780097_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
780097 F
Inpsection Type:
Compliance Inspection
Reason for Visit:
Routine
Date of visit:
11/03/2017 Entry Time
Farm Name:
All In Farms, Inc.
Owner:
Ail In Farms Inc
Mailing Address:
PO Box 535
Physical Address:
813 Butler Farm Rd
Facility Status:
E r..ry.. fi—+ n I
fiity Status: PVZUVt! Permit: AWS780097 ❑ Denied Access
Inactive Or Closed Date:
County: Robeson Region: Fayetteville
09:30 am Exit Time: 10:30 am Incident #
Owner Email:
Phone: [phone]
Elizabethtown NC 283370535
Saint Pauls NC 28384
r ..,nc�n. �........... Murphy -Brown LLC
Location of Farm: Latitude: 34' 44' 42" Longitude: 78° 55' 03"
from St. Pauls, take Hway #20 toward Tar Heel. Take a right onto SR 1924. Take the third left which will be SR 1930. Farm
entrance will be 1 mile on riahl
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, i£ Treat Waste Application
Records and Documents Other Issues
Certified Operator: Clay Hodgin DeVane Operator Certification Number: 9%"2
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Primary Inspector. Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
inspection Summary:
Calibration Sept 15 Sludge Survey Extension to 21-31-2019
Address bare spots on lagoon bank tops.
Remove hay that has had a birthday.
page: 1

Permit: AWS780097 Owner- Facility : AEI In Farms Inc Facility Number. 780097
Inspection Date: 11/03/17 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 8,000 7,400
Total Design Capacity: 8,000
Total SSLW: 1,080,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
25.80
57.00
Lagoon
LAG 1
25.80
page: 2

Permit: AWS780097 Owner - Facility: All In Farms Inc Facility Number. 780097
Inspection Date: 11/03/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No No Ne
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
1101111
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑0
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑M
❑
❑
maintenance or improvement?
Waste Application
Yes No tM No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 01111
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS780097 Owner- Facility: All In Farms Inc Facility Number. 780097
Inspection Date: 11/03/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Wastl@ Application Yea No Na No
Crop Type 1 coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2 Coastal Bermuda Grass wt
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
1101111
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑.
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
M ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
[]
Waste Analysis?
❑
Soil analysis?
Cl
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

,_
Permit: AWS780097 Owner - Facility: All In Farms Inc Facility Number. 780097
Inspection Date: 11/03/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
yes
No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑M
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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 phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes No Ne No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑0
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWO of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑0
❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

'31
- I 1 F [- D
i yp�sit: rQc;ompliance inspection V uperation Review V structure r:vaivation V I eclinical Assistance
Reason for Visit: 4?koutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: / 0 Arrival Time: Departure Time: County: 6--joi -L Region:
Farm Name: A- h' Owner Email:
Owner Name: p c4Gti 4 9h Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: A 6 —y
Certification Number:
Certification Number:
Longitude:
Design Current DesiCurent ,� Design Current
S411-1
wine Capacity Po Wet Poult , Ca act Po ""� Cattle Ca aci Po
Wean to Finish La er Da' Cow
Wean to Feeder Non -La er DairyCalf
Feeder to Finish - ," Dairy Heifer
Farrow to Wean Design_ Current Cow
g
Farrow to Feeder D ;` Ptoul Ca aci Po _' Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets I jBeefBroodCow
Turkeys
Other Turkey Poults '
NJ 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 []j'1 o_ ❑ NA ❑ NE
0 Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes [ o
[:]Yes V3-Ro
ffRA ❑ NE
O'NA ❑ NE
[3<A ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Factlity Number: 7 - Date of Inspection: p OU
Waste Collection & Treatment
•4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Pd'`-5— ❑ NA ❑ NE
❑ No Q-NC ❑ NE
Structure 5 Structure 6
❑ Yes U2,1Q'o ❑ NA ❑ NE
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 [1 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CJ�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 E2'Ro ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:I'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. D 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): . IV C7
13. Soil Type(s): J4, 5 &(9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [. J "o ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes [3rlTo ❑ NA ❑ NE
l6. Did the facilityfail 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?
Required Records & Documents
❑ Yes [�r"No ❑ NA ❑ NE
❑ Yes r;�Mo ❑ 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
[31�o
❑ 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
EfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
D Yes
o
❑ 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

Facili Number: - Date of Ins ection: f?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[T o
❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[�'�To
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q'1 o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes
<o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3 o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3"No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ZrNo
❑ 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
[fNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinjis of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Sag_ 6 tiSl
Phone: 4 fir- 3 3
IU Date: o 00v
21412015

Type of Visit: t(yCompliance Inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emertency 0 Other 0 Denied Access
Date of Visit: rival Time: ;pJ Departure Time: �nd County: Region: �'J)
Farm Name: A 1 l C ri Fa kw[.S T�vt^c. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Ls Title: Phone:
Onsite Representative: 0)_ Integrator: _ = _ -I TO 7
Certified Operator: pu aM. Certification Number: L&q q2�
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
_
Design Current
Design
Current
Desiga Current
Swine =
Capacity Pop.
®Vet Puuftry
Capacity
Pop.
CattleMCapacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer_lDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
DryCow
Farrow to Feeder
D , �P,oultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01
Soars
Pullets
Beef Brood Cow
.., ::
Turkeys
Other
Turkey Poults
Other
Other
DischarEes and Stream lmoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[D�N� NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
iJ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
2-1-A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D" No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
To
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili 'Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes U144,or❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2-117�_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-Aier-
❑ 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-Ai�
❑ 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
[D-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markets as required by the permit?
❑ Yes
[]_bio
❑ 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
B- o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ 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): ,M s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes p o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3-lq-o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes []-Na ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a o ❑ 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 [3 ' o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E:rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ NNo ❑ NA [] NE
Page 2 of 3 21412014 Continued

Facility umber: - Date of Ins ection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ 4NG
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 properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[-Ko
❑ NA
❑ NE
❑ Yes
[3-19`5
❑ NA
❑ NE
❑ Yes
D-'M
❑ NA
❑ NE
❑ Yes Q-Nu ❑ NA ❑ NE
❑ Yes �o [] NA ❑ NE
❑ Yes C Vo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes (Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Eallo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oa2es as necessarv).
row L�tG 9_0 13
sG.dS.e SCj-AA1
IL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Z o l 6
Phone:
Date: J
21412014

WA
(Type of Visit: Q�,=0utine
liance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Q Complaint Q Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: %�f Arrival Time: Q.V Departure Time:W .l County:
Farm Name: 1 �k"-,-t6w W�f Owner Email:
Owner Name: q Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representativ
Certified Operator:
Back-up Operator:
Location of Farm:
I S zx-f u Title:
e:
LliKi
("y
Latitude:
Phone: 1 Ll
Integrator: L3
Certification Number: I 0
Certification Number: Z
Longitude:
[]Yes
Design Current's 4 Desi!gn-
I Current n Current
Swine Capacity Pop _ . ' Wet Poultry . Capacity op� �Catile Capacity Pop.
wr .ems r
Layer Dai Cow
Non L a er Dai Calf
`" w Dairy Heifer
Deslgn Current D Cow
D P,oul Ca °ace Po Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turke s 7
RwF
urkc Poultser Other
nish eder inish ean Feeder Finish
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?
[:]Yes
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?
[�'No ❑ NA ❑ NE
❑ No
❑ Yes ❑ No
Q'1C1A ❑ NE
Q'NA ❑ NE
❑ Yes ❑ No ffNA ❑ NE
❑ Yes Eg1<l0 ❑ NA ❑ NE
❑ Yes FL7rNo ❑ NA ❑ NE
Page 1 of 3 1/4/2011 Continued
Latitude:
Phone: 1 Ll
Integrator: L3
Certification Number: I 0
Certification Number: Z
Longitude:
[]Yes
Design Current's 4 Desi!gn-
I Current n Current
Swine Capacity Pop _ . ' Wet Poultry . Capacity op� �Catile Capacity Pop.
wr .ems r
Layer Dai Cow
Non L a er Dai Calf
`" w Dairy Heifer
Deslgn Current D Cow
D P,oul Ca °ace Po Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turke s 7
RwF
urkc Poultser Other
nish eder inish ean Feeder Finish
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?
[:]Yes
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?
[�'No ❑ NA ❑ NE
❑ No
❑ Yes ❑ No
Q'1C1A ❑ NE
Q'NA ❑ NE
❑ Yes ❑ No ffNA ❑ NE
❑ Yes Eg1<l0 ❑ NA ❑ NE
❑ Yes FL7rNo ❑ NA ❑ NE
Page 1 of 3 1/4/2011 Continued
nish eder inish ean Feeder Finish
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?
[:]Yes
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?
[�'No ❑ NA ❑ NE
❑ No
❑ Yes ❑ No
Q'1C1A ❑ NE
Q'NA ❑ NE
❑ Yes ❑ No ffNA ❑ NE
❑ Yes Eg1<l0 ❑ NA ❑ NE
❑ Yes FL7rNo ❑ NA ❑ NE
Page 1 of 3 1/4/2011 Continued
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?
[:]Yes
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?
[�'No ❑ NA ❑ NE
❑ No
❑ Yes ❑ No
Q'1C1A ❑ NE
Q'NA ❑ NE
❑ Yes ❑ No ffNA ❑ NE
❑ Yes Eg1<l0 ❑ NA ❑ NE
❑ Yes FL7rNo ❑ NA ❑ NE
Page 1 of 3 1/4/2011 Continued
Page 1 of 3 1/4/2011 Continued

Facie Number: - Date of Inspection: {J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:)Yes ®4114Z ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [4-i4'o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `"'! 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑i. -Qo
❑ 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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3-No-
❑ NA
❑ NE
maintenance or improvement?
1 L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [J o ❑ 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): 19C'/ "6k G D
13. Soil Type(s): {7 `O LK
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑c --No ❑ 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 ff] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
�Io
[:3 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
[K-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t 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 EtrNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

t 7
Facility Number: - Date of Inspection: J
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 properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
E Igo ❑NA ONE
[P,M- ❑NA ❑NE
❑ Yes ®-mod ❑ NA ❑ NE
❑ Yes ❑c -No 0 NA ❑ NE
❑ Yes U:�No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [3.N6 ❑ NA ❑ NE
❑ Yes
[2ja.,
O NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
[RTo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: 1.5 — NVv
Page 3 of 3 21412011

7
type of Visit: ,.,ompptiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -1 Arrival Time: f (; 3 o Departure Time: U=1County: a--_ Region:
Farm Name_ L i ra'"e-t_5 ZKe. Owner Email:
Owner Name: �� tiQr n�. Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
25d"4,fr
/
r-�
Title: � .Soar,
a-
Integrator:
Prone:
Certified Operator: C', �z~��� Certification Number: wlelk G%
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Fr`0
Design Current.
Design ,Current
Design Current
Swine �7rCapaci;y Pop.
Wet Poaftry
Cap city °Pop.
Cattie Capacity Pop.
can to Finish Layer IDai
Cow
can to Feeder
I INon-Layer
I
f
eeder to Finish(
"" ' `' -
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P,oult .
C•_a aci P,o
Non -Dairy
Layers
I
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
-
Turkeys
- -
Other
___1__y 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 Q No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
[—]Yes ❑ No
❑ Yes [K No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): (.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ 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 [a 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 [3 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® 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): N ��
l3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes © No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes 10 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

r Facility Number: - Date of Inspection:-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ANo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
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
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
C&No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[S No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Callo
❑ NA ❑ NE
❑ NA] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #); Explain any YES answers and/or any additional recommendations or any other comments.
Use -drawings of facility to better explain situations fuse additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l�'��
Date: /0
21412011

Type of Visit: QY,Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name f f j r-tQy S -lj Owner Email:
Owner Name: %� ��lh'4S C , Phone:
Mailing Address:
Physical Address:
Facility Contact:
ev
Onsite Representative:
Certified Operator: C�� S y Z-)Loya ti
Back-up Operator:
Location of Farm:
Title:
Integrator:
Certification Number:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current _ Design .; Current ,
Design Current
Swine Capacity Pop Wef!PoultryCapacity Pop. .'Cattle
- Capacity Pop.
Dairy Cow
Wean to Finish Layer
Wean to Feeder
Non La er I Daia Calf
T.
Feeder to Finish
r "� ; �u ` DairyHeifer
,:
Farrow to Wean
Design _.Currents ' Dry Cow
"
Farrow to Feeder
KD Poult Ca aci m P,o Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Boars
i
Turke s
Other .,"
Turkex Pouits_"'`i
Other
Other
-
Dischar¢es and Stream Impacts
1. 1s 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 allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
�]NA ❑NE
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection: —
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: T �c
Designed Freeboard (in):
Observed Freeboard (in):(p
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes S No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[X 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
Eg No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jo 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 Types):
13. Soil Type(s): AJ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Co No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
® No
❑ NA
❑ NE
18. is there a tack of properly operating waste application equipment?
❑ Yes
25 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
® 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
[I 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
D NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ca No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility 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 M No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
[:]Yes
LNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ 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 paees as necessarv).
�� ���J/v��rt�j� �l�vl��L.lco%G.✓�K/v�y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3.300
Date: Z &
21412011

is-ai-Zv0�
ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of VisitCommpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
O outine O Complaint
O Follow up Q Referral O Emergency
O Other ❑ Denied Access
Date of Visit: S /7- d Arrival Time: Departure Time: %7 ;3v ,.,, County:
Farm Name: —1411 4N `Aa"15, TNC . Owner Email:
Owner Name: —Alf -rN FrtiVMs+ 711C - Phone: —
Mailing Address:
Region: r20
Physical Address:
Facility Contact: g" 1�uaG.v Title: <<� Phone No: QQ
Onsite Representative: ��a �/ Integrator: 11 — URo:.,V
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = ' = " Longitude: = ° 01 = u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish 17000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Laver
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife?
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
[9NA
❑ NE
[ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[FINo
❑ NA
❑ NE
12128104 Continued

Facility dumber: ']
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: Gag i
—I
Spillway?: S
Designed Freeboard (in):"�s ,
Observed Freeboard (in):
Structure 4
❑ Yes ,[R o El NA El NE
❑ 1�
Yes "No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]�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 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 0 0 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wct stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E3<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,��
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 3No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes2<o
❑ 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 ElApplication Outside of Area
12.
rr
Croptype(s) �tr r�cd�t (N' clir4� J .Satoh-GygillJ �f1,S. / _
13.
Soil type(s) A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E� oo
❑ NA El NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
LK
❑ 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
B<o
ElNA ElNE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
B 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 � /A <_V'_ is _ Phone: ?/0, Sl33• 3331"
Re-viewer/Inspector Signature: �u-+c� Date: _4 l ] — 2- O O g
12128104 Continued

Facility Number: 79 —97 1 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 appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
❑ Yes LT No ❑ NA ❑ NE
❑ Yes Bl�o ❑ NA ❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
' No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
DIL
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
9'No
❑ NA
❑ NE
El Yes
EKo
El NA
[I NE
❑ Yes B<o ❑ NA ❑ NE
❑ Yes E3 o ❑ NA ❑ NE
❑ Yes El<O ❑ NA ❑ NE
❑ Yes
ETNNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
12128104

Type of Visit ('Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine o Complaint O Fallow up O Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: % /fd Arrival Time: VV Departure Time: County: J
Farm Name: wit /�'% S_ 1AjG. Owner Email:
Owner Name: A.Z_ �� S� f rt/ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: ,�APhone No:
AOnsite Representative: r I�,/ Integrator: /"I— 2
Certified Operator: V/�l� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E-1 o Longitude: [= 0 01 =
is
Design Current
Swine Capacity 1?apul ttou
Wet Poultry
Design Current Design
Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Gilts
LEI Boars
Other
❑ Other
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (1 f 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 No ❑ NA ❑ NE
❑ Yes
❑ No
ErNA
❑ NE
❑ Yes
❑ No
EIINA
❑ NE
❑ Yes
❑ No
Ml�
❑ NE
❑ Yes
BINo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4.
,.,�
is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
'LTNo ❑l NA ElNE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No EMA ❑ NE
StryctUre l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: �E
Designed Freeboard (in):� }�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lla o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
B1vo ❑ 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
LI 1vo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9- Does any part of the waste management system other than the waste structures require
❑ Yes
Q ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,.,/
L�S1Vo ❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ 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) w 'm..I4 C t_- �!
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
O"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Mo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
6,2 -/' /� lvQ��/ , C'
541 e�.�r 7v � T 1-,J
Reviewer/[nspector Name ` L Phone: � Q —
Re-Hewer/Inspector Si Date: .3 /D
Page 2 of 3 41 12 8/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stacking ❑ 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
2<o-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
lyK
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EKo
ElNA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ET'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues /
28. Were anv additional problems noted which cause non-compliance of the nermit or CAWMP? [I Yes 2 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UYNo
❑ 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
[3 N
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L 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?
[I��
Yes
� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
.(P l�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

If
1 ��l5 cr�YGd 7-o/—DS
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: s--09-a S Arrival Time: Departure Time: //•'ZO,4 County: 06�d�✓ Region:
Farm Name: 4AA1` ZAI � t'�S G� Owner Email:
Owner Name: f�V lir�"I�..�G Phone:
Mailing Address:
r_.0,!0Q
Physical Address:
Facility Contact: � % �l4 9 N l'itle: Sly Phone No:
Onsite Representative: �[t�;4� „_• Integrator: e�
Certified Operator: Clay bey4NL Operator Certification Number: /S� Z-
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = [ 0 longitude: = ° = & = N
DesignYCurrME' Design
C*urr`ent Design Current
Swine
C►apaci#yam Popultion et,Poultrw Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ an to Feeder
❑ Non -Laver
❑ Dairy Calf
Feeder to Finish I
TOOO:: ' ..
_ Dairy Heifer
❑ Farrow to Wean-
�D fol u�
���+ El Dry Cow
❑ Farrow to Feeder
El Layers
❑ Non-Daiix
❑ Farrow to Finish
o�
❑Beef Stacker
❑ Gilts
Non-LayersEl
❑Beef Feeder
❑ Boars
❑ Pullets
❑ turkeys
❑ Beef Brood Co
,
Other;=:
❑ Turkey Poults
❑ Other
El Other
Number of Structures:
,�
Discharges & Stream Impacts
�f
1. Is any discharge observed from any part of the operation?
El Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
El�J No
�
NNA
❑ NE
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
❑ Yes
❑ No
L'1 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes. notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
[a'K`o
[__1 NNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[--]Yes
❑ No
2<A
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 7— 9 7
Date of Inspection -Dy�OQ
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
Cj NA
❑ NE
Structure l 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
ET'No
❑ NA
LINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ErNo
❑ 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
en-vironmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ElNA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
,rNo
ETNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
��
Ll No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance/improvement?
11,
is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
E o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12.
Crop type(s) CX�k L&C1 -- (G �-� S. O vevS
13.
Soil type(s) do 4
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L" I No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
��o
LfJ No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
NNoo El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'? El Yes
D o ❑ NA
❑ NE
Reviewer/inspector/Same ie ffs Phone: 11D, 933j 3300
Reviewer/Inspector Signature: Date: S D`j —ZLw
rage —, of 1 12128104 Continued

1
Facility Number: 71? —97 1 Date of inspection
Required Records & Documents , -��
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNZ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FrNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONC
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ No
E NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E Jfo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff 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
BINA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L�I NNoo
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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?
El Yes
��
LEI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El yes
�,,�
h7 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
0'5-o-
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ yes
2Z
❑ NA
❑ NE
Additional Commentsand/or Drawings: -.
Page 3 of 3 12128104

Type of Visit S Compliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: %'3/-D% Arrival Time: /O. l7 Departure Time: %f : County: tC04bG VA1 Region: lc*20
Farm Name: hf ll r/ 641 r/ivf . Z�j C _ Owner Email:
Owner Name: Case te '� Glit.y A" twtAl a Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ DuaGw1 Integrator: +
Certified Operator: �n /a, beva'i e' Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ; = N Longitude: = ° = ' [__1 U
Design Current
Design Current Design Current
Swine Capacity Population Wet Poultry
Capacity Population Cattle Capacity]Population
❑ Wean to Finish
❑ La er
El Dairy
Cow
Calf
Beef Stocker
❑
[I Dairy Heifer
❑
❑
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes RNo El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes Wo El NA El NE
b. Did the discharge reach waters of the State? (If yes.. notify DWQ) El Yes (�No [I 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) El Yes [9 No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes Wo El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes WNo El NA El NE
other than from a discharge`?
Page 1 of 3 12128104 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes RNo El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes Wo El NA El NE
b. Did the discharge reach waters of the State? (If yes.. notify DWQ) El Yes (�No [I 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) El Yes [9 No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes Wo El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes WNo El NA El NE
other than from a discharge`?
Page 1 of 3 12128104 Continued

r
Facility Number: 7g- 7 Date of Inspection T -D
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1P No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1rg
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2?No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
IN No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[MNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
V3 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) t GcrAd u after.. leolvr :s e- 5", ff
13.
Soil type(s) A& A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
99 No
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
-Comments (refer to gnestlon #): Explain any. YES answers and/or:anyrecommendations or any other comRients
iJse drawrio s of facili io better explain situations: use.addittonal pages as,necessa
Reviewer/Inspector Name Q I S ; -. _:,_,::, .
Phone:
ReviewerlInspector Signature:
Date: -7-.�Z - ZOO % _
Page 2 of 12128/U4 Confinued

Facility Number; 7$ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate box.
❑ WUF ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O 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?
❑ Yes
WNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
ja No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
7No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
PNo
❑ 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
7 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
DTNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facitity: Number: OF , 97
40 Division of Water Quality
0 Division of Soil and Water Conservation ..,
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %D Z Q(y Arrival Time: 2` D Departure Time: /; d County: Ay!% !ZrA/ Region: 'w
Farm Name: Owner Email:
OwnerName: ' b_- i-aA1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �i Phone No:
Onsite Representative:
.// Xli )(1, 4� jj Integrator: /l/f �lr��y ZaAl
Certified Operator: I"`K /),,g AL C474 AaiJcw/r Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
_; ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: [� o =, [� Longitude: =° 0 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j❑ Layer V
❑ Non -Layer
Dry Poultry
Other
❑ Other — -- —
IIJ Non -
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?
Cattle Capa
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
I Number of
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?
Page I of 3
❑ Yes [% No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(B No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number: 78— y Date of Inspection O ZS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
❑ Yes [A No
❑ Yes KO No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: La
Spillway?: ye,s
Designed Freeboard (in): Z 5,
Observed Freeboard (in): 65`1 ,S
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[NNo
❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[ No
El NA [I NE
through a waste management or closure plan`?
1
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ti No
❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
O No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] O ]bs ❑ 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 C%No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
1+ �No ❑NA ONE
®No El NA El 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): ]AAL
Reviewer/Inspector Name Phone �%/D �%3 — 3 Q�
Reviewer/Inspector Signature: Date: %O
rugr vJ J /L/Z01V'# l.unlanueu

r
Facility Number: 7 — 7 7 Date of Inspection
s Re aired 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 P) No ❑ NA ❑ NE
the appropriate box_
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�5No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
pNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
YV
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P9 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
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional .Comments and/or Drawings:'
w
Page 3 of 3 I2128104

18 H 17-4
IType of Visit AD Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 49 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10jf Arrival Time: Departure Time: County: Region:
Farm Name: �W L5u rv,_ Owner Email:
Owner Name: Vim+4-t— hp uuri i&- Phone:
Mailing Address: I3 t eaot,2
Physical Address:
Facility Contact: 1 - Title: Phone No:
Onsite Representative: _ate j, _ Ntgt ._ i4i (�wtv%lntegrator: A VY`A 6 —
Certified Operator: Ve i �3 �"t e !u t=_y` _ Operator Certification Number: 971 q 11D
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o a 1 0 , Longitude: ❑ 6 ❑ 1 ❑
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the convevance man-made?
Design Current '
Cattle Capacity Population -.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy 1-leifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
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)?
i
Beef Brood CoV4I
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 9,No ❑ NA ❑ NE
❑ Yes
❑ No
IKNA
❑ NE
❑ Yes
❑ No
KNA
❑ NE
P§ NA
❑ NE
❑ Yes
❑ No
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
&o
❑ NA
❑ NE
12128104 Continued

IFacility Number: —+8 — `1'4 I Date of Inspection 31
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LKNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No L'NvA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 'ef
Spillway?: e7
Designed Freeboard (in): -�j�•
Observed Freeboard (in): �3b
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
[RNo ❑ 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
[R�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
D 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
RSNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
►,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of�Wind Drift ❑ Application Outside of Area
CZ.y° 1 tSB�
p
12. Crop type(s) DQ rwL— _q c� � , S n'L" eB r-ct � W - 6:Ae
V V
�
13. Soil type(s) p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
& Is there a lack of properly operating waste application equipment?
❑ Yes
JQ No
❑ NA
❑ NE
IReviewer/Inspector Name _ gm Phone: 9�_ ws-_6ofaz y I
Reviewer/]nspector Signature: �� Date: mA1�p�
12128104 Continued

Aility Number: '-} — Cl-+ Date of Inspection Il) 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1BNo ❑ NA ❑ NE
the appropirate box.
❑ WUP✓ ❑Checklists El Design" El Maps' El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5RNo ❑ NA ❑ NE
❑ Waste Applicatiow-' ❑ Weekly Freeboard"❑ Waste Analysis" ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification-'
❑ RainfalY ❑ 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
[25.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
[9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5d No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12128104

5
(Type of Visif ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for visit 40 Routine O Complaint O Follow up O Emergency Notification O Other
0 Denied Access
Facility Number Date or visit: /R .2 Tune: �
.... , 0 Not rational 0 Below Threshold
Permitted 10 Certified 13 Conditionally Certified 13 Registered Date'Last Operated or Above_ Threshold:
Farm Name: _ [ � ��+r t� c�_r�vc. County- . _ _&.e"�P'u �12a
Owner'' -Name: -_ y —xeC ./Zr' j.A- _ .... _ . 'Phone No: yl . A�i
Mailing Address: ..�.� ,f
Facility Contact: . __ _ _ _._� Title: _____. Phone No:
Onsite Representative:�1-6464-
- - - — -- integrator:
Certified Operator: ------------ , Lbur Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude �• ��"
awme -
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boors
Deszgm -Current - De:i Current
COP 1 &2aA
Namlir~r-b�Lagvons
..-
o :-MCatde
❑ Layer Dairy
Non -Layer Non -Dairy
Other
Total DeSigII.`.Capadty
Total SSLW
Discharrres & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
egp` Cmzetit
❑ Yes No
❑ Yes ❑ No
[:]Yes ❑ No
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? � �illway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .3 7JI
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes 16 No
Structure 6
12112103 Continued

I
Cty Number: 79 — g 7 Date of Inspection
1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes [P No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑Yes IM No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M No
8. Does any part of the waste management system other than waste structures require maintenanceftmprovement? ❑ Yes [� No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes j No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type � � r � � ai ra Z / Sill
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for laud 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 [9 No
16_ Is there a lack of adequate waste application equipment? ❑ Yes jNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 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.
' ijr"JJt,:e ia'?,00.v Oles ig.)
Reviewer/Iaspettor Name
Reviewer/inspector Signature:
Feld
I-ALof ,`r%arC,T-,i 31. 3 "1 O-C
Date:
Finals Notes
!�?_3
12/12M // ' ' Cold

cility Number: — 271 Date of Inspection
i
Rewired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28_ Does facility require a foIlow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDF.S Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 10 No
❑ Yes No
❑ Yes No
❑ Yes j� No
❑ Yes No
❑ Yes [jj No
❑ Yes 0 No
❑ Yes CP No
❑ Yes W No
1P Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes A3 No
❑ Yes No
❑ Yes No
12112103

Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visii O'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 9-9'a Tune:
NNot Operational C Below Threshold
®-P&mitted E'Ceirtiified /3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: _.._...-... ..
Farm Name: H.aArtX.,...-...... County:
Owner Name: ......... . .............................. . . .... .... . . ....... _..._.. _._ ......._.... Phone No: .�...
Mailing Address:
Facility Contact : ............................................... .......-..... .� Title:.........................-•••--................................. Phone No: ............ -....
_ ..
Onsite Representative: Integrator:
Certified Operator:........ Operator Certification Number:
Location of Farm:
M-Sw'ina ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude •
Design Current De�ga Current' - Design Current
_.
Swine Ca a ;P©itfationpoultry ;-Ca_ ci Population Cattle .Capacity .'Po ion
Wean to Feeder 7 ❑ Layer ❑ Dairy
er to Finish JE3 Non -Layer ❑ Non -Dairy
El Farrow to Wean
Farrow to Feeder
Farrow to Finish - - Total D C8 BCit
Gilts P Y T
Boars Total SSLW }
_ r
Number of Lagoons W
•AnRdirio Pnitric / Cniirl'Tranc-= _ _ — ` � s- ` `'
Disc es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ONO,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment I-, 'I-,
4. Is storage capacity (freeboard plus storm storage) less than adequate? [E'spillway ❑ Yes ❑'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ....... •I ............. ...^...................... .....
Freeboard (inches): 3
12112103 Continued

Facility Number: — q Date of Inspection t--�-1
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Avnlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
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?
(W WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (iel 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?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ny recommendiho orany�1
awings of facdit- better eaplam s�tuahvns (use addihonal es as
p g neeessar}),❑ Field Copv ❑ Final Notes
EU,R
-fia in n Jai r
Reviewer/Inspector Name
Reviewer/inspector Signature: M"'A tj _,r.rahi� Date: `� "� -v e
05103101 Continued

l�-��.�--w. �� .�� -- ,t ,.. _ _ ..�. < .,. _ ...tee .- _-- -•- � - --- �.. =— _ - -11
Type of Visit X Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit fiKRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
r
Facility Number Date ofVisit: Time:
10 Not Operational Below Threshold
Permitted ❑ Certified itionalh' Certified Registered Date Last Operated r A .'e Threshold:
Con
Farm Name: 0/ b ! � Count-•: , � -j'D'z,
Owner Name:
tilailing address:
Facilih- Contact: -54lbt er-- Title:
Onsite Representative:
Certified Operator: j'1--
Loc2tian of Farm:
Phone No.
Phone No:
Integrator: - 9P'04JArS
Operator Certification Dumber:
C Z Fr-3Sg
Swine ❑y ❑❑ Poultry Horse Latitude �' �� Longitude
Design
Current
Swine Capacity
Pa ulatioi
El Wean to Feeder
eederto Finish
Farrow to lkean
❑ Farrow to Feeder
❑ Farrow- to Finish
Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
C
Design Current Design Current
Poultry Capacity Population Cattle Ca ackh. Population
❑ Laver I I I IQ Dairy
❑ Non -Laver I I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
ILl Subsurface Drains Present ]]Ll Lagoon Area IIJ Spray Field Area
❑ No Li uid Waste Manaoetnent System
Discharges & Stream Impacts
l . Is am, discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is observed. was the conyevance man-made?
b. If discharge is obsen-ed, did it reach Water of the State? (if yes. notify DWQ)
c. if discharge is observed, what is the estimated flow in saUmin?
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
❑ Yes 11No
❑ Yes 2�No
❑ Yes No
❑ Yes
No
Yes
%No
❑ Yes
JNo
❑ Yes
�lJZ
Structure 6
Identifier_
Freeboard (inches):
05103101 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type wamack
13. Do the receiving crops differ with those designated in t 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?
Reduired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 1
t7 No
❑ Yes �No
ElYes o
❑ Yes o
❑ Yes o
❑ Yes j4rNo
❑ Yes o
❑ Yes <No
❑ Yes 9No
❑ Yes q
No
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes l\ o
❑ Yes o
❑ Yes No
❑ Yes .VNo
❑ Yes Iro
❑ Yes (�f o
El Yes o
❑ Yes RfNo
❑ Yes "'--'
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question ##): Eaphiin any YES answers aadlor any recommendations or any other comments.
ilse drawings ofYacilit to better explain situations. [use additional pages as necessary): ❑ Field Copy ❑ Final Notes
Gtl c**zlYX)5 X .s dam- 5h,04 reco►zrIr 'W"// 6'. 4/0"�
w� t sa..�le <cwcs
/OV/S ?Ova(/
Revievverflnspector Name , . ,
Reviewer/Inspector Signature: Date: _ Z Z ` A
05103101 V y
Continued

Type of Visit 0 Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
FaciGtv number (late of Visit: z Time: 0
O Not ODerational O Be
® Permitted A Certified O Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: i./0/4•r/r/� jigek County:
Owner Name: Phone No:�
Mailing Address: _ 7 7� �ia.•� �f!// L _.��,tc>/ ��6�r6�
Facility Contact: ����.�i� , S•w110 Phone No:
Onsite Representative: �1. �,-'v Integrator: A�.�
Certified Operator: �JErf� -/z� Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 " Longitude 0 0 `
Designs Current_.,. = Design Current Design Current
Swine Ca acity Po ulatian ._'Poultry ." .... Capacity Population ' _Cattle Capacity': PapuW on
❑ Wean to Feeder
IN Feeder to Finish
I 0'aPkO
�OD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons JEJ entSubsurface Drains Pres❑ La oon Area 10 Spray Field Area i.''
Zttridnig:PondslSolid,Traps ^:` ❑ No Liquid Waste Management System
Dischar:es & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flog in galimin?
d_ Does discharge by a lagoon system? (If yes. notify D A'Q)
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 11 etion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes RNo
❑ Yes RNo
❑ Yes tgNo
❑ Yes ;iNo
❑ Yes (RNo
❑ Yes XrNo
[:]Yes fiij7Vo
Structure 6
Continued

I' r
Facility Number: ],?
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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 stucrures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes jNrNo
❑ Yes XNo
❑ Yes P�;No
❑ Yes M No
❑ Yes IN No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type �,f"�.++ �,• �� `�� //9.�.0� _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 4No
b) Does the facility need a wettable acre determination? ❑ Yes �EjNo
c) This facility is pended for a wettable acre determination? ❑ Yes �INo
15. Does the receiving crop need improvement? ❑ Yes MNo
16. Is there a lack of adequate waste application equipment? ❑ Yes PNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLiE, checklists_ design, etc.)
El
No
14.
maps
ati
Does record keeping need improvement? (ie/irrigon, freeboard, waste analysis &soil saifiple reports)
❑ Yes
N 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
A No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O�No
(ie/ discharge, freeboard problems. over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;91 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AVM N P?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer:to,ques on #):='Exphttn any YE5 answers sudlor any reeommencfstwns or anv,outer comments:
Use."drawings of facilityt© better explain situatlods f se adcirrsottisl pages as necessary) ' ❑ Fte1d Copv ❑Final Notes4 r
�o....�ii✓�.�.fc /ai�� � ��f��.>•�i /� Cd��9�A`ti• O""
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: r/ Z
05103101 Continued

Facility Number: 700— % Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 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 ,1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 MNo
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 YNo
Additional.Comments::$nd/or.Drawings: ,_ f.�- ` - .�.,� �•<_ t��: .y... ��f_. ;
05103101

Type of Visit A.Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: -4 Tune: Z�dD
Q Not Operational Q Below Threshold
Kfermitted 13 Certified 0 Conditionally Certified [3 Registered Date Last Operated orAbove Threshold: ....,_...
Farm Name: It "- +<.rX�.44r. N... J 't.1r w6f.................... County: _....� B�ly'�.............. _...W. _.
OF I
Owner Name:„..!.` .......................tf' I...! .................. .................. Phone No: ...... ...... Q?.[,C. ....... ... » .
Facility Contact: . "An ....... ]l.._. ... Title: ............................................ Phone No:.................. .. .
Mailing Address: ......... 1T...7 ...---.Z,CLI-1! 1I . g0,0.l�r......... ......4s/� a1 f. Na.... Zt�
t
Onsite Representative:..........., ......... 1. ................... Integrator: ...... _......
lt
Certified Operator:..... ................................�� Operator Certification Number-..
- rh' ..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & && Longitude • 4
Design Current Design ' Current ;Design Carresot
;Swine-:CPaulaAttie, aPifiionCa aci Population, Poultry a
Wean to Feeder ❑ Layer ❑Dairy
FerFnish ❑ Non -Layer ❑ Non -Dairy
F=1
Farrow to Wean -
Farrow to Feeder ❑ Other
Farrow to Finish TotW Design CapacityIT
-
Boars 'Total SSLW;
Number of Lagoons ❑ Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area
Holding Poods I Solid T q g y� raps. ❑ No Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. if discharge is observed. did it reach Water of the State? (if yes, notify DWQ) ❑ Yes o
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway ❑ Yes 0410
Structure I Structure 2 Structure 3- Structure 4 Structure S Structure 5
Identifier: ............................ .......
Freeboard (inches): 5
5/00 Continued on hack

Facility Number: — Date of Inspection 1 D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) YYYYY���CC[
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �n
Waste Application /'
10. Are there any buffers that need maintenance/improvement? ❑ Yes glo
11. Is there evidence of over application? ❑ Excessive Poying ❑ PAN ❑ Hydraulic Overload ❑ Yes fi<No
12. Crop type GL al-aw/4 /")M . t4r cx. n.. /9'ate r'
13. Do the receiving crops differ with those designated in wCertifted Animal Waste Management Plan (CAWMP)?
❑ Yes
o
rNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
I
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
$No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes XNo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
MNo
"k(No
19.
Does reeord keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JqNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R(No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
A( No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
25.
yere any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
21$io
'voatt:irwharisar-.eeb"wing "'�sj� - Yoo wiii-fec�ye to 'u�F :
:C'0aesi)eike:aXwukthisvisit:.----..•.•.-.•.•.-••................•.•.•..- .
::::::::
peu 1re [om. is i �- P �e fat4i 1 cw e `
�+c
lice l aroun� �n-ride Spa e e� [ aor- '4Car 711e ^&40 '0
&f-►+Mkol'GAe=W ri d M ctr•C-L ZOO 1�k 1/c" j gaao�.
SP �� /_'� reco.-z&. IT
Reviewer/Iaspector Name
Reviewer/Inspector Signature:
Date: 2l _/T—Ul 5/00

Facility Number: — Date of Inspection WE4EF41Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
27. Are 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 J�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
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/or Drawings:'>
5100

Facility Number Date of Inspection L2 -Zoe
Time of Inspection 24 hr. (hh:mm)
® Permitted © Certified l/3 Conditionally Certified E3 Registered 13 Not operationaloperationall Date Last Operated: ..........................
Farm Name: l��if����iJ ���-,....... County:........../'!..............................................
vv............ . ...../ ...... ._........... % }.......
(honer Name: ............�...Phone No: ,./ /�/ �G��.�vl.....
. .................................................... ! .' ..._............. ....... ................
FacilityContact: ................................... l.....'.. ..... .......././.............. Title:................................................................ I hone No:..... ...................................
'failing Address: .._....�.�.l...rl �rC4'��/ L:.1/�<.cGf{G'. ✓/�r€vr.11/...C��....r!,. .���1................
r/ ..........................
Onsite Representative:......l��f/K• liFrt_L- nciv,tli�!rie/L Inte;;rator:..... /�f...G1 ,. ....................................
Certified Operator: .......... h_,�---/-f--11.... 1 /r ............................ Operator Certification Number:..........................................
Location of Farm:
.......................................................................
Latitude �•�� �• Longitude �• C` ���
_ Design Current _. Desigri Current - Design Current
Swine Capacity Population --Poultry Ca aci Po ulation Cattle Capacity Po'ulahon
❑ Wean to Feeder ❑Layer "❑ Dairy µ'
NJ Feeder to Finish11`: ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean :•--..
❑ Other
❑ Farrow to Feederi
❑ Farrow to Finish - T6tal Design Capacity
❑ Gilts f
❑ Boars T6ta1' SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes W No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (II' ye,, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Dins discharge bypass a lagoon system? (11-yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .............. .......................................................................... ...............................
!J
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
3/23/99
❑ Yes No
❑ Yes No
❑ Yes lS No
❑ Yes IN No /
❑ Yes 13 No
❑ Yes IgNo
Structure 6
❑ Yes RNo
Continued on back

Facility Number: — 9 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes rkNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? � Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M No
Waste AnDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type �.c2�-uc14,�X0 _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P4,No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes M No
b) Does the facility need a wettable acre determination? ❑ Yes ANo
c) This facility is pended for a wettable acre determination? ❑ Yes PrNo
15. Does the receiving crop need improvement? j'C53(`Yes j] No
16. Is there a lack of adequate waste application equipment? ❑ Yes )k] 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?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes $ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes X,No
24. Does facility require a follow-up visit by same agency? ❑ Yes ;qNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0; �Vo yiolafigns or deficiencies were izQte0• 00izig ithis:visit. • . u will •receive iiq fui-ther
comes aridetzee. a%out this visit.... ...... .:::::. :::...:.. .. •
gs of facility to better explain situations' (use additional pagesEas necessary) „,
'7. �.✓+�,vuys �tTOEf'f ���� %`% su i fAf7� �.Cs �i cJF�I 6,�% /.✓r ��
oo
Reviewer/Inspector Name
Reviewer/Inspector Signature: «�,� �� Date:
AL

Facility Number. 78— Date of Inspection 7v
Odor Issues
26_
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
KNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
DTNo
28_
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ANo
roads, building structure, and/or public property)
24.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
PVO
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
Q No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
;qNo
Kona '_ -omments an OC swings:
i

3 Division of Soil and Water Gotirservation :Qperation Review Y
Division of Soil and Water Conservation _ Compliance Inspection
x
Division of Water Quality Compliance Lispection s,
Other Agency Operation Reviews:`--� -
w -
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection jZ� 124 hr. (hh:mm)
Permitted 0 Certified E3 Conditionaliv Certified 0 Registered U Not O erational Date Last Operated
Farm Name: ... '!. ........ rTl..%&rn........ ranyi...................... County: .........6elr........
Owner Name:.....4.1c ................... .... Mkurl . . ....................... Phone No:........
Facility Contact: ......... QwY4et� ...................................Title: Phone No:
.....................elj&
.................. ,,��ff...................................................
;Mailing Address: ..... �. Z/ ......J�b.!r{�. �. I v.0............... .......................... Z
Onsite Representative ......... Ng !�Bt. .... Integrator 13 d �......................................
Certified Operator
Location of Farm:
,,,,•„•..... Operator Certification Number.
r............................................................................................................................................................................... ..............i
Latitude �' �� �'� Longitude
. ._ :—•- .. �
Current - Design Ctir.. :Desi n Current Design e.
nt
SwineCapacity Po ulation _.Poultry _CCatte Cty.:t' a acity Po pulation
❑ Wean to Feeder -: ❑Layer ❑Dairy
cq
Feeder to Finish _ry; ❑Nan -Layer Non
El Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity QQC7 =
❑ Gilts {
❑ Boars Total SSLW
-' Nnmber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray fleid Area
v
Holding Ponds /Solid-TrapsjEj No Liquid Waste Management System ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was die conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. fakes 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 ? Structure 3 Structure 4 Structure 5
Identifier: IIf
Freeboard (inches): v....................................................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes )KNo
❑ Yes No
❑ Yes No
❑ Yes ANo
❑ Yes No
❑ Yes No
❑ Yes / j No
Structure 6
❑ Yes No
Continued on back
b�\ack

Facility Number: 7 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 de4gnated in the Certified Aninh 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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�'Va viola#icjris:ar efdencie mere noted iltWirig �his:visit' You will i•eaeiye 0 l'ui-thgr
:: correspondence: a��titi this visit:......: :::::::::::::::::::::::::::: -
❑ Yes KNo
❑ Yes $ No
❑ Yes 94 No
❑ Yes O'No
❑ Yes j No
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes kTNo
❑ Yes 9No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes j No
❑ Yes ONo
❑ Yes • qNo
❑ Yes 0,No
❑ Yes 100
❑ Yes <No
Uomments=(refer to_queshon #} =r xplarxi`any;Y) answers and/or_'any recommendations: or any other comments:
Use drawrngs of facility to better explain sihtatibns (use add�bonal pages as necessary) ry
�nRlm 1S Itet� Q�.d t� rrr; iDY- Lt�t Aa be aer4roykel,
l -f���� dlKe Lc�ot'k 6w l//111 r�is 41� i �bnsti Y1�1
ewe 1� ee, CI e,.F t" �e I'm ua(c� -J, 1I tit Sp���i �d Scl nt.zter a f q �.
rrict�� S�54ee , will l e ik r[ace i._ 5-,-,MPr A# trit
Reviewer/Inspector Name'o �_ M
Reviewer/Inspector Signature: Date: '79
3/23/99

Facility Number: ?-- '7 I?ate of Inspection $ = ]r
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
ElYes
*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
KNo
28.
Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
❑ Yes
ANo
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
KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
Cl Yes
f 4No
,
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
3/23/99

Y
Division of Soil and Water Conservation [] Other Agency
<.£�a�Y• wrr�m r �' 3�'u'��safc3N�` �.`�- yi�,i!.,
IRDivision of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspectioti 1 6-7
Facility Number Time of Inspection =24 hr. (hh:inm)
0 Registered jxCertified E3 Applied for Permit Wermitted I Not O erational Date Last Operated: ...................
}j �,, 1�s r / County: o
FarmName: ..........�.gel..[!I......._R !i........ ....� Y............................. _ ..............la ........................................
Owner Name: I�ii# �I r................. Phone No: /0
.................................................---...a..........-----------
Facility Contact: ............. ........... T114.rx ......... Title• Phone No:
Mailing Address:..............l.T f3. ..................................... ..."�...� .......
OnsiteRepresentative:. pc[it D _. �h �Cct�rt5 0 �--4nY /red...........
..----.�!.....�--�----�... �..................� Integrator:.............--•--....--�.......................-.........../......
Certified Operator: ...............:.........*.. ..k.w ....... Operator Certification Number•...- .... ��.
Location of Farm:
Latitude 0• C '" " Longitude ' 6 "
Design _ Current Des* Current A<$ Design Ceirrenf-'
ute a Capacity Population - Poultry, 'Capacity, Population -Cattle . Y_ CapacityPopalation
❑ Wean to Feeder
Feeder to Finish
DOCK
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ OtherW
Total Desegn Capacity
� G `
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes JAI 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 P No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JM No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
main ten a n c e/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;VNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 14 No
7/25/97 Continued an back

r
�acility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes A No
Structures tl.aUoons Iloldin Ponds Flush fits 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
Identifier:
Freeboard (fty ..... ,,��,,.e, A .............
10. Is seepage observed from any of the structures? O Yes ANo
11. Is erosion, or any other. threats to the integrity of any of the structures observed? J4 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 DAVQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
1j No
Waste Application
14. Is there physical evidence of over application? r
❑ Yes
No
(If in excess of WMP, or runoffenteringwaters of the State. notify DWQ)
15. Crop type
-�ln:....... {R^!� ................................................................. ...............................
.'.........................
.....
16. Do the receiving crops differ with those designate in the Animal Waste Management Plan (AW.MP)?
❑ Yes
Pj No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
Rf No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Js there a lack of available waste application equipment'?
s
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
;VNo
22- Does record keeping need improvement?
❑ Yes
No
For Certified or PernAlled 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?
(:1 Yes
(XNo
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
ONo
0 No.violations or deficiencies were noted during this visit.- You.will receive no further
corresoondence about this.visit.
Comments (refeir to question #): Explain any YES answers andAw i1ri.y recommendations or any oilier`""comments :F
UseAira hugs of facility to better explain situations. (use additional pages as necessary): °
-0 1r7 4 A441r s
U, `
o�• a
ell
3 l l �11F• art.t,•t LOO Vyt trlo— to fA4t S�]z . N*O
r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: b`t;.3 '- F9
d

r
Y .
Routine
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Follom--uo of
Facility Number
0 Registered Certified © Applied for Permit © Permitted
Farm Name:..Te`*�,f... t/J.
(�' ....
Owner Name:.....�[�i��...............t
L
Facility Contact: ... .. p_G„ �( r
Follow-up of DSWC review Q Other
. Date of Inspection
Time of Inspection • �� 24 hr. (hh:mm)
Not O erational Date Last Operated;,,,,,,,,,,,,,,
County:..... ��U...........................................
N........................... ... Phone No:.......................................................................................
Title: .... Phone No:
Mailing Address:..
OnsiteRepresentative:........................................................................................................... Integrator:......................................................................................
Certified Operator; ................ Operator Certification Number
Location of Farm:
Latitude • =1 " Longitude • 6 46
x Dedgn�' Ctierent k "Resign Current'. rt m Design CurrenR �.
w Swme „,Capatty Populations.;` Poultiya q s Capacity 5PopuIaH6 C cattle' ri Capacrty Population
❑Wean
❑Dairy
❑ Non -Dairy
d :von
n Capa
Boars
til,"SSLW9
� �_?ham aaa ,-;"�„ ---•s ¢wm*.- ,,:ir.^� � .. ^,
Number of Lagoons M61ding Ponds'
� s-::
fr El Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
.......
T
❑ 1o Liquid Waste Management
.,. _, Ski fi .s.-: orb_ <. ..x,•z-.x ...,, ..rv.. :.-:..., ''R� .as .*:6 i:- .e� '._ ?EFN »
to Feeder
..'.�
'
❑Layer
❑Feeder to Finish
; r;
❑Non -Layer
Farrow to Wean
Farrow to FinishOther
tal Desig
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 Sttrlaci. Water? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is obsen-zd, what is the estimated flow in oal/min?
d. Does discharge bypass a lagoon system'? (If yes. notify DWQ) ❑Yes ❑ No
3. 1s there evidence of past discharge from any part of the operation? ❑Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ❑ No
S- Does any part of the waste management system {other than la,00ns/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 ❑ No
71�5197 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes ❑ No
Structures (La oons.Holdirt 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
Identifier:
Freeboard (ft): ................. ............
10.
is seepage observed from any of the structures?
❑ Yes
❑ No
11.
is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ 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
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type ....................................... ... ....................... I .............................................. I..............__.................................................
...................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
❑ 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
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No.violatio'ns or deficieocie's.we.re noted.du' dng this:visit. Yon�will i&e' ive-na further
correspoitdeikce about this'.
visit:
ix&F -- +2 5 wS' XComments-- (6rebbfFFer to qfa .. �+ IaiTa any#Y3• ? - ... f i V�+so:-.-.. anny oK h4@^Cr..Cc as"mikmrne-.adnnh•-•-�,T
Use
3
-
dra�ags of�faclhty�td betier exphzp; 5�tuations Ytuse add[honal pages as necry} �.�ry ' �",�
.
j k i5 -GX'c-w'_ waS s ed i n NOV Ow . er ) R.`1 `7
IUd 'L s �7�`Or- 4) // be-perforw_Ej`�1 g 9 % Pr
P
If� I
Oc-� ker 1q17 1vt�wtorGtvLdw -fit-©
54-+aJe - clAer-
7/25/97
w
Reviewer/Inspector NameC5
Reviewer/Inspector Signature: Date:
v - 6