Other
Other
Discharges 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)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
® NA ❑ NE
�NA ❑NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fa6th Nuinber: qT6 jDate of Inspection: tg, 1,a i
1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
13) No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
(4 NA
❑ NE
' Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 0 q
Observed Freeboard (in): _ 3 eZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MV 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): kPLRInQZA fa C U)) )EA- So be ans &G. I)
13. Soil Type(s): ,a do"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes (�] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes m No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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

Fadfl •Number: ct -a r5ate of Ins ecdon: f, ai / Z
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 ff] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 [M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes R] 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
FUs
mments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
e drawings of facility to better explain situations (use additional pages as necessary).
Sr►NQR LA�ao,a �{� N�i<Og V>:�e�Q ace C��l c��vRcss�a �a 5m%- tad pass=blc
)( "i(tPcK 395l n4l`F.06 WEE6 cet\Afke 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�. 5. Sys cos —
Phone: Gtu' 3OSS-u%51
Date: _ U\ail / '�
21412011

Type of Visit: gCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (R"1foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: , L.v County: Region:
Farm Name: bA L
irrVLS Owner Email:
Owner Name: l-e c� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 1 Phone:
Onsite Representative: Integrator: ! `1 __a
Certified Operator: Lk rMc— LtLLj_ -% r Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current..,
Design Current
Current
Swine
CapacttyP�op
Wet I?oultry
CapacitvPop�
�Devign
Cattleacity Pop.
Wean to Finish
Wean to Feeder
_
I
Layer
INon-Layer
sr
I
DairyCow
Dairy Calf
Feeder to Finish
Farrow to Wean
s
r
14 ��
Design Current-
DairyHeifer
Dry Cow
Farrow to Feeder
Farrow to Finish
-
D Poultry
Layers
_
Ca t tPo P.
Non -Dairy
Beef Stocker
Gilts
Boars
N
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
.
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
�To
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[—]No
[2'<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
O-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
I ` -K'
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E j o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff3<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2-1�o ❑ NA ❑ NE
Stru;7e I ms— 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 PET< ❑ 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 CJ 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 ffj<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [. Qo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes MNo
❑ 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): �&r►A.1�,pQc� �
36
13. Soil Type(s): [.L. K-
14. Do the receiving crops differ from those designated in the C MP?
❑ Yes
[g<e
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U" o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q Noo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0,1+
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
j o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q< [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑�lo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NoTa-N-A ❑ NE
Page 2 of 3 21412011 Continued

Facil ity Number: - Date of inspection:' O
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ag-Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 02-go ❑ 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 Jo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ErfrE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes V'V ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes To ❑ NA ❑ NE
❑ Yes t. to ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes g,<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [::]Yes B57(o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ga<o ❑ 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).
CIA—
,L),-LV- 40
Reviewer/Inspector Name: I (J « LC Phone: 7/L' 33
Reviewer/Inspector S ture: Date: 20zzejl
Page 3 of 3 2141201

i?zmS t0 /21 /ZO/O
78 H 12
Type of Visit 6 CZoutine
Hance Inspection 0 Operation Review- 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (; 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /Z., / � Departure Time: %• OS County:
Farm Name: F�tGa lvla.t/ r0C:Q_+-P" Owner Email•
Owner Name: ��"Y ��'t�a'y Phone: _
Mailing Address:
Physical Address:
AitSa A/
Region: Flo
Facility Contact: Title: ,yeWNG✓ yJ Phone No:
�/tC
Onsite Representative: �n /��"� Yr� l'ativi v Integrator: "u'�k;> � /✓
Certified Operator: IRaLun i-e- MC_LmyrV Operator Certification Number: 22 57Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__10 =` =" Longitude: 0° 0I 0
Design
Swine Capacity
Current
Population
Design Current
Wet Poultry Capacity Popnlation
Design Currettt
Cattle Capacity Population
❑ We to Finish
❑ Layer
El Dairy Cow
can
❑ an to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
�Q
ElDai Heifer
El Farrow to Wean
El Farrow to Feeder
ElFarrow to Finish
11
Dry Poultry
❑ La ers
❑Non -Layers
❑ Pullets
El Turkeys
❑ Turkev Pou Its
❑Other
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures:
FGilts
Boars
-
.00
❑ 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)
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 L7No ❑ NA ❑ NE
❑ Yes
[:]No
L"J NA
❑ NE
❑ Yes
❑ No
2 A
❑ NE
e<
El NE
❑ Yes
NNoo
El Yes
E❑
❑NA
ONE
El,NYes
,L`�1/o
<o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 7 — Z Date of Inspection
Waste Collection & Treatment ,�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes E7 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B 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 E`TNo ❑ 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? El Yes ,D<0__❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L_TNa ❑ 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 L�vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7No ❑ NA ❑ NE
maintenance/improvement? ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 0 F-AJ rV4e4 8c4 NS t/6+ 4arx 4, c/o ,-S
13. Soil type(s) 1A.10L R 11' JS 6o A LvAlc4loen
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Vo ❑ NA
❑ NE
To ❑ NA
❑ NE
ET'No ❑ NA
❑ NE
to ❑ NA
❑ NE
9-1q`o❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name I 1� lck/ KLVeS I Phone: IO,$133.3300
Reviewer/Inspector Signature: 862A Date: (o -03 -ZO/ 19
Page 2 of 3 12128104 Continued

Facility Number: 76 — Date of Inspection G -03-lO
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 BTo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
CTNo
❑ 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?
El Yes
/❑
L' NNo
ElNA-
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
�9�<o
El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P<oo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2'N�o
[INA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<oo
ElNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElR Yes
o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffeNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CK. ❑ 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
LTNo ❑ 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
ElEKo
.�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
21go ❑ NA
❑ NE
Comments and/or
12128104

Q Division of Water Quality
Facility Number 7 g Z O Division of Soil and Water Conservation
t Other Agency
Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S-Arrival Time: -f 7 Departure Time: County: ����` s'a.J Region:
Farm Name: 1' r e- e-A &--,< !J r,. — ° � ��"' _ Owner Email:
Owner Name: 3 G'�'h F r«(L , c ^f Phone:
Mailing Address:
Physical Address:
Facility Contact: Frei ^i Title: 0.4-3 /1JtA,_ Phone No:
OnsiteRepresentative: /'jatAy-ect. a<1�C.L"`«""`t Integrator:
Certified Operator: A"c vt c �. c- L Operator Certification Number: 2 2 5 7 Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = 4 0 « Longitude: E] ° = ' El u
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
[Feeder to Finish 17 12- Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
-Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 L7No ❑ NA ❑ NE
❑ Yes
❑ No
�A
❑ NE
❑ Yes
❑ No
D' A
❑ NE
9�A
[-INE
❑ Yes
No
El Yes
,❑
oo
El NA
❑ NE
❑ Yes
,L--�,
eiZ
❑ NA
❑ NE
12128104 Continued

Facility Number: 78— �f.Z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NNoo ❑ NA [I NE
a. If yes, is waste level into the structural freeboard? El Yes [3No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E tvo ❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[5No ❑ 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?
El Yes
Ga o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑' 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❑
NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�
31 o ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B 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 Drifi ❑ Application Outside of Area
12. Crop type(s) CCa n1 :,�i c._ t , tu.v_5 0 z _ �/�,�,s `0 S•- r� G►-a''.,► l0,5 .
13. Soil type(s) 01, B Rar'.JS C v A L yiv cl,louv.i
1.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,L_'�No
1-'9`No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
D<
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/Vy
07e t���..�: (!� 1� /ra.�c. <<5 NreWej ✓o.� 5�, � c�J P
Reviewer/Inspector Name Ro'e-k. R6V e_1 S Phone: y/O• �K33. 333 U
Reviewer/Inspector Signature: Date: S-Z/ —ZOO
12128104 Continued

Facility ]number: 79-221 Date of Inspection
Required 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 appropiate box. ❑ VAR ❑ Checklists ❑ Design ❑ Maps ❑ Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspectionss E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L,f oo El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Na ❑ NA ElNE
B 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes EJNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes B o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes RNo ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
[:]Yes
7L�,�o
[]NA
❑ NE
[I Yes
El o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes L7 1vo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
12128104

FZW_5 -7- o /'- a 8
Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3:5 Departure Time: County: F-0I6CS4—," Region: r�
Farm Name: �✓C 94"Y'.z.v /dal -a^ _ Owner Email:
Owner Name: V f.1'V14 t [-41M&^% Phone:
Mailing Address:
Physical Address:
Facility Contact: Ka� I>q4 Girl Title: • S Phone No:
Onsite Representative: Integrator: 44. �rQ�✓�✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: --T ❑ 0 Longitude: ❑ ° 0 ❑ 11
Design
Current Design
Current Design Current
Swine
Capac ity
Population Wet Poultry Capacity
Population- ' Cattle _ Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish Z ;, �_
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish [:1 Layers
❑ Non -Lavers
❑ Gilts ❑pullets
❑ Boars
a ❑ Turkeys
Other ❑Turkey Poults
❑ Other Other
❑ Dairy heifer
❑ Dry Cow
❑Non -Dairy
❑ Beef Stocker
� ❑Beef Feeder
❑Beef Brood Cow
--
umbe rpof Structures:
_n
V:14 . � � J - . �
`�- , q
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
D i"o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ISNA
Er
❑ NE
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
❑ Yes
❑ No
E 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
�_-�
lJ NA
❑ NE
1 Is there evidence ofa past discharge from any part of the operation`?
❑ Yes
'o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
a 1_AA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

0
Facility Number: 79-1/Z Date of Inspection E_V —4
Waste Collection & Treatment ,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes E,I NNo/o ❑ NA El NE
a. If yes, is waste level into the structural freeboard'? ❑l
Yes TNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z7"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 anv of the structures need maintenance or improvement? ❑Yes ET -No
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit'? (Not
Ll No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,��
9. Does any pan of the waste management system other than the waste structures require El Yes L`J No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑Yes 0`Z0 ❑ NA ❑ NE
maintenance/improvement?
I I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ['T No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ FaiIurc to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) cow W, Grkt o- PaSF
13. Soil type(s) �d �� %� "WS t.�s-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,ETNo El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElE Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [3"—No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes [3 No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes t_1 No ❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: _9/D. � 3. 3304
Date: .:5--- 09 —0lJOS
12128104 Continued

Facility Number: 7$ — Date of Inspection F 09 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes D No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other ,—,�
21. Does record keeping need improvement? If yes, check the appropriate box below. ElE
Yes [ go ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ElNA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
,[a'�10
!=1 5o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I-o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,❑,'
Er<
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0-;goo-
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E31vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETRo
❑ 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
90
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
_ ,��
[3 5o
❑ 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
Bi�qo-
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

f P>m
® Division of Water Quality
Facility Number g q Z O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Z • 53 County: Rohes')Al Region:
Farm Name: ban1 Lewi S D111- - A -e- Owner Email:
Owner Name: bQIU L e-wi's Phone:
Mailing Address:
Physical Address:
Facility Contact: , a'�'�b �A aA✓ Title: 1 �� • 5�1h� _ _ Phone No: yi023 2Z, Z
Onsite Representative: KoA Ptgl aN% Diw L-e-,-ji's Integrator:'
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] e = ' = « Longitude: = ° = ' = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 7220 -7470
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
1 \ VIl-Li
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design':.„ ±
Cattle Capacity' Pf
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes a No ❑ NA ❑ NE
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
[,4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
12128104 Continued

V.
Facility Number:
Date of inspection 3.23-07
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? ❑ Yes Eff No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?: NQ
Designed Freeboard (in): )91S`
Observed Freeboard (in): 2Z
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
M 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
{fl No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
00 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[N No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
60 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) CC wtJ . ul ku^T y bens-S , &_rAi � C hs4u c r ��57w4o-��
Gr vzi i n1
11
Soil type(s) �a �a�N� GbA I- uNLAbuy+,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
7 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[2?No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IgNO
❑ NA
❑ NE
17_
Does the facility lack adequate acreage for land application?
❑ Yes
EM No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
jNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �iLk ]�ede. is Phone: (`Ilb) m3-333o
Reviewer/InspectorSignature: Date: 3-23- ZOo%
12128104 Continued

IMF
•
3 2
Facility Number: '%g �]�. -D-D =_d
-- Date of Inspection Z3
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available'?
❑ Yes
[A No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[° No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
[� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
I
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
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
ElNA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of visit O Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: g—Qg—Oia Arrival Time: I z .' Z0Q Departure Time: Z : Q County: )ZO"Al Region:
Farm Name: +N L6Jis 1'6'11 P'3f r Owner Email:
Owner Name: 6 a AJ Ze..J i S Phone:
Mailing Address:
Physical Address:
Facility Contact: _ _ 11<sr M� Duarte Title: le G G : Phone No:
Onsite Representative: ,rIntegrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
FRO
Location of Farm: Latitude: E__J o E] u Longitude: = ° = I =
Design
Current
Design Current
Design C•vrrent
Swine C•agacity
Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑ Dairy Calf
Feeder to Finish Z D 1
Dairy Heifer
❑ Farrow to Wean
Dry Poultry.
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
ElBeef Brood Cowl
. , .
Li Turke s
Other
❑ Other
❑ Turkey Poulis
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[N)No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No
❑ 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
MNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
r�tmNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Fa ility �q umber: % 2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[A No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z
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
[A No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[A No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[$ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1�9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Qd 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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EM No
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
r9No
❑ NA
❑ NE
Comments (refer to question #): Explain auy YESTanswers And/or any recommendations or any other�comments
riJse drawings of facility to better explain situattons.. Nn Additional pages as necessary):
Reviewer/Ins ector Name - —
P �G Phone:
Reviewer/Inspector Signature: Date: 9-09'200e�'
Page Z of-3 12128104 Continued

R
Facility Number: ']g— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P;No ❑ NA ❑ NE
the appropriate box. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M1 No El NA El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ 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 0No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1% No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
$No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W) 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
UfNo
❑ 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
A No
❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: I (i Arrival Time: L Departure Time: County: 2o6e Region: r/Qo
Farm Name: i �EiL —P e, Owner Email:
Owner Name: tmll
l r Phone:
Mailing Address: _ � $ �Pi eSA cl , _ o rruwk , 30
Physical Address:
Facility Contact: Title:
��//
Onsite Representative: J: SA- bucta%y, / Dg Le...,; 5
Certified Operator: e
Back-up Operator:
Phone No:
Integrator, A4 ilk r,IN
Operator Certification Number: 4- S
Back-up Certification Number:
Location of Farm: Latitude: F__jo [--] ' 0" Longitude: = ° =' = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
z'0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current .
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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)
Z. 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?
E
❑ Yes QRNo ❑ NA ❑ NE
❑ Yes
❑ No
NNA
❑ NE
❑ Yes
❑ No
[a NA
❑ NE
[5 INA
❑ NE
❑ Yes
❑ No
❑ Yes
[�KNo
❑ NA
❑ NE
❑ Yes
[(No
❑ NA
❑ NE
12128104 Continued

Facility Number: — RZ
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 91 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No M NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: PLO
Designed Freeboard (in): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F1 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 [25No ❑ 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 Lp No ❑ NA ❑ NE
& Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. 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 (XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2 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 Drifl El Application Outside of Area -
12. Crop type(s) lscr.� W-�Soe.S F7extnn r�Lo� - �aStvs�l �-1 , SYs�a��� �+L_
13. Soil type(s) Waa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes K No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes 4 No
17. Does the facility lack adequate acreage for land application? ❑ Yes E No
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name a " �: € Phone: 9j9—� Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — QL Date of Inspection I rt
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP
❑ Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J;� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
1504 µ❑ Yes
LANo
❑ NA
[:1 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
R] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes MNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CifNo
❑ 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
�9 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
NNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
12129104

Type of Visit • Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: /-'9S
O Not rational Q Below Threshold
12 Permitted 13 Cer 'hied © Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
Farm Name: q 14 � �p h e r a.�
i-� County: o
Owner Name- _ �� n,._ - , . y, at .. .. Phone No: f - 9 a 9
Mailing Address:
Facility Contact: ...- - - -- — __. Title: --- . Phone No:
Onsite Representative:
Certified Operator: - - _ d_- _ L t , ; s - w - Operator Certification Number: ---
Location of Farm:
I'w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude "
Swine
n Wean to Feeder
10 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
0 Farrow to Finish
Boars
Niiaiber• o£.Lpgoo1is
2p 1 77
11:1 s gn Current 'Design current -
.. -
try _ i'�.�nr:fv Pnrurinfi.,a -Cattle `ravmAt.v - imn"isifien
DmCh2rges & 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 -trade?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Strucnue 3 Structure 4 Structure 5
Identifier: __ _ .L__ .....--- - . _ _.
Freeboard (inches): .3
D 'I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12/72103 Con#riued

Facility Number: 7 f( a Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, reaps, etc.)
❑ Yes
❑ 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?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/tnspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[1 Yes
❑ 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
W No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
El 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 I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number: -- y'a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [I 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 maintenancefunprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste ApLhcation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
I I. Is there evidence of over application? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop we ��rm �r.�.� d ra LC�Y /7P� /�%�// !a .-n . (_ n� u /k!h r4f Iso y�ra
13. Do the receiving crops differ widAhose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.

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
Datc orVicit:4.L-1Time r ^T]
k Facility Number .
L� I11oi O erational 0 Below Threshold
® Permitted ® Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _D&&, �e_k.--) I ) 14 L A,,Gp County: f 2.0
Owner Name: _ _ D&,2, I—e- J i C Phone No: a g� O
Mailing Address: _ 1 QS 4 9c-4-1, S A Ck t,�, rC a Grrk k 110 C,
Facility Contact: —_D6,1 L �L< Title: Phone No:
Onsite Representative: �._._ L=C- i Integrator: 10EM ([ S _
Certified Operator: �r vti �o t,S� Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' ° - Longitude ' �• ��
Design Current
Swine
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
�] Fa oww to Feeder
❑ Farrow to Finish
❑ —Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Po ulation
❑ Laver I ❑ Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1 10 Subsurface Drains Present j❑ Laeoon'Area
Holding Ponds / Solid Traps I JE3 No Liquid Waste Management System
Discharges & Stream impacts
I _ Is any discharge observed from any part of the operation?
Dischame originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed_ was the conveyance mar, -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 eaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches): 31
05103101
.J Spray Field Area J
❑ Yes EP No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes [A No
Structure 6
Continued

a
Facility Number: --9 Date of Inspection v o
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 [� 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 q No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [21No
12. Crop type ll Cr r^ L.- CkG Sw, . Grc. ; 01
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 5 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
[NrNo
16,
Is there a lack of adequate waste application equipment?
❑ Yes
El No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
allo
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
�JNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
$3 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Z No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
{PNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
UjNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
C5 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Commentst(refe� to.questian #): Eaplairi airy YSaanswers recommendations or any other cnmmetsts;= k
as Entat
lise drawiugsrof faeility to better explain sttuataons(use additional pages its Qecessary) ❑Field Copy ❑Final Notes
��t'V,1 ('C t:p f � •�- � C�3`-1 � � l,c.e C� C�q o �
..
Reviewer/Inspector Name
Reviewer/Inspector Signature: L Date:
O5103101 Q Continued

Facility lumber: — Date of inspection
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below f� 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 `o
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 [ZJ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or:Drawings'
O5103101

Facility Number z Date of Visit: /DL�4Z Time:
10 Not Operational Below Threshold
® Permitted ® Certified /[3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold -
Farm name: _ %��x! �Ji f _ 4� County: Z-4le-f01 _
Owner Name: D1,111, _ .GJi--' // / / Phone No: K_9/d/ 02?' 90�,7
Mailing Address: _2 62 7 /�fr f �. G��u � �4ss ,� µ- Al
Facility Contact: �^� ��1-� Title: Phone No:
Onsite Representative:
Certified Operator: __ ��'.✓�.� /_�/�
Location of Farm:
Integrator: Wiz,,_ -!
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 " Longitude 0' 0 0
:Design Current Design Current °Design' Carrettt '
Swine Capacity Po ulation`_ _M Pgaitn Capacity PaDulatioa Cattle. __Capacity. Pop'nlatmn
❑ Wean to Feeder
® Feeder to Finish
5'2o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'Number of Lagoons ` / ❑ Subsurface Drains Present ❑ Lagoon Area ❑ 5 rati Field Area
Holding Ponds`/. Solid Traps ❑ No Li uid Waste Management System = g
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff No
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes CRIhio
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DW'Q) ❑ Yes [RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 52-No
% aste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �a'No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): 3711
05103101 Continued

Facilih lumber: 79 — YZ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes CK 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 R;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 Pa No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [)-?No
Waste Application
10. Are there anv buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type,E�'n.H C. rhs�prrgi, 1 ,�s��r �rs..Cl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes D3 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes K No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes [2TNo
15. Does the receiving crop need improvement? ❑ Yes [�lNo
16. Is there a lack of adequate waste application equipment? ❑ Yes QRNo
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?
(ie/ WUP, checklists, design, maps, etc.) ❑Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes allo
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 AVJMP? ❑ Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments;(reter to question Explain:_ YES:ansRers and/or any, recommendations or- any, other comments.-
_. W_ -
Use_drawings of facility to better,ezpls sttuateoas. (ase addrtronal pages as uetessarv) El Field Gov El Final Note,
/t7af� = G? Q�i �/ �� a�� /�c.✓c� -��o .4��d ���W .a yie'.4'.,1 eo d.�� � ,��
Reviewer/Inspector Name
Reviewer/Inspector Signature: 0'z,— Date: a 2 Z
05103101 Continued

Facility Number: A — 9Z1 Date of Inspection /b d�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads. building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s), inoperable shutters.. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes CK No
❑ Yes R No
❑ Yes PQ'tio
❑ Yes Aj
❑ Yes lr,�-, No
❑ Yes ZNo
❑ Yes P�LNo

W
D>iv>es><oin of Water ualt
Qi ty e
Division of Soil and Water Conservatton;
x
_ Q Other Agency,
M - -
E
f Visit ompliance Inspection O Operation Review O Lagoon Evaluation
n for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z t)ate of visit: 2&—O Time: Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last OperateA..9;Zve Threshold:Farm Name: �k 1. . i...GL. �r &.nen County:.........:1`......................................
.. ......... .....................................................
Owner Name:.L�1..!!J............................. F`.eL.c� . S.. .... Phone No:.......... 2............��7,�................................
Facility Contact: ............... Q �ur%�. .4.1t'e...•r—......................Title:........................ — Phone No:...................................................
Mailing Address: ..... � � R...(...... �.!.,R.�.i�r4�CA.,..... ls.!.'.rk!-!!'lr.......2 �
Onsite Representative: l{�t.�•n fir. Integrator:..-......- cq-+eD(..'1.............................
.........................................................................................................
Certified Operator:... (...Q. ..... s...... L—rG�1S Operator Certification Number ...........................
.......................................................
Location of Farm:
rM
❑ Swine ❑ Poultry ❑ Cattle [:]Horse Latitude �• �� Longitude
Design Current
owmc
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiIts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity `�Lv
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present J10 Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps I I[] No Liquid Waste Management System
Discharge- & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li'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. II'discharge is observed, what is the estimated flow in galhnin'?
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
ldcntificr:.............................................................................................................................................................................
Freeboard (inches): 30
5100
❑ Yes XNG
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes rNo
o
ElYes
❑ Yes �KN0
Structure 6
Continued on back

LJ
Facility Number:71' — �Z Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ' A /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 KN'O
(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
a
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes eo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. is there evidence f over application? / ❑Excessiv7r,4
nding ❑ PAN ❑ H-yd/ra7_54_dLj7Lqq"/_57,f.
Overl❑/Yes
12. Crop type u �� _ rn A1, L7eavi_ Ovtl'
13. Do the receiving crops differ with those designated it the Certified/nimal Waste M99iagemen(Plan (C P)? ❑ Yes Kio
14. a) Does the facility lack adequate acreage for land application? ❑ Yes •r `` o
b) Does the facility need a wettable acre determination? ❑ Yes o
c) This facility is pended for a wettable acre determination? ❑ Yes o
15. Does the receiving crop need improvement? Cl Yes VNo
16. Is there a lack of adequate waste application equipment? ❑ Yes J�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes WO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 0
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
_
❑ Yes AfNo
24. Does facility require a follow-up visit by same agency'?
❑ Yes gNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes "J?:Mo
cw'd.'hivisit:Yo'i-rceivei1oviol'ains:ordefcien*u wiRo CurQe
Tories oridence: ah' f this visit~
Comtnents.(refer to question #): Explain any YES answers and/or any recommendations or any other coiuments
Use drawl s of facility to better explain situations. {use additional pages as necessary):
fCtr-pA
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7—
ZG -0 / 5/00

LJ
Facility Number: f, — Date of Inspection 7- —G 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
❑ YesN0
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 o
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 kNo
``
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 XNO
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes Y" &
32- Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
�
El Yes ,<No
Aqditiorud Comments and/or rawinp: - _ - - -
5100

[3 Division of Soil and '
k
E3 Division of Sail and '
® Division of w4o4
Wl>>... __. will
_.,_:`. -. -
Other Agency Opel
ilton = Operation Review , f' =ti
itton -`Cam liariee ec,� tion r�
p
nee nspection 11 •''�
1
-
L Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other J
Facility Number 7 Z Date of inspection G oa
Time of Inspection _QY> 24 hr. (hh:mm)
[] permitted C] Certified ❑ Conditionally Certified © Registered Not O erational Date Lust O crated:
1' p ...................
FarmName: ......_...1� ..- ............ ............................. County:........ ........................ I—, ....... ...........
J i
OwnerName: u� .........---..------..._.._.. Phone No:.....�?",loG�zP- �4 97
FacilityContact: ........01.4? ....I < � ........................... Title: ................................................................ Phone No: ...................................................
Mailing Address:.....�0�%...�.�Y`t� � f�...�.r!.r��G.�fl�....II,�G!��.��.�.....�c���_./ ..........................
OnsiteRepresentative :........ � ....-�✓��/.. Integrator: ... 1��/fL����,��"�f.......................
Certified Operator:.......lr✓�....s4`. ..r!?%,� Operator Certification Number:..... .....................................
Location oFFarm:
I .............. ............................................................ ......... ........................... ............. ........ ......................................... ......... ................... ..................................................................
= T
Latitude =• =° Longitude =' =` =11
Design Current' Design Curt•erit Design Current
Swine Poultry . Cattle atioriCapacity Population Capacity
❑ Wean to Feeder ❑ Layer ❑ Dairy
C&Feeder to Finish 7,2 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
` ❑ Farrow to Feeder [] Other
❑ Farrow to Finish
❑ Gilts; Total Design Capacity
❑ Boars TotaVSSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance inan-made'.' ❑ Yes KNo
b. If disc harLyc is observed, did it. reach Water of the Statc? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gallmin'l
d" Docs discharge bypass a lagoon s steiw� If yes, notify DW El Yes �No
>p" b y ( Q)
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Oj�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P2 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,3 No
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 9 y
Freeboard (inches): ....""..... ,1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No
seepage, etc.)
3/23199 Continued on buck

7
• Facility Number: — Z Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11 . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12- Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack 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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (le/ 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?
(ic/ 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?
0: No vielatitiris:ordefieiencies were itgte� during this:visit: Yoi} will �eecive Rio futther..:.
correspondence: about. this visit •. • : • .. .. ..... -
❑ Yes N+Io
❑ Yes t4No
❑ Yes KNo
❑ Yes e�*io
❑ Yes ekNo
❑ Yes XNo
❑ Yes OkNo
❑ Yes )ffNo
❑ Yes NNo
❑ Yes ,KNo
Yes ❑ No
❑ Yes PVNo
❑ Yes ;ErNo
❑ YesNo
❑ Yes No
❑ Yes J No
Cl Yes 11�LNo
❑ Yes ,� No
❑ Yes No
❑ Yes gNo
❑ Yes ;'No
bmments-(iifer to:quesaon #) 'Explain any YES answers and/or any recoimmendations dr any other comments: L
;e ("Vags of fac tty to better explain situations {use addthonal pages as:necessaiy) _ F ,�
12,
Reviewer/Inspector Name
A.
Reviewer/Inspector Signature:
Date:' 2/ Z

~ Facility Number:' — Date of IiLspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes JRNo
liquid level of lagoon or storage pond with no agitation?
27. Arc there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PkNo
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 eNo
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 ANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
-AdditjonaI,'jU-'ornrncnts an or- rawin

V
[i Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality .
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection©
Time of Inspection
: 24 hr. (hh:mm)
U Registered Wertified [3 Applied for Permit Permitted
IDNotOperationai
Date Last Operated: ..........................
Farm Name:..... &.n ... Lew!s......
.........LYL........ P', :�e.........................
county: ...............
_....... .......................
Owner Name: .................... baki ................
................. .............................
Phone No:..... .........
UP..........6.fn. ... ..... .`.� T �.........
Facility Contact: ........ j „r j Title:
..........
Phone No.
Mailing Address :............ � .....l
QQ--uu
.l 11.�.... 4 %A .
.................................. .
....... .......... .Jr.(.own f.......
NG..... a836
OnsiteRepresentative:.....uctvjjWAS,
Jo�e�� �,Itintegrator:........./'�?.I.........5 —4•
..................l..... ............. �.......
�..........
Certified Operator;................m;..d
.............#:... L9taZS
... Operator Certification Number,........................
Location of Farm:
Latitude ' ' « Longitude a 6 cf
!Wine""""
a ".,Poultry �`=Capacity P
❑ Wean to Feeder
Feeder to Finish
O
ap
El Farrow to Wean
❑ Farrow to Feeder
S
❑ Farrow to Finish
❑ Gilts
❑ Boars
' I❑ Non -Laver
1❑ Other
Subsurface Drains Present
��'❑ No Liquid Waste
.X
Area I[] Spray Meld Area
0
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
flo No
2. Is any discharge observed from any part of the operation?
❑ Yes
)V No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
In No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
ENNo
c. If discharge is observes ,.what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
JZ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Ig No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P�No
5. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
19 No
maintenance/improvement?
5. 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
A No
7125/97 Continued on back

Facility Numhrr: —
8. Are there lagoons or storage ponds on site which need to be properly closed'! ❑ Yes XNo
Structures (Lagoon."Molding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi Fier:
�r
Freeboard (ft):
10. Is seepage observed from any of the structures'! j] Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 1KNo
12.. Do any of the structures need maintenance/improvement? ❑ Yes ANo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
r
1
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes XNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes ANo
(if in excess of WMP, or runoff ente 'ng waters of the State, notify DWQ)
15. Crop type ................... Oxw�mp ...... .. .. .50VUS
...............
16, Do the receiving crops differ with those designated in the Animal Waste Alanaeement Plan (AWMP)? ❑ Yes ;kNo
17. Does the facility have a lack of adequate acreage for land application? Cl Yes No
18. Does the receiving crop need improvement? ❑ Yes XNo
19. •Is there a lack of available waste application equipment? ❑ Yes' A No
20. Does facility require a follow-up visit by same agency? ❑ Yes ANo
21. Did Reviewernnspector fail to discuss review/inspection with on -site representative? Cl Yes XNo
22. Does record keeping need improvement? ` A'Yes ❑ ,No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available? Cl Yes ANo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Permit:' ❑ Yes XNo
0 No violations or deficiencie's.were ntite'd-during' this visit. You.will receive no further
correspondence about this.visit:•
Comments"(refer to question #)i .Eipiaidany YES4nswers and/or a* recOOmendattons or any other, 6613,".i is
'Use drawings of facility -to better explain situations. (use additional pages as necessary):`' `
.).q. AZAJ Yr cxc� 14, _eacA
ram.
he 'A
7/25/97
V
6
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: _ �j--l1—��

Division of Soil and Water Conservation 0 Qther Agency
Division of Water Quality
0 Routine O Complaint O Follow-up of my ins ection O Follow-up or DSWC review O Other
Facility Number
© Registered - j$ Certified 0 Applied for Permit Vf Permitted
Date of Inspection
Time of Inspection _ / ; C 24 hr. (hh:mm)
0 Not Operational J. Date Last Operated:. .........................
Farm Name:...... r25%oZ County:..... fl-n.........................................
....................--...........................................................
Owner Name: ............ Caro /I `5 ....... 1e %D
Phone No: T'
Facility Contact: Les [iC s�u `1,� Title: ........--•---..------•-• .................. Phone No:...................................................
.............................................................
Mailing Address:---.....C:.D ........ +(a�........
...
W.irS[cµi,�......���.
. -.. .......
Onsitc Representative-------------, l {� ,l Integrator:....(%f"O 5 ,, . -............................................ ....... `............. T c
Certified Operator:--------,-- Nn.' n.L,.S................:.............i..�YtGly ........... I............ Operator Certification Number:.........................................
Location of Farm:
Latitude ' 4 69 Longitude 0 6 69
r "C
DesignY . urrent
Design
-
:Current ik� Desrgn Current
w
$wme. w
Capacity, Population Ponllry _ . ' , ':. Capacr#y Population ..Cattle Capacity=sPopuiahoq .
❑ Wean to Feeder
❑ Layer
❑Dairy
;
❑ Feeder to Finish
❑ Non -Lay erl
10Non-Dairy
❑ Farrow to Wean
El Farrow to Feeder
; ❑ Other.,`
.�{ :
aTotalDeM,g" Capac ty ~ pp
Farrow to Finish
aq�
Gilts
s
❑ Boars
Total SSLW
Number of Lagoons /Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon❑ Spray Field Area Area �
`; ❑ No Liquid Waste Management System
s• s
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ( No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
M No
c. If discharge is observed, what is the estimated flow in gal/min?
NfA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
DO No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
EgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
16No
7/25/97
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Od No
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft) rr.,1♦...................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes X 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 91\10
Waste Application
14. Is there physical evidence of over application? ❑ Yes fiqNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQJA _.
15. Crop type.isr:....UL1r�iPl f:......,.. /rX .-...+'['............................
.....................................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMPV
❑ Yes
;K-No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
Di No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
XNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,0 No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
JK No
0 No.violations or deficiencies were noted- during' this. visit. - .Youmill receive no further
correspondence about this.visit::.
Cannmentsl(refer to question#):. Explain any YES aitswers'andlor amt nV reconen-dations;or any other comments. s'
.> A
Use drawings of.facthty to better explain situations. (use addittonal`pages as necessary) Yy
A /m , Tlto w VA, 3 507K,9 .0)&way1, avt -{> , s�p c�
. .
Y #/Ij
N� � lcQed S �~ o`� 7r'25�97 �
I Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: al-/07

State of North Carolina
Department of Environment,
Health and Natural Resources •
Fayetteville Regional Office A4
James B. Hunt, Jr., Governor p H H N R
Jonathan B. Howes, Secretary
DIVISION OF WATER QUALITY
June 2, 1997
Mr. Dan Lewis
Rt. 1, Box 122
Orrum, NC 29369
SUBJECT: Annual Compliance Inspection
DHL-Page Farm & Dan Lewis Farm
Registration No. 78-78 & 78-90
Robeson County
Dear Mr. Lewis:
On May 20, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
inspected the subject swine facility. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided and
observations made during the inspection that the facility was in compliance with 15A NCAC 2H,
Part.0217 at the time of the inspection. Please refer to the comments section on the rear of the
inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for a
minimum of 250 bogs must have a certified waste management plan on or before December 31,
1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and Water
have specialist available to assist you with upgrading of existing facilities and certification -
If You have any questions concerning this matter, please call John Hasty at [phone].
Sincerely,
/ohnC. Hasty, Jr.
Environmental Specialist
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. NRCS
Wachovia Building. Suite 714. Fayetteville �
Ntw
FAX [phone]
North Carolina 28301-5043 C An Equal Opportunity Affirmative Action Employer
Voice 910-486r 1541 50% recycled/ 1 0% post -consumer paper

FacMty Number Date of Inspection
Time of Inspallon If = We ?A hr. time
Farm Status: -
Ce c:L, (�� ? Total nme (in boon) Spent onReview
- ,• _ _ _ —,•
or Inspection ('includes tmv l and processing)
Farm?1 m .- L — Pega Cottmy: ajarL
.�...�..
Owner N mec - ay" L e (5 Phone No: L1I6) z 8— 9 a 9 7
Mailing Address: QDyC I ZZ Qr'ru►^►.. „ f NC - - , ZM 6.
Onsite Representative:. n C96 CC41
CwMed Qperator: 4.+- ,.� P_ ca_ r Operator Certification Number:
Location of Firm:
Latitude Longitude 8M
JUG. 0 3 1991.
13 Not Operational Date Last Operated:
FAYETMMLLE
Type of Operation and Design Capacity REG. OFFICE
' � ts. � E }:� C;ey r < -, _- t a .y '�... �� - " =� �' ` s,R- '-;.`'.�i'�.° d - « � t ,�': -'k-y. >..�..-�'•r` y�'Y., ""' T'. ry -rrxs spy" .,
$N'inC C s s Number
Wean to Feeder ❑10 Dairy
Feeder to Finish Non-Lrjer Beef
Farrow to Weans e "; yr «a3 A J F: r 4 o- r. f Al A 9YsiF r rr Y y s 4aa
Fwmw to F r r .. s vm : � a 6: ^ heir4.
Farrow to Finish OtherT�,,,,,,C� of LivesW
Number of Lagoons /Holding Ponds , , = Subsurfac[ Drains Present
Lagoon A is rea S ra hi
Area
^..+-.+�-s.Ys, r -r '-�"3 ' ,,^rya �, i�f••'� !' ,`rid -'S!a i� - g y*�,,''
rreral
1. Arc there any buffers that need masntenan=rm4 rnvemeat? RECENED ❑ Yes *10
2. Is airy ftcbarge observed from any part of the operation? ❑ Yes )0�90
JUN o t997+
a_ If disrlrarge is observed, was the conveyaau made? 0 Yes No
b. if discharge is observed, did it reach 5urfuee Watm? (If yes, notify ASSESSMENT UHM Yes No
c. If discharge is observed, what is the estimated now in PlAmin�?AU f �
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) E3 Yes ` tNo
3. Is 1h= evidence of past discharge from any part of the opetadm? ❑ Yes ONo
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes XNO
S. Does any part of the was'oe management system (other than lagoonsIolding ponds) require 13 Yes 1:tNo
=intosaor!rarprvvearettt?

_1. _ 79"
b. % fazility not in con plimcc with my applicable aeeack ems?
7. Did the facility EaD to ban a certified operator in responsible dwV (if inspadon after ull97)?
L Are there lagoons or stotW ponds on sitt which um d to be propmiy closed?
tructures Magoons and/or Holding
9. Is stnwhual iieeboard leas thaw adequate?
Freeboard (ft).-A41pon 1 isgoon 2 hagoon 3
10. Is seepage observed ftm say of the structuzes?
i L Is erosion, or say other threats to the integrity of say of the amctures observed?
12. Do any of the structum need
(if any of questions !M2 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Av licatlon
14. is them physical evidence of over application?
_(If in excess of WMP, or nmoff entering waters of the State, notify DWQ)
is. Crop type
lb. Do the active crops differ with those designated is the Animal Waste Management Plan?
1'i. 7Joeslhe YiIity hg e x fack of adequate acreage for bad application?
IS. Does the cover crap need improvcrosnt?
19. is then a lack of available irrigation equipment?
For Ctrtffied Fsicliities _I ly
20. Doex tlic facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in say dray!
22. Does record keeping need improve?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewfnspeetion with owner or operant in ebargc?
n Yes w
n Yes *o
E3 Yes �No
n Yes o
. #Z.
Lagoon 4
13 Yes *0
❑ Yes ONo
❑ Yes XNo
❑ Yes A No
n Yes *0
❑ Yes *No
❑ Yes
n Yes O.No
❑ Yes Pkio
n Yes XNO
❑ Yes ;No
❑ Yes ❑ No
n Yes r' No
n Yes 'PiNo
Comments (refer to question : ;Faeplain aziY Y. 5 unswexs sadlaraxiy recaa3rixeadat�on9 or any oibet coanncaw
Use drawl ' of f!0 ty,ta better C:9 situations. (weliddztiaaal P88a
t
o e s e
I hr y r±n
K r . L e ..I i S � 0�s d a'vQ '1s,}I D 5+ Q �1a5 sc e5 -e •
Reviewer/inspecur Name
Revfwer/1nsptctor Signature:
r. Doiw'sion of Water Quality, irate. Quality Secdon, Fatality Assessment Unit 11/14/96

State of North Carolina
Department of Environment,LT19;WA
Health and Natural Resources IT
4 •
Division of Water Quality
James B. Hunt, Jr.,' Governor
Jonathan B. Howes, Secretary p E H N F 1
A. Preston Howard, Jr., P.E., Director
May 14, 1997
CERTIFIED MAIL
_RETURN RECEIPT REQUESTED
Dan Lewis
Dan Lewis
RR1 Box 122
Orrum NC 28369
Farm Number: 78-92
Dear Dan Lewis:
You are hereby notified that Dan Lewis, in accordance with G.S. 143-215.10C, must apply for
coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has
thirty (30) 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 system after the specified date.
Your application must be returned within thirty (30) 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
Permits and Engineering Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any question concerning this letter, please call J R Joshi at [phone] extension
363 or Ed Buchan with the Fayetteville Regional Office at [phone].
Sincerely,
for A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Fayetteville Regional Office (w/o encl.)
P.Q. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Steve W. Tedder, Chairman
Dan Lewis
Dan Lewis / DHL-Page
2087 Bethesda Ch. Rd.
Orrum NC 28369
Dear Mr. Lewis:
1 ••
Ar J
�1rT
E3 FE
� J V tZ
DF-j 5 1 1997
FAYEEFIFEVILE
�"i;G. CIFFICE
Subject Classification of Animal Waste Management Systems
Facility: Dan Lewis / DHL-Page
Facility ID #: 78-92
County: Robeson
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge (OIC) by January 1, 1997, for each
animal waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more
horses, 1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management
system. Our records indicate that your facility is registered with the Division of Water Quality and meets
the requirements for designating an OIC.
A training and certification program is available for animal waste management system operators. For
information on the training programs please contact your local Cooperative Extension Agent. Operator
certifications are issued by the Water Pollution Control Systems Operators Certification Conunission
(WPCSOCC). For information on the certification process, please contact the Technical Assistance and
Certification Unit at [phone]. The type of training and certification required for the operator of each
system is based on the nature of the mastes to be treated and the treatment process(es) primarily used to treat
the animal waste. There are two types of animal waste management systems, type A and type B. Type A
animal waste management systems are generally used to treat waste generated by monogastric animals
which produce a low -fiber waste. Type B animal waste management systems are generally used to treat
waste generated by ruminants and other animals which produce a high -fiber waste. The type of training and
certification an operator receives should correspond with the type of system(s) they intend to operate. For
more information on the classification of your system please contact the Technical Assistance and
Certification Unit
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not
intend to operate your animal waste management system yourself, you must designate an employee or
engage a contract operator to be the Operator in Charge. The person designated as the Operator in Charge,
whether yourself or another person, must possess a currently valid certificate of the appropriate type.
Sincerely,
-4.Ott 14.1
Joseph B. McMinn, Supervisor
Technical Assistance and Certification Unit
cd/AW OIC Designation
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

WRoutine 0 ComElaint 0 Follow-up of DWQ inspection 0 Follow -! of DSWC review 0 Other
FacilityNamber Z
Date of Inspection 13723 7"qi
F Time of Inspection -EFL= Use ?A hr. time
Farm Status: Cie A-, -J�t eJ 7 Total Time (in hours) Spent ouRMew
or Inspection (includes travel and processing)
Farm L ~ -! --a-4 -- _ A'AeMlark.
County.
Owner Name: Phone No: 7
Mailing Address:_AL,.1.,,_BQg Orr"v%.A Z83L9
OnsiteRTresentative: bar. Le-t.)'L5 b%riza IP5
Certified Operator. — b 9LO - I - g' cam; 5 - Operator CutBution Number.
Location of Farm:
Latitude Longitude
03 Not Operadonsil Date UM Operated; -
Type of Operation and Design Capacity
S ne pbd&y t
Number � ;Cattle '',Number )z
Dairy
Wean to Feeder FoLaw
Feeder to Finish QNcn-Lym K3 Beef I
Rm
E Um to Wean
F m
aTTOW to Fftder
Farrow to Finish Other Type of Livestock
Subsurface Drains Present
1� if, oldingTo
Number N
LO Lagoon =Arta �,4 N[Spray Held Area
`957 N
V&Peral
1. Are there any buffers that need mainteummAmVrov
2- Is my discharge observed from any pan of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Waterl (If yez, notify DWQ)
c. If discharge is observed, what is the estimated flow in PlAmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is them evidence of past discharge from any part of the operation?
4. Was them any adverse impacts to the waters of the State other than from a discharge?
S. Does any Part of the waste management system (other than lagoon&Uldmg ponds) Mquire
Imintenancermquavement?
E3 Yes *0
E3 Yes *0
13 yes ItNo
13 Yes M No
10 Yin'No
13 Yes No
0 Yes No
13 Yes tNio
Continued an back

6. is ftcnity not in compliance with any applicable sed)ack criteria?
7. Did the facility ban to have a certified operator in tesponst'ble charge (if i I irlion dker 1/1"?
L Art there lagoons or storage ponds an site which need to be properly closed!
$troctures (Lagoons mad/or Holding onds
9. Is structural f =board less than adequate?
Fmeboard (8): - 3�on 1 Lagoon 2 Lagoon 3
10. Is seepage observed fmm any of the strut t res?
11. Is erosion, or nay other threats to the integrity of any of the structures observed?
12. Do any of the structures need
(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 adquate markers to identify start and stop pumping levels?
Waste Avalication
14. Is them physical evidence of over application?
-(If in excess of Whe, or runoff entering waters of the State, notify DWQ)
15. Crop type per M cA4Q--
16. Do the active crops differ with those designated in the AniinW Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
Eor Cerrifred Facilitiesgnly
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily avanable?
21. Does the facility fail to comply with the Animal Waste Mamgemcnt Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Revwwedinspector fail to discuss review/mspecdon with owner or operator in charge?
❑ Yes '
E3 Yes *0
❑ Yes ONO
El Yes �lo
Lagoon 4 1
0 Yes P(No
❑ Yes ONo
E3 Yes XNo
0 Yes ANO
D Yes *o-
E3 Yes �No
❑ Yes 9040
E3 Yes P,No
[-t Yes 410
E3 Yes ANO
[3 Yes P(No
❑ Yes ❑ No
13 Yes *0
13 Yes P.No
Canrmrar3 {refer,to questroa # F.aplsin:ariy YES ausweisaaad/ar aay;reca�m�daaoaa or nay ctht~r oo mreatv.-
s � y � ,•�.. •-- � ... r. , -,� r �; r Yam. � � -� ..
USe�ilrB"gln s n Oa
INS r n-,
Mr i3 o.s daHQ 40t.W � �5+ kmS sc 'e4
Reviewer/Inspector Name -` . � ' 7 V
Reviwer/Inspector Signature: Dade: Z 3 -2j
cc: Division of Water DualitySecdmL Fag &y Assasmeut UAh 11/14/96
ft

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Dan Lewis
Rt_ 1, Box 122
Ornua, NC 28369
Dear Mr. Lewis:
1DCHNF;Z
DIVISION OF WATER QUALITY
June 2, 1997
SUBJECT: Annual Compliance Inspection
DHL-Page Farm & Dan Lewis Farm
Registration No. 78-78 & 78-90
Robeson County .
On May 20, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
inspected the subject swine facility. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided and
observations made during the inspection that the facility was in compliance with 15A NCAC 2H,
Part.0217 at the time of the inspection. Please refer to the comment_ s section on the rear of the
inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for a
minimum of 250 hogs must have a certified waste management plan on or before December 31,
1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and Water
have specialist available to assist you with upgrading of existing facilities and certification.
If You have any questions concerning this matter, please call John Hasty at [phone].
5inoerely,
/2obnnC. Hasty, Jr.
Environmental Specialist
or,-. Operations Breach
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. MRCS
Wachovia Building, Suite 714, Fayetteville �y FAX [phone]
North Carolina 28301-5043 N� 0 An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

a
Q
I:
As

6r b b a'tity aiot is comphom w►fth aay app3icabda tredaae>t aftisia?
13 Yee *b
7. Did the Sdibty M to hava a cerMad operator in dMP (ifias "dw slkr inAr }?
D Yes A*10
L Are finr+e lqp ma or stoma pond: an " which need 0 be p Waty dasad?
D Yee P&
$�� � ¢� a�/ar Rolditta pa�dsi
9. h sbu*nW freebaarrd less than mbgmW
13Ya
Freeboard (,�paa 1 imagm 2 Lapa. 3
Lapoao 4
10. b seepage obsesa d *mn nay offfie *nei =? _
D Yee
11. b arosieao, er arty adm thm1 6 Ge b tegtity of ary fiftbe abservvV
E3 Yea jgiv
11 Do any of the Sauctumnaetd . _
D Yes gNo
(if amy of quesdam 9-12 was am m ed yes, and the dtaldou poser m
htumedbut pubUt buff or ewdronmentd threm soft DWQ)
_U. Do my of the xftcum lack adgwh aasvluzs to ids► start ®d slog pmmpiag lewr]s?
0 Yea No
Esau Aoalkatfon
A Is f u phy=W evidence of over gVhcod m?
D Yes to
Of in excess of . ar raaaff enuring waters of the State, mm* DWQ)
15. Crop type
16. DD tine avp: differ with dwe dWgnaoad in the Anim waste Maaagemeal Plan?
13 Yet *No
17. Dom the f=ity have a lack of adequate nuage for Ind apgli=dam?
Yea
19. Does the cover pop read imprvveummt?
13 Yes AND
19. is Here a ladle of a`►ailable irrigation cq*meat?
Q Yes
Ifsr Certified FacOitie: t7oh
20. Does the EuMW foil to have a copy of the Amma1 waste Msaagumm Plea readily avnfiable?
13 Yes )(No
Zl. Does the family fag to couply with lire Animal Waste Manegemat Pl a is rmy wW
0 Yes ;io
22. Dace rtim keeping need nmpmeam l
10 Yea [i No
21 Does hcffity ragrum a follow-vp visit by same seams?
13Ya �No
24. Did ReWmarnaspeacm hff to discus reviewAnspeadon m* erwna or operator in s hrQ t
M Yea
7C;oasymsass(re%rato!g�rreswtro�n�if��J`yE�Iam.aay YES smasve�x�s/�ayad�To�r*auy►�raardeivar� a �aay at�renmm�: - _,���,��,,,�r-Q ° , �",
Vat aii.�liGil�ty �Mi f7R►�i �t!.,�trii �aLi4�11!Li{�.�..�i�i ai�[il t�l._:''�t; r<', r: •;•.
-pot
Sew►
Mt. �,e rslS �0.S atGnQ qua �aa'
Reviewer/Jrespexaor Name
Redwer/impector Sipstare:
C= Division of Wow Quality, Water Qdv ality Sscmf m P'acU&y A:somm—• iy e.
Dwe: = 2 3 -9Z