820053_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua]

I ype ox visit: +.,ozoutine
nce inspection v uperanon mevtew v atruciure r,vaivanon V r ecnmcai ASSIStance
Reason for Visit: O Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: _:5'0451 Arrival Time: Departure Time: County: S' 50/PRegion: 2
Farm Name: E o -L j S ev4-S/6 Owner Email:
Owner Name: ' / itJ c�_t%,IA_ Phone: .41
Mailing Address:
Physical Address:
Facility Contact: &J-6 �L(� Title:
Onsite Representative: 1
Certified Operator: G 0
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 1/11 P
Certification Number: [ 2- 7
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q44V__❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No EDITA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[—]No
=N
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish17
Farrow to Wean
Farrow to Feeder
Design Current
CapBelty Pop.
0
Wet Poultry
Layer
Non -La er
Dr F,oult ,
Deaign Current
Capacity pop,
IDairy
I
Design Current
Ca acit P.o
Design Current
Cattle Capacity Pop.
Cow
Dairy Calf
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
❑ No
La ers
❑ NE
2. is there evidence of a past discharge from any part of the operation?
Beef Stocker
�o
Gilts
Non -Layers
Beef Feeder
Boars
No
Pullets
❑ NE
of the State other than from a discharge?
Beef Brood 0--
owTurke
Other
Other
s
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q44V__❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No EDITA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[—]No
=N
❑ 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
Q'11�A
❑ 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2013 Continued

Facility Number: - :5-3 IDate of Inspection: 5;D!,k_u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []-N7r❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p
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
�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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E4_ A G'
❑ 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
I 1<o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ YesNo
❑ 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 Approved
Area
12. Crop Type(s): 1-3
13. Soil Type(s): e- L e, C� oykho y,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ltd ` "'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
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
ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
c
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E -_No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [D Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Z o ❑ NA ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes No O NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes u '5o ❑ NA
25. Is A facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [}-156� ❑ 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
[D—To
❑ NA
[3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
L ]-Ko
❑ 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 the 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/[nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L2""1° ❑ NA ❑ NE
❑ Yes ❑'< ❑ NA ❑ NE
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes ] N ❑ NA ❑ NE
❑ Yes�`NoO NA ❑ NE
Gommerits (referto question;4') �Explatnrany;YES answers andlar,any: additional recommendations or any other comments.
Use�dr,.a/wi7ngs,,offacili:oto.bet/{tper�,ex'plAinsttiaar. tons:(use.add`itionalpagg''es.as/n�e�ces�sa.. }. I
z_alq
� 7
C-4)
Reviewer/Inspector Name:
r
Reviewer/lnspector Signature:
1-3 L
Page 3 of 3
Phonell b ,,3 �-33�
Date: 6 j U -4 -AK
21412015

LI &S TrA--, I ( IS
(Type of Visit:t Com liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: e Routine Q Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 4' W Q�' P��`7 i�f Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ��� 5 5etpj /, l�(�/ Title:
..r
Onsite Representative:
Integrator:
Phone:
8-S
Certified Operator: �� c ��ii�CL
Certification Number: ���
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
ls�ign Current
1
�, �Destgn Current
I = # a
,i t4�Design ,Current:
Swine Capacity Pap.
Wet Poulty ''h Popt r
�S�Efl=; '��L�_
' %
4'� '', Cattle �t k' CapacityPop
IC�apactty
R- �F1R
a l i.1i �'.IF i��� RV'. �_.Snvii
Wean to Finish
Layer
` Dairy Cow
Wean to Feeder '
Non -La er
Dairy Calf
Feeder to Finish p
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, P,oultr, Ca acit P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'keys
Other
Turkey Poults
Other
Other
i
1
Anq U15
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWIZ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes [j]-Kb�❑NA ❑NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 31�o
❑ Yes E!fNo
[q-" ❑ N E
0-t'A ❑ NE
E3 -<A
❑ N E
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): � &'' aYit��, s -fp 0 F"' —(*
13. Soil Type(s): I7`- & P_ G o i We, Lot "A6,, k- L1PtAft
14.
Do the receiving crops differ from those designated in the CAWMP r
❑ Yes
RTNo
❑ NA
Facili y Number: jDate of Inspection:
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[5"No
Waste Collection & Treatment
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LSV u NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�IC
❑ NE
StructweStruct re 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
EJ -t -o
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
Spillway?:
❑ NA
❑ N E
Required
Records & Documents
Designed Freeboard (in):
19.
Observed Freeboard (in):��
❑ Yes
❑'No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
21�o
O NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ffl"No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ER"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
�2No
[DNA
❑ NE
maintenance or improvement?
r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): � &'' aYit��, s -fp 0 F"' —(*
13. Soil Type(s): I7`- & P_ G o i We, Lot "A6,, k- L1PtAft
14.
Do the receiving crops differ from those designated in the CAWMP r
❑ Yes
RTNo
❑ NA
0 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
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EJ -t -o
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
[fr"No
❑ NA
❑ N E
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[E No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps 0 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 [IS I udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �i No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 16 No ❑ NA ❑ NE
Page 2 of 3 21412019 Continued

Facility Number: 1r, X 3 Date of !ns ectlon:
❑ Yes
EfrNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2-5o' ❑ NA
❑ NE
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
D Yes
[n"No
❑ Non-compliant sludge levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
ErNo
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E N ❑ NA
D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EfrNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
D Yes
[n"No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
ErNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2fNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
VfNo
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: u10
Date:
2/4/201

btl[1 S
.0VIIIII
Type of Visit: V-CCo pliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visi • Arrival Time:I—i '1 Departure Time: County:
Farm Name:-�►.tfWl,�" rQ-M_"� _ Owner Email:
Owner Name: Z Eit,Sy` CAa_�, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: L Title: Phone:
i
Onsite Representative: i Integrator: r4
Certified Operator: F'i 4AI I &0I / Certification Number: t -[ 8;_7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine - Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
1. Is any discharge observed from any part of the operation?
Layer
®
❑ NA
Dai Cow
eeder
Nan -La er
EE
Dair Calf
inish p
❑ Yes
[]No
[21NA
Dai Heifer
Mn7Fhinish
Wean
❑ Yes
Design
Current
D Cow
FeederDe.
P,oultr
Ca act
I'o
Non -Dairy
Finish
La ers
❑ No
NA
Beef Stocker
2. Is there evidence of a past discharge from any part of the operation?
Non -Layers
[ErNo
❑ NA
Beef Feeder
Boars
Pullets
El"No
❑ NA
Beef Brood Cow
of the State other than from a discharge?
Turkeys,
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
[21NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E�-VA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ErNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

0 el
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage cap city (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J.Nc—❑ NAE] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 29'11AS ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IL pZ /0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [-No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [R'�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes U3No ❑ 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�4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s);
14. Do the receiving crops differ from those designated in the CAWMP? r
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[!I. -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�(No
❑ NA
❑ NE
Required Records & Documents
<o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p 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 [rNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: Date of Inspection: U- Lc. .t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q- [] NA ❑ NE
25. Is the faeiiiiy out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes - 0'l�0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J�^ ❑ 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? [:]Yes L No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 9 loo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [21<o ❑ NA ❑ NE
Comments (refer to.question ft Explain any YES answers and/or any additional recommendations or any other come
mfits,
Use:dr"swims of facility.to better.exglain situations (use additional pages as necessary).
❑ Yes [�<o ❑ NA ❑ NE
❑ Yes [2lo ❑ NA ❑ NE
❑ Yes [I�No [DNA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
/4.1ffloll '.1 x-.11 1­1�
S,4—� — to—(3-1-s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A - C) -'- 'q 1 �' P , 9, 2-,
Phone: 3-
Date
2/4/2011

ivision of Water Quality
Facility NumherI_.._+� Q Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: S , 4t'(,
Farm Name: F�-w _ L&AA-; T "'� Owner Email:
i
Owner Name: J' Phone:
Mailing Address:
Physical Address:
Facility Contact: &t jL I bZ4�(AAet( Title:
Onsite Representative:
lc
Certified Operator: �1 H f�L "'`4Df
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Regio F�
Phone:
Integrator: &16
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Pullets
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Daia Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes []3,N!5__ ❑ NA ❑ NE
❑ Yes [:]No EErl�A ❑ NE
❑ Yes 0 No Eq-K7C ❑ NE
❑ Yes [] No
❑ Yes ErTqo
❑ Yes [Ej'f o
DlA
❑ N I-
NA
NA
❑NE
❑NA
❑NE
Page I of 3 2/4/2011 Continued

f '
Facility Number: Date of Inspection: -k
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E344ts' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Stntcture 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? 1] Yes E�jNo ❑ 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 EJINo ❑ NA ❑ NE
waste management or closure plan?
C�ny of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7o any of the structures need maintenance or improvement?/Yes F-1NA F]NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [jXo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fo [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): �3'e. ,
13. Soil Type(s): (/L >! e— vt- nLi
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�"
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� "o
[] NA
[3 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ONO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
E]Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []/No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Z o
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 Continued

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?
iments (refer to question ft Explain, any. VES answers and/or a
draiwina's of fneility to better'exninin"aituations'7use additional i
❑ Yes ,3'1\io ❑ NA ❑ NE
[:]Yes 0No ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ YesgNo ❑ NA ❑ NE
ons or any other comments.
as necessarv).
Co
b�
s,o q 7,V
+7
p
�U' 1 �5
t1,:..�� � �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesQ'1/�
❑ NA F] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑'!Vo
❑ NA [3 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
'h..f' "No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[D<o
❑ 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?
iments (refer to question ft Explain, any. VES answers and/or a
draiwina's of fneility to better'exninin"aituations'7use additional i
❑ Yes ,3'1\io ❑ NA ❑ NE
[:]Yes 0No ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ YesgNo ❑ NA ❑ NE
ons or any other comments.
as necessarv).
Co
b�
s,o q 7,V
+7
p
�U' 1 �5
t1,:..�� � �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

Type of Visit: Qj ebmpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:1V!191 n I Arrival Time: I Departure Time: ' County: Region:
Farm Name: !I/�'-'r (-�f/(/-I/jQ Owner Email:
' J
C
Owner Name: ( Phone:
Mailing Address:
Physical Address:
Facility Contact: b-'tJ'✓�f,.1u-�l Title: Phone:
Onsite Representative: Integrator: l y L 43
Certified Operator: st Kk e Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes QNo .. NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [!['ITA- ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑°lqA-- ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Dcsign @urrcnt
Ucsign
Current
Design Current
Swine
Capacity Pop.
V4'et Poultry
Ca�palei
Plop.:
Cattle Capacity Pop.
can to Finish
Layer
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder�a�aeitPo
IIP " C
Non -Dairy
Farrow to Finish
j ,
Layers
„ r Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I .
Pullets
Beef Brood Cow
Turkeys
Otherri,'N,
Turkey Poults
Other
a
vr.tn:W.:I:funq:.uo-�:n
Other
E
}
oc�M:.:w
x.M4.n^[.4•U-W-':iJL-,
. -_M- nBw:'µi.N.:w..1
m, Ya5
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes QNo .. NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [!['ITA- ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑°lqA-- ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

�.y
ILJ
Facillty.Numb„�r: tj Date of Ins ection:­
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EINe� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No A ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [D-N-o—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 E3-<'7 ❑ 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 l]-"" ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q<o [DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
b No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): 3 S G O
13. Soil Type(s): eV(p
14. Do the receiving crops differ from those designated in the CAW P?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
F441'b
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yese❑-
-5-o-
❑ NA
❑ NE
acres determination?
`
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2j.N'o
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[DXo
❑ NA
❑ NE
Re uired Records & Documents
,__,g�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[, o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ o
❑ NA
❑ NE
the appropriate box.
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 013Q0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EKO ❑ 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

i
Facili Number: Date of Inspection:
�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]I_Ne�❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[0y>W ❑ NA
❑ NE
the appropriate box(cs) 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
efiTo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E] < ❑ 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 the 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 [4 No ❑ NA [] NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ✓ No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
[:]Yes
eNo
❑ NA
❑ NE
❑ Yes
n -No
❑ NA
❑ NE
Comments (r fer to question #) Explain any .YES`answers and/or any additional recommendations or any other comments.
U e drawinf facility. to better explain situations (use addition fil pages as necessary).
�-� 41,6
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
L_-MWML1W1KZa
Date: �l
2/4/2011

!'ype of Visit: UCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 011ioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 101 y f♦ Departure Time: ]/,' County: �.SCadl
Farm Name: �Ir �.SflR{'nS `.7 *"� IFA {ZMS Owner Email:
Owner Name: ['hone:
Mailing Address:
Physical Address:
Region: rP40
Facility Contact; _L:�c��sA���< Title: Phone:
Onsite Representative: �, -t,r1� Integrator: iMURt7h� ZRDwrj
Certified Operator: Certification Number: Pi 9 Q7
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
\'
Discharaes and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2"No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
❑ Yes ❑ No
[]Yes E34I0
❑ Yes �fo
2NA ❑ NE
[YNA ❑ NE
ffNA
Desll;n Current
❑ NA
Design
'.Current. ,'. Y ..
Design Current
Swine
Capacity Papa
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Q Sl
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Ur, P�oultr?
Ca .aeity
P,a
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharaes and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2"No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
❑ Yes ❑ No
[]Yes E34I0
❑ Yes �fo
2NA ❑ NE
[YNA ❑ NE
ffNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
❑ Yes
[2No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
�No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3'NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:3
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[& N' 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
Co"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[j3"'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
E3�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ "No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind/ow `❑f Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): rP Rte u VSA f 11 wit 1 I �. C7 G
13. Soil Type(s): 11� „} P•�(U X11 F_ t }. ern b££ s C. R1r.\hN t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2No ❑ 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
[2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2'f10
❑ 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 C9""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 C!31No ❑ A ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C—]NoVNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 7 /�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [El"'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 BO'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
DINA ❑ NE
❑ Yes C1 rNo ❑ NA ❑ NE
❑ Yes [g<o ❑ NA ❑ NE
❑ Yes [244o ❑ NA ❑ NE
❑ Yes [[344o ❑ NA ❑ NE
❑ Yes
[]�4o
D NA
❑ NE
❑ Yes
E3 -No
❑ NA
❑ NE
[:]Yes
[�j No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:y ' t \\,-
Page 3 of 3 2/4/2011

6&COi M -
{Type of Visit: QrCompli ce inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
(Reason for Visit: outline 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: A Arrival Time: ; Departure Time: County:
I
Farm Name: `rr W �at� 5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: (2L&C (S -B&tr& kL V. - Title: �[,�. Phone:
Onsite Representative: �' p Integrator: M Z
j
Certified Operator: ,��+ S - lf'C-1 Certification Number: 11 g %
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[]NO
�A
It) esign.Current+;
Swine Capacity :,` Pop
Design Current
WYeit}citvPop
::a Design Current
Cattle Capacity Pop.
T] -5A
=
Wean to Finish
La er a;.s
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
'
�� ;, '` � �
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . 1?oult`.` Ca sci ` '
:iP
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[]NO
�A
❑ NE
❑ Yes
❑ No
T] -5A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ Yes
LLd<
❑ Yes
I2-110
❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facill oNumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'Po ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IQ-K7r ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9'<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Arc there structures on-site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L'g,
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2<0
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:goi' o
❑ NA
❑ NE
maintenance or improvement?
❑ Yes of
��
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Waste Application
Il 4A
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No
❑ NA
❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D Ev'dence o Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s); c� ._ ('_ S &_0
13. Soil Type(s): 1-4.x, LILA IJ
14. Do the receiving crops differ from those designated in th CAWM ❑YesTo ❑ ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No F-1NAv ❑ 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 Cl"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes + No ❑ NA ❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [5Io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 12<0
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists D Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections_ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes of
��
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
Il 4A
❑ NE
Page 2 of 3 214/2011 Continued

F`
Facility- Number: - Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes Cl<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I `1<° ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ET<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes []No E3'I A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No rL ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No 024A ❑ NE
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No rCKA ❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No M'f4A ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No Et<A ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No �A ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No E30K'' ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments-t-�.r��a
U.se drawings'of'facility to better explain situations (use additional pages as necessary), t ?
_ � �--%
Reviewer/Inspector
Reviewer/Inspector Si
Page 3 of 3
Phone:910—
Date:
4
D ate:
21W01 I

,TAO 2-0y-- Zo/D
( ivision of Water Quality
Facility Number $2 5.3 0 Division of Soil and Water Conservation
0 Other Agency
Type of VisitCCompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0-Rou��tine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: /: 5$ ►rt. Departure Time: 2: jS County:
Farm Name: B -T Owner Email:
Owner Name: oar f IA/ �a vAn s
Mailing Address:
Phone:
Region:
Physical Address:
Facility Contact: CGrh'S BR 1'L�ll c/tC -Title:! a 5��� . Phone No:
Onsite Representative: Integrator: GC �^ "�` �'''•'+S
Certified Operator: -1111S, it' ra'�_C.104"k Operator Certification Number: '4AJ4 19$27
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o ='
0 Longitude: =0=' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish 52190 Z$Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑
❑ Non -Layer er
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Design Current
Capacity Population
❑
Number of Structures: ED
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
[:1 No
[I NA
0 N
❑ Yes
[:]No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: S2— .5,� Date of Inspection -03- ID
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Y N
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[Ko
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): dmz &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ fo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2<o
❑ NA
❑ NE
through a waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0'1Qo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�fo
❑ 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
D<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0'100 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r►Y+ a- -y 5 ".a j C raiN i O 5 .
13. Soil type(s) L wl L N
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3, o El NA El NE
15. Does the receiving crop and/or land application site need improvement? El2 Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ,�0/No [:]NA C3 NE
El.,,
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 001 o ❑ NA ❑ NE
Reviewer/lns ,` + �1 r r v
p G .A'. Q Phone: 9 JO . SF 33 , 33 00
ector Name
Reviewer/Inspector Signature: /c..c
Date: z —0 3 -- 2-0 1 v
12/28104 Continued

Facility Number: 8z—S3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ERfo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R- o ❑ 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
BNo
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ko
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
C3LJ Yes
,2
lvo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B<o
❑ 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
B"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?
E3[3 Yes
. _,
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D<
❑ NA
❑ NE
12/28104

SLq_r e,, I., , of /o -b z - 0065
Division of Water Quality
Facility Number �2 _J S3 Q Division of Soil and Water Conservation
O Other Agency
Type of VisitACoommpliance
Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
C�1 Routine O Complaint
O Follow up 0 Referral O Emergency
O Other ❑ Denied Access
Date of Visit: I 1-23--o9lArrival Time: Departure Time: County: Sa��s'c�1 Region: ZZC
Farm Name: Owner Email:
Owner Name: `' Phone:
Mailing Address:
Physical Address:
Facility Contact: Gd4rS BZYw3 L K Title: % -G Phone No: _
Onsite Representative: Cu'4r•- s re�V_V-I j i C—� Integrator: Co 60,V•'1 L
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
Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =1 Longitude: =0=5 °=5
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑
Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turke 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 Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
TTNA
❑ NE
❑ Yes
❑ No
2 A
❑ NE
2NA
❑ NE
❑ Yes
❑ No
❑ Yes<SNo
❑ NA
❑ NE
❑ Yes
0'15'o'
❑ NA
❑ NE
12/28/04 Continued

0-9
Facility Number: S2 — 53 1 Date of Inspection g�o
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r�
Observed Freeboard (in):
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 El Yes
,.,�
LTNo
❑ 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
B<o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [__1 Yes
3
El NA [__1 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
[Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
LBNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
,.,,ND�
LA
❑ 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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) AA '.Lm' C �.� �rvtc.?� cy'- ""j i

Facility Number: 82 - 53 Date of Inspection .�
Required Records & Documents ��,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El(J Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes GN"o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps [3 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
I3NO
❑ NA
❑ NE
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NA
❑ 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?
[I Yes
, �❑
L�J'No .
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
[I,.M NA
[:1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
Lt"No
[:1NA
[1NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
[D<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
e o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B<o
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,,%
03<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ER<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[I Yes
L`,1No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L7No
❑ NA
❑ NE
12128104

6 AIS
cl-oq-09 t2.2
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: 8=2170 Arrival Time: Departure Time: County: 6744 Som Region:
Farm Name: Owner Email:
Owner Name:'' Phone:
Mailing Address:
Physical Address:
Facility Contact: CL1r4ii 5 $arra"*k Title: —r. -d-• sp,.,L.. Phone No:
Onsite Representative: CcLr-4r s aav-wiZk Integrator: ainx'sc-
Certifled Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
F,QD
Latitude: =0
=, =u Longitude: [=0=6 =61
Design Current Design Current Design` .Current:•;
Swine 'CepacityPopulation Wet Poultry; - Capacity Population Cattle Capacity. Population
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish $2?0 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
D_iseharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f 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 21qo ❑ NA ❑ NE
El Yes
El No
ETNA
El NE
[:1 Yes
[I No
[3<A
❑ NE
E3<
❑ NE
❑ Yes
❑ No
❑ Yes
3<0
[:1 NA
❑ NE
❑ Yes
2-5o
❑ NA
❑ NE
12128104 Continued

i
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
L3No
❑ NA ❑ NE
Facility Number: SZ,- 53 Date of Inspection -21 -O
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Waste Collection & Treatment
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes[3'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
2<o
Spillway?:
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
Designed Freeboard (in):
Is there a lack of properly operating waste application equipment? ❑ Yes
201No
❑ NA ❑ NE
Observed Freeboard (in): Z$
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3'5o
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
/
B o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3 o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0-<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
9<o
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
L3No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
/
Crop type(s) �e wYKwdw l Aa4 S'"'Lil rO, S.
13.
Soil type(s) �tti . CrA ..J Imo3 L, w, Ln/
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[E<o
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
LSNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
2<o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
201No
❑ NA ❑ NE
Reviewer/Inspector Name'i
..: rev. e.`}S �.. � Phone:
y o
Reviewer/inspector Signature: R Date: 9-21-2-008
Page 2 of 3 12/28/04 Continued

Facility Number: 9'2 — 5-.3 Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ir No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [3 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
[D<o ❑ NA
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[B<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
to
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
to
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej'N'o
[__1 NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E,
L'1Na
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
ISNo ❑ 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
[D<o ❑ 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
2<0 ❑ 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
ElL?
�, �
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EPTo�❑ NA
❑ NE
Additianal Camments and/or Drawings: w„ ,
Page 3 of 3 12/28/04

Facility., Number.,
Division of'Water Quality:
Division of Soil and Water C�nscrvation
gencY
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: :Z /O Departure Time: 2; County: Sfif!.-SbAt Region: AV40
Farm Name: Owner Email:
Owner Name: F4J r, -MX Say rs A,'y'rc/aC4 Phone:
Mailing Address:
Physical Address:
Facility Contact: r_Wlfr��. Title: �NV, Ilk`, Phone No:
Onsite Representative: I _uvt�~S �tfiC�' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o=6 =
6= Longitude: =0=' 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish I 52TO 15304:0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Oth'er
❑ 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?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoeket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
Number of Structures: FF1
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[g No
[INA
❑NE
❑ NA
[:INE
❑ Yes
[4 No
[]Yes
[�No
[INA
EINE
❑ Yes
50 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 9z- 3
Date of Inspection /0 7
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes d No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes QfNo ❑ NA EINE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA EINE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA [:IN E
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) L7A�1�ruw Mct I% Grq;N ( f65)
T
13. Soil type(s) ee_ . Ak_ �_a�`�►hay
14. Do the receiving crops differ from those designated in the CAWMP? []Yes J16 No [:INA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
1$. Is there a lack of properly operating waste application equipment? ❑ Yes
M No [:INA ❑ NE
No ❑ NA ❑ NE
M No [INA ❑NE
59 No ❑ NA ❑ NE
Comments (refer.to question #): 'Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility,to better explain situations. (use additional pages as necessary}: ,
T
Reviewer/Inspector Name R ^ / C Lls v Phone: Ad
Reviewer/inspector Signature: Date: /6-D-11-2aa 7
Page 2 of 3 - 12/28/04 Continued

Facility Number: $2 —5'-3 1 Date of Inspection
Required Records & Documents '
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,M No El NA El 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 [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[4 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
DO No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
�] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
M 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
r2 No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ®Routine 0 Complaint 0 f=ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IS -09 -MOI Arrival Time: //;DD .wl. Departure'rime: County: SL i e_zml Region: .640
Farm Name: if £ *64"14 1 Owner Email:
Owner Name: /fir 7_64 -1 Phone:
ip
Mailing Address:
Physical Address:
Facility Contact: � aw,es &4-C I cL41,_ Title:
Onsite Representative. C tLA s nr:a i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 6011av- i e—
Operator Certification Number:
Back-up Certification Number:
�o =, g =0=e
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Opacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ` ❑ Non-Layet
Feeder to Finish Z O SW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F 71:,
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA EINE
❑ Yes
W No
[INA
❑NE
❑ Yes
5d No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
ZNo
❑ Yes
E]No
[INA
❑NE
❑ Yes
W No
[INA
❑ NE
12128104 Continued

v
Facility Number: $Z —53 Date of Inspection -O8-49
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [X No ❑ NA CINE
Structure 1 . Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentiEer:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes ®No ❑ NA [-INE
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 19 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 29 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, 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 Drill ❑ Application Outside of Area
12. Crop type(s) C&1 -N &3 V deL lL:g
F Se br-aAi s,
t
13. Soil type(s) 4ymbee4- _ r vXk-t4&/ Me C-w-tl^lho U
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 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
21 No
❑ NA
❑ NE
Reviewer/Inspector Name ° I�i C�'� ° ` '1�''QV'5 �t "; h:f` i r f t"�y` Phone: i9/D� 'f-S�v /Sje/
Reviewer/Inspector Signature: Date: 5-48 Zac)!v
12/28/04 Continued

Facility Number: gZ —_537 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists El Design El Maps E3 Other
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No [INA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency'?
AdditionttlrComments andlor.i)r4win s
❑ Yes ,® No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
EINE
❑Yes
9jNo
❑NA
[:1NE
❑ Yes
JK] No
[INA
❑NE
❑ Yes $] No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[]Yes ®No [INA ❑NE
]2/28/04

2
,?a a s3
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit G Routine O Complalnt O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: 3 l lG I D Arrival Time: Departure Time: County: Sa #- S -no -+ Region: FPO
r J
Farm Name: W �Q r �� % _I Fn r rr• Owner Email:
t w YorY�
Owner Name: Phone:
Mailing Address:
Physical Address: _ /—/Ca!v &e- A
Facility Contact:
"Title:
Onsite Representative: Lt u,- -1-e�t 9-4 k (,a I r
Certified Operator: SO ►r e s- & ' S;,k t-1.
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder I
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: ),or i e
Operator Certification Number: ---)I Rr7_
Back-up Certification Number:
Latitude: =0
=[
= Longitude: =0=1
°❑1 ❑
fA
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non --Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Design Current
Cattle Capacity Popuiadon
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
F 171
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[Z] No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: g,a — 53
Date of Inspection I 3JR- 0-1"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. 1f yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: .. -.-/
Spillway?:
Designed Freeboard (in): 12 PC,
Observed Freeboard (in): 6215h 11157 13_
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 uP No
❑ Yes ❑ No
Structure 5
El NA ❑NI -
❑NA ❑NE
Structure 6
❑ Yes m No ❑ NA ❑ NE
❑ Yes R 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? M Yes [j No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes © No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ager r+ ..� u//Dr�a �. Z Q S C u r N C, -'A C4-4- to A--' - --
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
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Q9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[Z No
❑ NA
❑ NE
Comments {refer fo question #): E'xpinon any YES answers and/or any recammendatlons or any other comments.
Use drawings oftfacillty.to better explain situations. use additional pages as necessary};
f L rw e- +0 Ca.l 6A 0'4 .5 D , 1
Qs' Sati.io�Gs s1,nw VV%.pYa�� �•. ,
5 w,o ii Wt� S'FC Gct F5 Ca'• +n^� a�.� o -Y 4-1� t �oe� sc S �c�:�►.c►�.v}lnrzS_ p�ecvG
7~
"g" •-�; , s ��"cr
Reviewer/Inspector Name Phone: �jlb �/�G /sS/%
Reviewer/Inspector Signature: Date:
Z7 / 12/28/04 Continued

4 '
Facility Number: Date of InspectionF7-7 T7)
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [J§ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(D No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
[] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
© No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[p No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�D No
❑ NA
❑ NE
12/28/04

i
(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date Date of Visit: a ' '0 Time:
FO Not Operational O Below Threshold
®'Permitted G<eertified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ..... 1.....,A7 ..... ...... eG+1 �.....1�.. T .................................. County:.. SRS.........................................»..........
Owner Name: f'
Hdn
..�Qllt.�S,...../�.,...�n.�.✓/:.G�iP.P2................................................../...... DP_hon1eNo:....'J...�..�........�5...{f.....................................................
Mailing Address:... .,1r�r %..........Ai %eAs.....»� C ......Ra? ...... �1.GL h r�t......e ......................... .........................
Facility Contact: ...T.�m" .... r.....Fa .rdg1.4......................Title:................................................................ Phone No: .. ....... �m�% .. ,P.........
Onsite Representative: ..Iow....
ufP',?l1a,!.................................................., Integrator•
b?l..:A.�'.....i..,�l�,[.yi..£...................................
Certified Operator:....., ._9.!j..e_f...... f:...,!'�Rr.�-[1C '�I.............. Operator Certification Number•... a
Location of farm:
8' wine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude • 4 44
Swine
�Destgn +' Cues
nt
_a:.a:a aut ; tru uiauun
❑ Wean to Feeder❑
11;t.tUNt-A.:U aun ,rry ulnuon;
Layer
Wieder to Finish p p
''
❑ Non -Layer
❑ Farrow to Wean
SII ❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
i Total Desi;
❑ Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier;...............1.............................................................................................................................................................. .......
Freeboard (inches): o?.q
❑ Yes Pq<o
❑ Yes go o
❑ Yes
❑ Yes QXo
[]Yes 0-A b
❑ Yes ❑-wo
❑ Yes Iwo
Structure 6
12112103 Continued

b
Facility Number: -n — Date of Inspection s
Renmred Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ©-Ko
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? .
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes UMo'
23. Does record keeping need improvement? If yes, check the appropriate box below. [es ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis Q -Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNO
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[+lf�o
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[No
33.
(ie/ discharge, freeboard problems, over application)
❑ Yes
EjVo
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on-site representative?
❑ Yes
91 o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
B No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Q foo
NPDES Permitted Facilities
❑ 120 Minute Inspections ❑ Annual Certification Form
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Rtes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E;kNo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[No
33.
Did the facility fail to conduct an annual sludge survey?
(des
❑ No
34.
Did the facility fail to calibrate waste application equipment?
j9 -fes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑-wo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall []Inspection After l" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this You will receive no further correspondence about this visit.
tvisit.
Ili PI !11'+fi , 1!{ Ej- y€slrF 'i€ F3 }1t}kd ;- 4- y'ryi� 3a9 ��. }.Fq §. +s.F�i ::j i :'d 39:..-iP -E {:_ - F ue3i9q�i{j'n Fslja •}ln.-.'d .`C
ddtt�onalCoiiatncnts ant!!or D`aivin .,s.: .. . 1 P S F 1 :. S '.:. r{ fit"7' fi H { } t FF':. E !} �� ��1C 1 3 i'i 1 S r }41` t F 1 ,{ L !' is
�e€:�€fi k.,,a1n,. f<,;
.. =.:,,,,,yy>��..3:u.. ;€,.,u.,},.,lu..P �r F } P,�l�} r�,iG :,_i;, PFE �.,.E.P:��d� :,�!_ ,€ =n1�i ai��! E! ;:.1!.:,,, r� .
-.,€�
f 23 /01^- Fa,f-dofA 51ded �Aed- A 4rok .sod _s&,,eles 0-07
P resvlJS have nd be,, r U;vrs1,
/ An #1 vat
933 017d -#3q 11?r, Fa�rGJof� Sj�,�e/% �rLr7t �h£ �.sJur/g1 S'vrvr�, d�cl fie
Cli1ikrCt/Iail 01C wuSi'e ap1oJ,}cu�a, e�v��orhrnf` wov�ri 6e tl`�irar�%
6y kAe encj o.,4
T%,ere ore Some woedX Sup�iq y s f�ru� s1Ctc� T o Ae r''eo vved o�- t4e toe vT
eke 109 00)l , Ili�y pPCc/ )tn Co r1�:�,„c iso wor i( on ef05in cont rel
I jCM �
rcrr. . �do�(s G -D o�,{ Terre i s oar ovrr a PP 1� rd 'o jJ
4sve *-ha f , y I -e vi -e w,
Records are well Ke J.
12112103 Mctr K L5ronHey
ina,tic aA,61>� a - a s- 0 Y

Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: T-uly S , 1995
Time: 11 '2 5 -
,Farm NamelOwner: Kick s
Mailing Address: Q� M. Sak 4s RurA06,b Nc_ ZB38� 1�ia, 3i •_ R7 _
County: Aft rnp=*1
,Integrator: Coir Phone: „{ g E o ' 4 x 01,41
On Site Representative: �L.�4ae6n - CA. mi1i V -,Au Phone: t 4io ) s�, k 4 k
Physical Address/Location: 62 la -sr- _2X rni ea. s* d- ;n6as-ec", eL sit Ass i, mcl
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: -6
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: ° ,}%' Longitude: -2$
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (j&or No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or® Was any erosion observed? (&or No
Is adequate land available for spray? Yes or No is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? I&or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No �� �.�►••
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes ort If Yes, Please Explain.
.Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No "De'5 roi t-Q-l..4kd
.Additional Comments: —zPet%A0'Vj
•1
Inspector Name c�k v',Af- ?t�*r at o CCte Signature
Say 1-c �r4 Wact+e►�.a Citd.
Fa.Y e�k4:fle n�C a83o f
cc: Facility Assessment Unit Use Attachments if Needed.