820026_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: QeZoutine
ace Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:ti`s (j `� Arrival Time: �` �. Departure Time: County:Sia 4.
Farm Name: � (�` P r a -✓m f Owner Email:
Owner Name: d- R�'tit5 C Phone:
Mailing Address:
Physical Address:
Facility Contact: co«��5 ��^�!(<e J( Title:
C�Onsite Representative:
Certified Operator: .(
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: U -S
Certification Number:-�('rr3
Certification Number:
Longitude:
1
111 1111 �!
11111 Design Current
❑ NA
Design
tu r te—n tj
t
Swine
Capacity Fnp.
Wet PoultryCapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Da iry Heifer
HNon-Dai
Farrow to Wean
n
Current
DryCow
Farrow to Feeder
Farrow to Finish
i
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef $rood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? {If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes []" o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes []No
❑ Yes [:]No
❑ Yes 0
❑ Yes []-ISo
C3,N'A ❑ NE
[TNA ❑ NE
D A
❑ NE
❑ NA
❑ NE
[]NA
❑N
Page 1 of 3 2/412015 Continued

11
Facility Number: jDate of Inspection:
24. I]id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ eo ❑ NA
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:
❑ NE
❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes <o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal`?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. 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 12-1Qo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes 02 -Ko ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes Er -No
❑ Yes E] No
[—]Yes 6
❑ NA ❑ NE
❑NA ❑N
❑ NA ❑ NE
Reviewer/Inspector Signature: Dater
Page 3 of 3 21412 4 5

Facility Number: jDate of inspection-
Io
❑ NA
❑ NE
Wasit Collection &Treatment
[Ej�ko
❑ NA
❑ NE
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
NA
❑ NE
S a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
❑ Yes
Identifier:
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Spillway?:
❑ 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?
Designed Freeboard (in):
❑o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Observed Freeboard (in):
❑'�O
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5o
❑ 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
E3<o
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
D o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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 ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-N' ❑ 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 r ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s): _Q (�,q Nr E�� () R tr
14. Do the receiving crops differ from those designated in the CAWMP? D Yesoto ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [B<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
Io
❑ NA
❑ NE
❑ Yes
[Ej�ko
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[DK -o
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EE�Ko_
❑ 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
ED Kb
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'�O
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: Date of Inspection:
52'1Vo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
of
❑ Yes
[a,Ko'❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[J -1V° ❑ NA
❑ NE
the appropriate box(es) below.
ETNo
❑ NA
❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[21No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑,N ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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
52'1Vo
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
❑-<o_
❑ NA
❑ NE
[-]Yes
� o
❑ NA
❑ NE
❑Yes
L2-Klo
❑NA
0 N
Comments (refer, to questlon #). Explain any YES answers and/or any additional recommendations or any other comthents , a
Use'i�rawin s of facili.Ly;it6 better explain situationsuse°additionalpages as necessar l
62-
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
-t7
1 A Phoncq 0' 1(3 3 -383 I
re: E-�Date: O
214/2 15

M
Type of Visit: e'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r2�
Date of Visit: Arrival Time: / Departure Time: County: �J ��% Region: F" C
Farm Name: r% �� S c?t,_) �T Owner Email:
U
Owner Name: -- (y(-c��'^��_- Phone:
Mailing Address:
Phvsical Address
Facility Contact: C���I S g0,^t✓tdt Title: Phone:
Onsite Representative: Integrator: MfJ s
Certified Operator: Cv'­4 q d it,y Certification Number:;,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.0 R � � �1AlYI11� �
a
�'
IJ "o
❑ NA
❑ NE
M yDesigneCurrent
Design
Current
Design Current
Swine t� ".C al W, Pop
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
s+ Yimi. ilkt
❑ Yes
[] No
[]4tA
❑ NE
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
❑ No
[BINA
Dai ry Calf
Feeder to Finish
❑ Yes
�o
❑ NA
Dairy Heii'er
Farrow to Wean
❑ Yes
Design
Current
Dry Cow
Farrow to Feeder
cit
P.o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
F„ Boars ±.
Pullets
Beef Brood Cow
x
Turkeys
Turkey Poults
Other,
Other
LL
:F.j:". i_ Lb li. :'::.v . I Po :::�. . I.. .:.'.....� 'F 1 X�m:'.;
..': ry t'u 111,:,v.�F.m Y.�- vuhv,m'
..1JS'mA.uX,AR4':w:.IDNLNNIii:.91G��
Disebarees and Stream ImnaCts 1p
1. Is any discharge observed from any part of the operation?
[] Yes
IJ "o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
[]-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
[]4tA
❑ 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
[BINA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E20`rVo
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 2/412015 Continued

Facility Number: jDate of Inspection: 71
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage Pius heavy rainfall) less than adequate? ❑ Yes E3 -N -o— ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No [-3-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
14. Do the receiving crops differ from t ose designs d in the CAWMP?
❑ Yes
[d
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
Observed Freeboard (in):T
acres determination.'
5. Are there any immediate threats to the integrity of any ofthe structures observed!
❑ Yes
EEj<o
❑SVA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q'No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q<o
❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Efl—No
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U/No
❑ NA
❑ N E
(not applicable to rooted pits, dry stacks, and/or wet stacks)
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2110
❑ NA
❑ NE
maintenance or improvement?
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Waste Application
ZI No
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]-No
❑ NA
❑ NE
maintenance or improvement'?
21411015 Continued
11. is there evidence of incorrect land application? I lyes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window � ❑ Evidence of Wind Drin [3 Application Outside of Approved Area
1'l
12, Crop Type(s): C� �- A , '� 6 ✓of6 0
13. Soil Type(s): i <r &�
14. Do the receiving crops differ from t ose designs d in the CAWMP?
❑ Yes
[d
❑ 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 tacility lack adequate acreage for land application?
❑ Yes
[ "o
❑ 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
Efl—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? Ifyes, check the appropriate box below.
❑ Yes
[DNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZI No
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[rNo
❑ NA
❑ NE
Page 2 of 3
21411015 Continued

I S rtrN (6
' ivision of Water Resources
. F,acity Number - ONo _11 sion of Sail and Water Conservation
Othe20 gen
Type of Visit:o%pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C7 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
t�h Arrival Time: Departure Time: County: Skkk Region:
Owner Email:
Owner Name: q Phone:
Mailing Address:
Physical Address:
Facility Contact: 6"1 '42.0- t'C l " Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Y A& 'b S
Certiflcation Number: /,. 7 qJ 7
Certification Number:
Longitude:
Design Current
Capacity Pap.
Finish
rWFeeader
Wet Poultry
Layer
lReslgn
Capacity
Current
Pap.
Design C*urrept
Cattle Capacity Pop.
Dai Cow
1. Is any discharge observed from any part of the operation?
Feeder
Nan -La er
❑ NA
❑ NE
Dai Calf
o Finish
Farrow to Wean
Farrow to Feeder
Dr, P,ouI-T
Design
Ca _4c It
Current
P,o -
Dairy Heifer
[Dry Cow
Non -Dairy
NA
Farrow to Finish
Layers
❑ Yes
❑ No
Beef Stocker
c. What is the estimated volume that reached waters of the State (gallons)?
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other J
Pullets
Turkeys
Turkey Poults
Other
❑ Na
NA
❑ NE
Beef Brood Cow
❑Yes
o
❑ NA
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2�- o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
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
❑ Na
NA
❑ NE
2. Is there evidence of a past discharge from any pari of the operation?
❑Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste &flection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2pir`❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑No O -WA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ Yes
ffNc
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
ErNo
❑ NA ❑ NE
the appropriate box.
Designed Freeboard (in):
❑WUP El Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
Observed Freeboard (in): .
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C2<o
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[jj-<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[!�No
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[]30<o
❑ NA
❑ NE
waste management or closure plan?
214/2014 Continued
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
[34o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2,1qo
❑ 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
[3"no
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[21
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []3*<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): V3 �_S 6 D r1 dL
13. Soil Type(s):
14. Do the receiving crops differ from th6se designatefj in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
V /
❑ Yes [Et o
❑ Yes [!<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [3-1<o [] NA ❑ NE
[:]Yes [211o' ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNc
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ErNo
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C2<o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 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
[] No
❑ NA ❑ NE
L� Page 2 of 3 .
214/2014 Continued

Facility Number: -I JDate of Inspection:
24. Did file facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z]"11o'_ ❑ 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I3'"o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [24K ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L1d►?1'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 [ 1 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 [5<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes []5o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [:�No ❑ NA ❑ NE
Comments (refer to, question :#): Explain any YES answers and/or any additional recommendations or any.other comments.,'
Use'dratwings offacility to better explain situations (use additional. pages as necessary),
1.3
3,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
It
Phone:
Date: tot
2/4/2011

W[ ( (DR IS 56)
&tMivislon of Water Quality
Facility Number w, � - � 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: G<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 009outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' ,30 Departure Time: / a County:
Farm Name: (� Q,U vwj C` "4,&,2 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: CU yJ71 C p�.n'v Cl�,�' Title: Phone:
Onsite Representative: _ Integrator: MIG
Certified Operator: T Certification Number: S 7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean =eOtto
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Impacts
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La cr
_ E3
Pullets
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
—Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. is any discharge observed from any part of the operation? ❑ Yes 0>�—❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other: `
a. Was the conveyance man-made? [:]Yes ❑No 0<A ❑ NE
h. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No [�5<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 DWQ) [:]Yes [] No LZrNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EfNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

' Facility Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is -storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
g -?da
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D-N7V
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
❑Other:
Spillway?:
❑ Yes
YNo
❑ NA
❑ NE
Designed Freeboard (in):
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Observed Freeboard (in):`
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9'
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ubflo-
❑ 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
©-iKo
❑ 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
[-Ko
❑ 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
❑-10-
❑ NA
❑ NE
maintenance or improvement?
Waste Amplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3,No'
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑-h o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ,❑ Application Outside of Approved Area
12. Crop Type(s): � ey USA .�-�-q. S i� o rl ty /� i -, < - 'ti
❑ NE
t "
13. Soil Type(s): '*
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3"5o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []'t o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes [3No ❑ NA ❑ NE
[3 Yes [a"No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L'J 'No
El"
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[-.3"'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
YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9'
❑ 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 2/4/2011 Continued

` Facility Number: - Date of -Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D No ❑ NA ❑ NE
t -
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes tS"" ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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 [:kN`o ❑ NA ❑ NE
❑ Yes []--[Vo ❑ NA ❑ NE
❑ Yes Q -No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
C20<o
❑ NA
❑ NE
❑ Yes
[2 -No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. I
UseArawings of facility to better explain situations (use additional passes as necessary).
C
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % 1k l-� J
Date: S� D& j S
2/4/2014

�31wms 13 LKtrj IQ(3D
`11 v slon of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: qJ9,ornpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow -u 0 Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County. Regia
1 "i
Farm Name: --�LV-`M- S I— -t, Owner Email:
Owner Name: .„.„ J �T Phone:
Mailing Address:
Physical Address:
Facility Contact:
<, +q G et"r C.e Title:
Onsite Representative: kr
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other.
Latitude:
Phone:
Integrator:
I
integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Discharees and Stream Imnacts
Non -La
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
t. Is any discharge observed from any part of the operation?
❑ Yes
[,r] -ale.
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0 No
[3 -N -A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
[] No
[3 "'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 DWQ)
❑ Yes
❑ No
Ej<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
❑filo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Quo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

[F Date of Ins e�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes E] -M ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [dam❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � o ❑ NA ❑ NE
(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 ❑ 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 g;-PFa, ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes :.�/❑ 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 Z rNo❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] YesNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If ycs, check the appropriate box below.
❑ Yes
2j"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop indow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EjlIo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5 -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6 --No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
E2<o
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�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. 0 Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ ]rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes VN
❑ NA C-]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

f~rrcili Number: - Date of Ins ectio
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:
1_JNo ❑NA E] NE
M,o ❑ NA ❑ NE
26. Did the facility fail to 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 9.9-0 ❑ NA FINE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesNo ❑ 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 10 ❑ 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 Io ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E leo [3 NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ YesF!(No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
17
Sf"� 5� ErF 40 P__C_ 5 ( _/S�
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Lt
Date 1
/ /2011

01VIvision of Water Quality
Facility Number ®- ® Q Division of Soil and Water Conservation
O Other Agency �lP
Type of Visit:��om��pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: GJ utlne 0 Complaint O Follow-up C) Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: 3 D `1 Departure Time: Q 3a County
Farm Name: ; eMcl rr �,a�Q �H�.� Owner Email:
Owner Name: 1 �o� l �/� IS�'^^� C� ([ ` n r�_ Phone:
Mailing Address:
Physical Address:
Region: �_
Facility Contact: ;�Y�o� u i n Title: X9 Can y. - Phone:
Onsite Representative: Integrator: --o4 _xvtod-ter
Certified Operator: Certification Number:
Sack -up Operator: Certification Number:
Location of Farm:
Design. Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
eederto Finish p
Farrow to Wean
Farrow to Feeder DO
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non -L;
Pullets
Other
Poults
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?
I Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dai Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Z. No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
Page l of 3 2/4/2011 Continued

Facility Number: r- Date of inspection: 3
/
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
® No
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
❑Other:
Designed Freeboard (in): l
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[! Weather
Code
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[R No
❑ NA
❑ NE
waste management or closure plan?
2/4/2011 Continued
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health
or en ronmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
0 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZI 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 aLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind/ow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):d11Ll�rt..----
r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or dperate 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
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ELNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[! Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[& No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number; & - (p Date of Inspection:
1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E] NE
❑ NA ❑ NE
❑ Yes ❑c No ❑ NA ❑ NE
❑ Yes gj No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes JZ] No ❑ NA ❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any :YES answers.and/or,,any additional recommendations or any other�comments �. f;
Use drawings of-facllity to better explain. ituations (use additionui pages` as, necessa ):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ,j
2/4/2011

ivision of Water Quality
Facility Number ®- O Division of Soil and Water Conservation 7-1
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 17-7-IL1 Arrival Time: r a(7 Departure Time: County:Region: ��
Farm Name: ���,� �a• �a �►y� Owner Email:
Owner Name: 7—e 4(y 0a r ri Phone:
Mailing Address:
Physical Address:
Facility Contact: U; Title: 4221,y� Phone:
Onsite Representative: _ `rl _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
❑ No
Wean to Feeder
❑ NE
Feeder to Finish
D
Farrow to Wean
ppp
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dai Caw
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes R_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes C, No
[—]Yes Ca No
❑ NA ❑ NE
❑NA [j NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - A t,, D I Date of inspection: 7-7-/1
Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes allo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): % f�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 No ❑ 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?
❑ Yes
EL No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
JK� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eig-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): er '!f�(/G+�^.
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 ® 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
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EL No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
0 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 [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 2/4/2011 Condnued

Facili Number: - Date of Inspection: -- ?
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CS 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 provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[]Yes allo ❑ NA ❑ NE
❑ Yes 2] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes
Ea No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
Cominents (refer to question#) Explain tiny YES answers:and/or anyudditional:recommendations ar any other comments �� 1 4 ki
Use drawings of facility;to better''explufn situations (use addltionnl pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:f p-133-3Jt�o
Date: 7 '7-4igo //
2/4/2011

"vision of Water Quality
Facility Number 0 Division of Soil and Water Conservation,.
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Qk5fructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency &l6ther ❑ Denied Access
Date of Visit: O Arrival Time: ; D Departure Time: ' / County: P" Region:
Farm Name: r"�% �''J'1✓L� __ Owner Email:
Owner Name: ��`��'�' u-� ✓t rti Phone:
Mailing Address:
Physical Address:
Facility Contact: IZ4 aij V Title: OLUnwe— Phone No:
Onsite Representative: ,4'� Integrator:Idz 'X'9w
Certified Operator: Operator= Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6 = Longitude: = o = i =11
Design Current
awiur Uspacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry. Capacity Population
❑
Layer
❑ Non -Layer
Dry Poultry
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design 'Current
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures.,
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 CgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
[:INA
❑ NE
[]Yes
SNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: ( Date of Inspection r
Waste Collection & Treatment
�`. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes J,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:
4�it
r/yG
" t�:
Phone:
�JD`'1%— Tjet'
Spillway?:
Date:
_z:w4w0
Designed Freeboard (in):
Observed Freeboard (in): 3 7
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
N 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
allo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 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
E.No
❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2!�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside of
Area
12. Crop type(s) l pi zf}!'!�_,- �f
13. Soil type(s) &CA /N,? G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
AnTCTFvr^.n- rrrd s
e Z2 �i 4.6,
a �'Ai7�-wdJ bay
off` / 4 / D., I"� s _44 W,) �'_Prx-Wa 5 Alaor l k to
Reviewer/Inspector Name
4�it
r/yG
" t�:
Phone:
�JD`'1%— Tjet'
Reviewer/Inspector Signature:
Date:
_z:w4w0
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
r Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PrNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2I. Does record keeping need improvement? If yes, check the appropriate box below. [--]Yes SNo ❑ NA CINE
❑ 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 C -No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA EINE
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
[3No
[:INA
❑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
EINE
Other Issues
J
7
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
ENo
❑ 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
IN No
❑ NA
❑ NE
Additional Commen'fs*and/,or'iD"ravings , ?V �r,
, pry r � .
J
7
Page 3 of 3 12/28/04

Division of Water Quality d'7— Ob
=Fadlityumber 0 Division of Soil and Water Conservation 4.� !'
0 Other Agency
Type of Visit (YCo—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &40-'Utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:; V t7 Departure Time: County: Region: JEEZb
Farm Name: Ze-a y''.1— ym'-__ Ai.101.1 Owner Email:
Owner Name: �jc " u n ►1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 G7 dy ( V tA�, ✓. ✓— Title: f)tt 1 ja .eg— Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o =g = Longitude: =0=& o=
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder I ILI Non -Layer I EEI�
Feederto Finish "
❑ Farrow to Wean
NLFarrow to Feeder 00 00
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (Ifyes, 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 1 of 3
[]Yes. A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: - Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;EI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5P 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 Z.No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5dNo ❑ 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 rWindow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) B-rr t'In�.j U
13. Soil type(s) / AIT Z&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZLNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes ANo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes C, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
❑ Ycs
ZNo
❑ NA
❑ NE
❑ Yes
1KNo
❑ NA
❑ NE
ReviewerA nspecto r Name , Yv ®� e _ Phone: 1�`Jli',1i3_7_33od
Reviewer/Inspector Signature: Date: 7� —,-.zO I O
Page 2 of 3
I ZI-M/U4 UmUnuea

Facility Number: — Date of Inspection L t9��
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 59 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®.No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®,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
M -No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(RNo
❑ 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
[RNo
❑ 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
allo
❑ NA
❑ NE
v Al d7c . ",a�'Bi i.Yr-U: t4 r'l"$E �" €s ti i,.P�"n�, Jk , y__i: 'b' f ,f �:: �I(' I �,p i{�?'�� � h -- :_ � i � N;,�.
Additlanal Comments and/or Drawings � ' ,Il; spa t s ;.
r ,....:......._,., ...., t ..kl:f.
� ...y;i
.e ��'�ti� f '� J_- - �..4 t w. "", , ..' :, � MINOR
,,, c i .1,01
.AL
Page 3 of 3 12/28/04

All
O Division of water Quality
Facility Number �� J �tJ O Division of Soil and Water Conservation
- O Other Ageney rte
Type of Vis€tCC�ommpliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
C7 KGutine 0 Complaint
O Follow up O Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:% / Arrival Time: Departure Time: County: " Region:
Farm Name: gam✓%em e— Da ' -.—L �� � Owner Email:
Owner Name:. zIAfH/)IJr 1,S 01-1- . Q I -A ; yx A. Phone:
Mailing Address:
Physical Address:
Facility Contact: rL-JJ je ©� + ►'l yt. Title: 4j2j'r Phone No:
Onsite Representative: 0L—.t_ Integrator:
Certified Operator:.. J."e-- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ I =61 longitude: =0=1
001 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder 100
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non -L
Pullets
POURS
Discharp,es
& Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Design Current
Capacity Population
❑
Number of Structures: 0—
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No [:INA ❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑Yes
❑No
[INA
ONE
[:1 NA
[:1 NE
❑Yes
El No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
12/28104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f �r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V3 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
RLNo
❑ 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
DQ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZINo
❑ NA
FINE
(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
[2�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) �3rr, at._� a4ea .S=e
13. Soil type(s) f7eA h4a (�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 N ❑ 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 [- No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No ❑ NA ❑ NE
-
Co'mn ents (refer to question #): Explain any YES answers and/or any recommendations oria.ny othericbmments t {
Use drawings of facility to better explain situations, (use nddrtional pages as; €
!,.
Reviewerllnspector Name t]9
e�--� x;r Phone:i�—'f �3-�33
OF
Reviewer/inspector Signature: Date:
11128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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
&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
allo
❑ 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
J -No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E.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
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
12/28/04

.'w
Type of Visit QCommpliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 04outine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q' Arrival Time: 1 1,0 Departure Time: County: Region:
10,
Farm Name: _aepiau a e— r %w~ Owner Email:
Owner Name: r alJtl A/C 15 vn. (? LA, ei r` Phone:
Mailing Address:
Physical Address: I
Facility Contact: / �[ r -A PI Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: f
Operator Certification Number:��J�
Sack -up Certification Number:
Location of Farm: Latitude: =a = = Longitude: =o=, 0"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
114-09911111
! ,Currenty,t
'AallDestgn
Design Current
❑ NA
Design Current
7.Swine .; a" 4.•
r} rCapacity;'Popu.
on" r yWct lPoui ry
�' �: .
Capacity Population
Cattle
Cap ^city Population
_ ❑ Wean to Finish
k's [] Laver
❑ No
❑Dai Cow
❑ NE
❑Wean to Feeder
�' ❑Non La cr
❑ No
❑Dai Calf
❑ NE
. ® Feeder to Finish
t k" 7.
t , �. `" '"
❑ DairyHeifer
❑ Farrow to Wean
1)ry Poultry
❑ No
❑ D Cow
❑ NE
Farrow to Feeder
❑ Yes
�&No
ElNon-Dairy
❑ NE
❑ Farrow to Finish
❑ Layers
allo
El Beef Stocker
❑ NE
❑ Gilts
❑ Non-LayersMets
10 Beef Feeder
❑ l3oarsL]
❑ Pullets
Continued
Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑Other
❑ Other
IIINumber of Structures:
7[�-h21E�5.c�-.rii v��'.:µ���:i'eI .ki1i: �'4�•h3.. r... -l. � rY. ����-'.x�.C.� �il�i �l.:.u�,;,i'F tai-0.lAi il��ll�.:�':�L:�E''.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

t
Facility Number: — Date of Inspection$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31.99
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes RLNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes (91 No ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [SNo ❑ NA EINE
(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 D� No [INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [H No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ANo [:INA ❑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 types) 3eV_7 1 J,,
13. Soil type(s) IL2 Zt 4 Ma U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
Reviewer/Inspector Name { "� s�'oi'r-; Phone: y`!1?- 33a v
Reviewer/Inspector Signature: Date:/p-t;9L';4a 0G
Page 2 of 3 12128/04 Continued

r
,t
Facility Number: — Date of Inspection Io- e
Required Records _& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I Maps F-1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? [:]Yes [g No [:INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2No [INA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Cg 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
J,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
JZ 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
RNo
❑ NA
❑ NE
A;ddltional,Comm n'tsand/or Drawings: ''; r,�_' t ,
Page 3 of 3 12128/04
Page 3 of 3 12128/04

I
ivision of Water Quality
Facility Number s f0 Division of Soil and Water Conservation
Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r�3oG Departure Time: jD County:
Farm Name: ff�/�- !�'�� Owner Email:
Owner Name: 7�1��,�(+' �i��.S�� �li: r1 n Phone:
Mailing Address:
Physical Address:
Facility Contact: V1 Title:
Onsite Representative: .-, e
Certified Operator: .S'A ,1�1_
Back-up Operator:
Location of Farm:
Swine
l❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
LJ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Region:
Phone No:
Integrator: �'' •
Operator Certifica ion Number: 424 sl ._
Back-up Certification Number:
Latitude: 0 =1 Longitude: =0=1
°01
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
t ❑ Non-Layet
a -r -i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowj
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: '
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard'?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [RNo [:INA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
ldcntifier:
or wettable acre determination?[] Yes
XNo
❑ NA
❑ NE
Spillway?:
❑ Yes
[RNo
❑ NA
EINE
Designed Freeboard (in): / %
❑ Yes
®.No
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR 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
[KNo
❑ NA
EINE
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
10 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,IR 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
[ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) An" Z2�:mn/
13. Soil type(s)a��
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 QdNo ❑ NA EINE
16. Did the facility fail to secure and/or operate per the irrigation design
or wettable acre determination?[] Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A
A,
Reviewer/inspector Name 'ye6-7— Phone: 7rj.- 3300
Reviewer/inspector Signature: Date:
12/28/04 Continued

rFacility Number: — to Date of Inspection —07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [--]Yes [ZNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No [--INA ❑NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. �9 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weckly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
51 No
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
IR 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
21 No
❑ NA
❑ NE
General Pen -nit'? (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
J4 No
❑ NA
❑ NE
Additional Comments and/or Drawines':
12128104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - �D(o Arrival /.'OD Departure Time: / ; County: Region: J�
Farm Name: D t f" `JW ✓' .�Q-.+� ` a l��'� Owner Email:
Owner Name: ^/ �d LA'j I,\ Phone:
Mailing Address:
Physical Address:
Facility Contact: � 46 at + VL Title: Phone No:
Onsite Representative: Integrator:f
Certified Operator: Operator Certification Number: _,Uk2!
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =' =' =" Longitude: =0=,
�Gu
Design C►urrent
Design C►urrent
ne n
Wet Poultry Capacity Population
Cattle C+apa�c%ty Population
❑ Wean to Finish
I IQ Layer
I I
Dairy Cow
❑ Wean to Feeder
1110 Non -Layer I 1
❑ Dairy Calf
❑ Dairy Heifer
® Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ DEY Cow
Farrow to Feeder D D 0
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -Layers
❑ Pullets
❑ Turke s
❑ Beef Stacker
El Beef Feeder
❑ Beef Brood Cow
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures: EE
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? ([lyes, 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 1 of 3
❑ Yes &No [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
" No
El NA
❑ NE
❑ Yes
JRLNo
❑ NA
[:IN I,
12/28/04 Continued

t
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure I 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 Callo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed []Yes 5QNo [INA ❑ N E
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 g No [INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes Z No [:INA ❑ 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 5.No ❑ NA EINE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 .No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen"Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > i 0% 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) Z)_;f-ynMjc &-e` 11 -6r --x e- / e9Ve,Sz*cJ.
13.
Soil type(s) �Gr_l-117f �,
•
Reviewer/Inspector Name I - — T - -- --`� Phone:
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
5� No
❑ NA
EINE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
91 No
❑ NA
❑ NE
Comments (refer to question #} `Explain°any YIS;answers and/or, any recommendations or any other comments:
Use drawings of facility to better expiain.situations. (use additional pages as necessary):
•
Reviewer/Inspector Name I - — T - -- --`� Phone:
Reviewer/Inspector Signature: Date: (P — 2: O (o
Nage z oj3 12/28/04 Continued

t
t/ Facility Number: Date of Inspection 6
t
1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA. ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes , R No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists❑ DesignEl Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,[No [INA ❑ 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
U[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
;RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
g No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J,No
❑ NA
❑ N E
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
[kNo
❑ 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
,qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C&NNo
❑ NA
❑ NE
Additional Comments'and/6r`Drawingsc
Page 3 of 3 12/28/04

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:G®- Arrival "Time: Departure "rinse: County: �?Grh�Sa±�— Region: f—O
Farm Name: t3�Qa,� GCq.r, Owner Email:
Owner Name: Te��1r _42lzli,7 Phone: _ 1c7 — -7
Mailing Address: �?8�i.%t.G—,Q1e��22a� C/»Td,7 NG �g3�
Physical Address:
Facility Contact: QW. .q_ Title:
Onsite Representative:
Phone No: 9'0 - s9.q - :)&Qs—
Integrator: 1_6ifll
Certified Operator:~����N �,�i�_ �Operator Certification Number: RIC
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eederto Finish
Farrow to Wean
'Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ O ❑ I ❑ 11
Longitude: =0=4
o❑4 ❑ 6I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
Non -La
Pullets
U Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Da Cow
❑ Non -Dairy
❑ Beel'Slocke[
❑ Beef Feeder
❑ Beef Brood Cowl I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F 7/.
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 9110 ❑ NA ❑ NE
[:]Yes
❑No
[INA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[91<o
❑ NA
❑ NE
❑ Yes
❑'10
❑ NA
❑ NE
11128104 Continued

Facility Number: 9.2 — ` Date of Inspection
.r }`� '..t_
r '.�� �`
Phone: �]/[� Nom•/Sv/ rr/73a
Reviewer/InspectorSignature:
Waste Collection & Treatment
Date: G-30.0
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D'1Io
❑ 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?: �f o
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2] No
[:INA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
allo
❑ NA
Cl 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
[INA
❑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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Anylication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3No ❑ 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
SSS 30o SQ
12. Crop type(s) >�irw,s..✓� �4re rr�i �e..�..Ffo — �N� Sr., _ /l '(
13. Soil type(s) fQ 4 A, C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes Levo ❑ NA �
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ❑ No ❑ NA B NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA B NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2,5o ❑ NA ❑ NE
Pk*5e- a^P/ ryaair dart
ped -w01 / a 1449,n #
Reviewer/Inspector Name `/!'Ja;,1f Qru�kffr�
.r }`� '..t_
r '.�� �`
Phone: �]/[� Nom•/Sv/ rr/73a
Reviewer/InspectorSignature:
Date: G-30.0
12/28/04 Continued

Facility Number: — pate of Inspection o -off
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [R<oo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E2.Wo ❑ NA ❑ NE
the appropirate box. ❑ Yjl�F❑ Ch tsts ❑ Dri ❑ M� ❑
21. Does record keeping need improvement? If yes, check the a propriate box below, ❑ Yes 04oElNA ❑ NE
&-/7 ��./ A!-/5'> 1-S- i-iy71.?
❑-VAwtc-Appfic itie" ❑ 1VVeelrh}-I"reeb=d ❑ W4SteArialyMS ❑ lysis ❑ ❑
❑ Aftttfa* ❑4Cteelrtrrg ❑ Q„ V�Pt� -- ❑ ❑ s ❑
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
fall to calibrate wasfe a�iplicat ion egw�ment asrequ�ed�by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does,facility require a follow-up visit by same agency?
❑ Yes
D -f1 o
❑ NA
❑ NE
❑ Yes
E�Ko
❑ NA
❑ NE
❑ Yes
[9<o
❑ NA
❑ NE
❑ Yes
9 -No
❑ NA
❑ NE
❑ Yes
20�o
❑ NA
❑ NE
❑ Yes
21NO o
❑ NA
❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes 9'go ❑ NA ❑ NE
❑ Yes 9'<L) ❑ NA ❑ NE
❑ Yes a<o ❑ NA ❑ NE
❑ Yes
2,<o
❑ NA
❑ NE
❑ Yes
la<o
❑ NA
❑ NE
a �L ir;ir�wgt,AdtlopaCma rnentsand/wK r �:k
12/28/04
12/28/04

10
V</
IType of Visit * Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine o Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
FaciiirN. Number Date of \'isit: "/ZQI Time: /0'/
10
,�..��
Not Operational Below Threshold
M -Permitted Utertif9ed ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm dame: 16Pa,lee- Qam farm County: -3g� [Ca4
Owner Name: Qu,nn Phone No: 910
Mailing Address: 1029 A'ar .,/ Rood-- ��,'
//,, .57q.2Facility Contact: __ Ze.,O, _ Q✓:.��, _ _ Title: Phone No:90
Onsite Representative: Tri Integrator: Of 4rn1r'na,
Certified Operator: Operator Certification Number: �y
Location of Farm:
NKwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 01 0. Longitude e �• ��
Design Current
Swine ranarift Pannintinn
❑ Wean to Feeder
�eder to Finish
❑ Farrow to Wean
[grow to Feeder 103
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver j I IEJ Dairy
❑Non -Laver I 1E] Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Discharges haemes g Stream Imaacts
1. Is any discharge observed from an}' part of the operation?
I!J Subsurface D
❑ No Liquid W
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches)
05/03/01
Structure i Structure ? Structure 3 Structure 4
Structure 5
Spray Field .ores
❑ Yes R<0
❑ Yes �o
❑ Yes allo
❑ Yes
2,5.o
❑ Yes
2No
❑ Yes
BNo
❑ Yes
2�M-
Strucrure 6
I I IYii�Yl�
Continued

r Face ity Number: $2 —,I&
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 maintenancelimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes 0'90-
❑ Yes 0,14o
❑ Yes 2'11-o
❑ Yes [15o
❑ Yes E o
❑ Yes SNo
❑ Yes ED -N-6
12. Crop type Qern�ua/wQfass , 5.,.,.. // Gram _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PPO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M No --
b) Does the facility need a wettable acre determination?
❑ Yes
B -No
c) This facility is pended for a wettable acre determination?
❑ Yes
[-No
15. Does the receiving crop need improvement?
❑ Yes
Eg-K-o
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑.AFo
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
S+iv-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
0 -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
G-N"o
Air Quality representative immediately.
14.7'9:1'Ii1':a."• m'taFL' 'EY.F:7•�°17€1;3F!'iti33€?M "tx,l�;i°'"'•31L.f...Fi'.I:I1Eiis,ftLLlit�"-" •N.'€N3=ltllues'.:P3it,,•,.,,..iliF»I:::.d'!k I!'t1�7.�:H'"":�" .:aHY'!t,CL. .r,Si::3L .F s i�.'�.
i4CommRi6:(ref&;4d;questton.,#), + F.xplam°any YES!answerwan br:any��recommendations-or�any other comments''" �.�� �_
�s�r..<! r r, s - f ,� u nl'> a ;d. it:e . '€..��II
i [Y•�} `rNs f. €"y"iaJ.�7{. � W €k- 1'E7Af�i�i 3€.7 € 7f 7 '�: 'k 1.. 7, '''f YY7i€€7sh 1 7 11! jri i37s4 ° _
!Use tfrawi rbgs;of.facifity�to better explain situations. (use additional pages asyaecessary' ). 1, #;jam ueid Copy J ❑Final Notes € I' W
i-ddI!•�.' Ij-f�{,M�, - - y'S•4��3 I� 1 `F 5 �..�Fi r;'� �t ,i. �F. qa'1, 15i 1 ? l' -f ° Ri . f 1� : 'j €
t,, fFtl �'iff Y AA tt'1t3� x'11. t'yf�I ff1 }tt' -,1 rl�S �- 7- F17"-.t� } 3 €Fi .!. 7 7�9iI+`�}}II �ii �t�l, :. f i'G77 C fG-�.!�}•i 13s { ..}I{ �i I -«.7r' i^I }..€.« .�i� '! —E1- 177F-.'1 .yk.irv}F�i43r€17., I�
.�. E,1., v:lilt.:�..I[N�.:f,liLF_�„!1.�•�3:113Y.,.`4-is:,i.,K.�IL�'a�'i�u,iff.,.��.11E 11'3rs1�..1.._i�i.3L.F.�#�,.,7,...,MEt€+�,�.a.+.,l��,�i1.31t��}"..h.n.�.1�3�.�I.3.1�.E 1...li uiliL f•r�3aitw :;.i.:n.t3...kii,.�f a�-Y.�. _rti,�i'..�..$rk�r;�tl.�..u��, !�_.i}
f /ctgoorl • �o crvor� eld5%.7,
L
al'o✓nj
Has GdvgAgrass SPezl 4v sow i�v Bs�a ��s� 9 ooc/ 9rp�s Co✓��,
Reviewer/Inspector 11 tti=s! �,;P't...}€ll;"''li 5 s > I, ,1�� € i t�
Name..._ �� `(13'x!
7��. 7 �'��`, :;� �3..��,E�ih'�i. ;f; ; .� , k: ,,,r,r v„�a;1'���
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Q -Ko
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/,3U3#,'.CJwQkH%fs, jeeign,;aaps, etc.)
❑ Yes
QM
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
QKo
❑ Wit p is ion ❑❑�3taa a ysis jZ,�il-Sempting
y- I6 - Uy -> >, y
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9M
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9 -No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑-No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
P- i-0
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[moo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9Nu.
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
allo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes M-NtT
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
O swekitrg-frorm ❑ C orm ❑
❑ ,�inute Inspections
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

Site Requires Immediate Attention:
Facility No.
E
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ` 1995
Time:
Farm Name/Owner:_1
Mailing Address:. d2.a
County: ni 12
Integrator: _ C g kep S
On Site Representative:D
Physical Address/Location:
0.7 At; - F►t~�
12,5b,4 Ll -
Phone:
"Le -f- Phone:
F.
O N S,E /'II g pro t irrP A
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site: Z6
DEM Certification Number: ACE,_DEM Certification Number: ACNEW
Latitude: 0Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon havesufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) leor No Actual Freeboard: --Z -Ft. Inches
Was any seepage observed from the lag n(s)? Yes or ?9 Was any erosion observed? Yes or6ib
Is adequate land available for spray?( -
or No Is the ver crop adequate? e' or No
Crop(s) being utilized: % (-4/% s,zAL
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinffgs��? Y� or No
100 Feet from Wells? Cis or go
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied -or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 6
Is animal waste discharged into water ofAe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management record (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?'e or No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 "y5 11 ; 4EAM
r
� FO.RT$ CAROLM DEPARTMEM OF E NVMOMC=, MMTH & NATURAL RESOURCES
DIVISION OF EliMONIElTAL KANAGZKMT
Fayetteville Regional Office
Animal operation Compliance Inspection Fora
r
: F&171� :RP►ISgJOW�IER ccY=•� �
4M- iSPE=10N"DATE t« FAR SBR
r
MfgttA LL �-Ee rs
367—A Certs 4 C. 28320
9r0 9?z —44-64
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
5ECTIQN I
imal 0oaration T
Horses, cattle, Wn poultry, or sheep
sl LOTION II
Y I N I COKKENTS
Z. Does the number and type of animal meet or exceed
the {.0277} criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation BEGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CERTIFIED ANIlSAL
WMTZ P .
S. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCs minimum
setback criteria for neighbcring houses,
wells, etc?
a

�_ __ JUL 14 '95 11 4b�f I
SECTION IIz
Y N COM?l MTS
Field Site Management
y -- r r
t
I. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 It. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
C_XRTZPICATION PLAN?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or ether similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BIP) of the approved _CMff YICATTON?
7. Does animal waste lagoon have sufficient
freeboard? Now much? (Approximately )
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
07CTION IV
a ants •