820074_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

ill YA$ "al
2-
Type of Visit: 0-compliance Inspection p Operation Review O Structure Evaluation O Technical Assists
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Den
Date of Visit: po Arrival Time:. Departure Time: { County:
Farm Name: 27w Rt Owner Email:
Owner Name: ]��-�C %OGc.I Phone:
Mailing Address:
Physical Address:
Facility Contact: qr'L1'e Title: Phone:
t Onsite Representative: Integrator: '5 �4�f
'_4g
Certified Operator:
Back-up Operator:
Location of Farm:
r(
Certification Number: A, 712,
Certification Number:
Latitude: Longitude:
p:
Design Current
Design
Current
Design Current
Swore
Capacity Pop,
Wet Poultry
Capacity
Pap.
Gat#le Capacity Pop:
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -layer
Dairy Calf
Feeder to Finish
[X~[7
Dairy Heifer
Farrow to Wean
i
Design
Current
Dry Cow
Farrow to Feeder `
D . ■1?onl
Ca aci
I;o
Non -Dairy —
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
n
Other
�'
!
Turkey Poults
Other
a
Other
f'
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [q'No ❑ NA ❑ NE
❑ Yes ❑ No QIi A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
J�ffNA
❑ 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)
O Yes
[:]No
NA
[:]NE
2. is there evidence of a past discharge from any part of the operation?
[] Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
F:(No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 21412015 Continued

Facili Number: F jDate of Inspection: Zb tKr-111
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
,e-NA—❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y2-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[' l�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
Q'No
❑ NA
❑ NE
waste management or closure plan?
IT any of questions 4fi were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3' i�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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�-�l.�
L l"o
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 ibs. ❑ 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): ��t'J` ���- S (> u Gec."'l-3
13. Soil Type(s): �.
14. Do the receiving crops differ from th se designated in the CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a'�lo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
] Yes
C 3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
Yes
[]]No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E(No [] NA ❑ NE
Page 2 of 3 21412015 Continued

IFacili Number: _ Date of Ins ection: 6 Ai ti
/81
24?Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
0- o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ED,<
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑Xo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
13<0
❑ 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
[3*No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
D No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ea -go
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2.14
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EkKol
❑ NA
❑ NE
Comments (refer to quest�oa+ €} ,Explain any':YES answers and/or�any addrtional recommendations or.Aany oth6i comments.
Use drawings_of facility togbetter explaut situations [use additiogal;paaec ges nessary ).
o� _
3-1
T o_.:3o 6 �s l
Reviewer/inspector Name: LJ 1 u U LIL
Reviewer/inspector Signature:
Page 3 of 3
Phone: %40 -M
Date: '10 gl't4
21412015

Type of Visit: C -e mpliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Q-Routine O Complaint O Follow-up O Referral O�Emerggeency 0 Other O Denied Access
Date of Visit: fzrrival Time: Departure Time:County:
Farm Name:` t`t c Owner Email:
Owner Name: (L dr/t Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Bach -up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region.n-
Integrator: PS-5
Certification Number: [4 7l
Certification Number:
Longitude:
Design Current
Design Current- Design Current
Swine
Capacity Pop-
mWet Poultry:
Capacity
Pop,Cattle - Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
a1;L
Y
-
Design
4" —.Dairy Heifer
Curre Dry Cow
Farrow to Wean
Farrow to Feeder
D 1'oult :
Layers
Ca aei
P,o q Non-Dairy
y Beef Stocker
Farrow to Finish
Gilts
Non -Layers
w��..
Beef Feeder
Boars
Pullets
Turkeys
try,
Beef Brood Cow
ip F-i
urkey Poultser Other
-_JtE SEE,
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation"
❑ Yes
NA
❑ N E
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[17A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[9'57A
❑ 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
E?<A
❑ NE
2. is there evidence of a past discharge from any part of the operation'?
❑ Yes
[ -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ENo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Nutnber: &6 _ Date of Inspection:
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 Eg A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<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
e 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
.l
, o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes\
�lo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
a] 4o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CEJ<o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ol'Approved Area
12. Crop Type(s): Ci.(1 A,) e--y � 5 6 n
13. Soil Type(s):
L
14. Do the receiving crops differ from thole designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
g-<o
❑ Ycs
Ej`No
❑ Yes
allo
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [e-&o ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility tail to have the Certificate of Coverage & Permit readily available? ❑ Yes Oo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F; 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 Q'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 [EI'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E?`�o
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

FacW � Number: tM _ = jDate of Inspection: ' Q..r
'M
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes []'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []�I�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes O No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 [ 1q-o ❑ NA ❑ NE
❑ Yes ['"No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes
[]"No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
E2'110
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to beater explain situations (use additi©nal pages as necessary,)C6/'44' � -),3
cct(
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 3
Date: M
21412015

Type of visit: coor[:ompliance inspection U operation Review U btructure Evaluation U Technical Assistance
Reason for Visit: 01010'utine () Complaint 0 Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: 5 Departure Time: O County
Farm Name _ S _T 10L'22� 7� Owner Email:
Owner Name: _ S i ey e-1 14 awa,44 Phone:
Mailing Address:
Physical Address:
Facility Contact: 4# Pi"C- [pwMAA41 Title:
Onsite Representative:
Certified Operator: { t
9� TylvlL Region_r_! �
Phone:
Integrator: jAf 17
Certification Number: 16 7 / Z-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
"Design
Current
Design Current
Swine Capacity Pop.
We#-Pouhry;:., :,`Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
f Design
Current
-
Dairy Heifer
Dry Cow
Non -Dam
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:..
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [j],W [] NA ❑ NE
❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[-]Yes
❑ No
[DNA
❑ 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
[ZNA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
[�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 onhinued

i'9
FaciliNumber: - Date of Inspection: 3 Wke•
Waste Collection & Treatment
4. I!'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1E ° o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑441V- ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): of u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3-Wo ❑ 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
120fio
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Z jXo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[&I 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
[21Qb
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C1 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E? 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): C,(� j`�� v�-�..� -5C -
13. Soil Type(s):
14. Do the receiving crops differ from those Agnated in the CAWMP?
❑ Yes
[12ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
3No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[p'fio
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F_k90
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
[] Yes
No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
([ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ 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 E 'r&o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r!�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection: T I D
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑,Ko
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [310
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 [Z�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1214o
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 CAVRAP? ❑ Yes [ "No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes eNo ❑ NA ❑ NE
Comments (refer to question.# Explain any -YES answers and/or any additional recommendations or any other comments:_; _
Use drawings of facility to better exFdain situations (use additional pages as necessary).
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
cjtbVAO+�;-N F-- 11'I(f
[t4 s VA,
P - 4L S
Reviewerllnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
[-]Yes �No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E3"'No ❑ NA ❑ NE
[-]Yes [B"'No ❑ NA ❑ NE
Phone:
333G
Date: 3 )&,
214112014

t I/W5 9r) yn ct. / ( A
Type of Visit: UCom nce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: rr
Departure Time: Ii.c f l County:
Farm Name _�Zl'
h owa,.Q_.
r—4JUt1s
Owner Email:
L
Owner Name:
�.Q+r✓�j
n
Woo"
Phone:
Region:
Mailing Address:
k
Physical Address:
Facility Contact: L-0-0111 f -C WAJ Gc Title: QCj u: Vz Phone:
Onsite Representative: 1 { Integrator: VO4
Certified Operator: it Certification Number: 16 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
fi :; Design Current Design C►urrent
SwMineM
Capacity Pop.
Wet Poultry ;Pop. Cattle Capacity Pop.
%Capacity
La er Dairy Cow
Wean to Finish
Wean to Feeder
on -Layer Dairy Calf
`' Dairy Heifer
Feeder to Finish
Farrow Wean
$, z&
co
to
Dry Cow
Farrow to Feeder
D.. gPoult �aaci Fo . Non -Dairy
Farrow to Finish
Layers Beef Stocker
Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Gilts
Boars
Other P
Turkev Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes L-t4o ❑NA ❑NE
[:]Yes [:]No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[—]No
U NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
dNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eg�,o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Q No
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

Facility Number: XT
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-NT--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [E -NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'lgo ❑ 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 l-T "'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 ®O ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑,Nlcr ❑ NA ❑ NE
maintenance or improvement?
Waste ADD1lc2tion
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f!No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload D 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): D
13. Soil Type(s):
14. Do the receiving crops differ from t ose designated in the CAWMP? ❑ Yes Ek90 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ZVo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
El"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
U-f4io
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
E5,Ko
❑ 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 [t3'1Io
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [::]Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No
❑ NA ❑ NE
D Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z]'I� o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Quo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 [ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [J/flo L] NA ❑ NE
❑ Yes [2rNo
[:]Yes EfNo
❑ Yes /2fNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Eaplatn aayIYES answers.and/or any additional reoommendabons orany other commeu ' .
Use" drawings of facility..to better explain-'sttaahonst(yseladditional pages as necessary)
sf
Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4f ( d' `[3 3 ` J
Date: � LAN
V
21412014

I ype of Visit: (:: Compliance Inspection U Operation Review O Structure Evaluation (_) Technical Assistance
Reason for Visit: QAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other �0 Denied Access
Date of Visit: Arrival Time: Departure Time: County.4NI-
Region• /(}
Farm Name: �•-t�tr� Owner Email:
Owner Name: Sy 41 1A) fit, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: c�fz
Certified Operator: t
Back-up Operator:
i
Location of Farm:
Title:
Latitude:
Phone: /
Integrator: -Mg `7 o96
Certification Number:
Certification Number:
Longitude:
Desrgn Current
µ Design Current
-'- Design Current
Swine
Ca�iacity Pop.
Wet PAoultry Capactty Pop.
Cattle *Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean,Current
Dry Cow
Farrow to Feeder
-.
Dr Poultr Ca` aciPo' .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Layers
Boars
Pullets
jBeef Brood Cow
-
°
Turke s
Other
Turkey Poults
El Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
3`ro
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(0,NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3%iGo
❑ 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
9
21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No �0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [:]No ❑ 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— 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 [EkNa ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [a4 ❑ 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 El"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 Wio Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .-be- "
13. Soil Type(s): li,� tL r 0 ,J-, b y
14. Do the receiving crops differ from those designated in the AWMP?
[]Yes
, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Oo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑,Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[::]Yes
D-No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ON.
❑ 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
LJ o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
C1,1 "'
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number. Date of Ins ectioa:
_ 7%
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [4]-M , ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;[44e- ❑ 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 [5-ITo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification? [:]Yes [g.Na- ❑ 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 L2-hlo ❑ NA ❑ NE
❑ Yes [D-No ❑ NA [] NE
❑ Yes [q,*o ❑ NA ❑ NE
❑ Yes [g+I-o ❑ NA ❑ NE
❑ Yes
[3'1�o
❑ NA
❑ NE
❑ Yes
[ENo
❑ NA
❑ NE
[:)Yes
No
❑ NA
❑ NE
, _ l recommendahonskor°aay tither comments.
omm eats (refer to question
Use drawings .of facility_ to better expla►n s tuahans (use additional pages as ecessary). �'"
Reviewer/Inspector Name: j
�7
Reviewer/Inspector Signature: L.
Page 3 of 3
Ak
F - `((Z
Phdi>fe 4A��3
Date:
21412011

Type of Visit: &Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: I�toutine Q Complaint O Follow-up O Referral O EmerQenev O Other O Denied Access
Date of Visit: Arrival Time:1 Departure Time: County:
Farm Name: �L��+`r�G�.il�'�1 f� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 4:K-V e Title: Phone:
Onsite Representative: Integrator: ifl l
Certified Operator: l Certification Number: IL 7 1
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current= kDesign� Cuirreat
�*
Design Current
_
Swine }'.Capacityr= Pop. Wet Poultry Cap�acttvPop.
Cattle Capacity Pop.
Wean to Finish
Dai Cow
Wean to Feeder
r
Dai Calf
Feeder to Finish*�-
-,f -
Dai Heifer
Farrow to Wean
Desega�Current
D Cow
Farrow to Feeder
rvYCaae.
Non-DatryFarrow
to Finish
jnL
Beef Stocker
Gilts
rs
Beef Feeder
Boars
Beef Broad Cow
Qer
ultsOther
Discharges and Stream Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a- Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ®jlVo ❑ NA ❑ NE
❑ Yes [-]No Ea�NA [:)NE
[-]Yes [-]No [ ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]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 CR No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - pate of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!]fit' ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-Pic' ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes
[5 ' 5 ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2' 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
QN'T-'O NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q>d- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
1_fS o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ Yes
❑ Yes
ER -NO
Elmo
[a/1Co
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes Q-No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
[:]Yes to ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes [a -No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes I No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number:72 7� Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [�Jo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
allo—
❑ NA
❑ NE
❑ Yes
[;Pro
❑ NA
❑ NE
[—]Yes
E&Nb
❑ NA
❑ NE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes [2'1Cio ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1BM° ' ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑>o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [g4o ❑ NA ❑ NE
Reviewer/inspector Signature:
Page 3 of 3

` 1 I
Type of Visit: O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: QXoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S-v--# jam Arrival Time: Q S �? Departure Time: (j; Countyc�A��—
AI Q.._1 Region: rA0
Farm Name: ``��}``�*g.``q\\'',ty �e t,�pjt ] F�(t;� Owner Email:
Owner Name: C iftV6 ip „— Phone:
rinv..zAR
Mailing Address:
Physical Address:
Facility Contact: ;pWok4 P Title: ��lh�� . Phone:
Onsite Representative: NlrNp- Integrator: R
Certified Operator: 5Af-n �Df K Nw> _ _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
S.
Design* 'Current
Capaci :Po
-
i�
Wet Poultry
Design�Curr�ent-, `
Capacity Pop
Design C•Qrrent
Cattle on Capacity Pop.
Wean.to Finish
La er
I IDairy
Cow
Wean to FeederI
jNon-LaXer
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Design Current
DTy Cow
Farrow to Feeder
Dr. P,oul
Ca aci 1?0
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers;
Beef feeder
Boars
Pullets
Beef Brood Cow
01
Turke s
Other
I I Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [2(No ❑ NA ❑ NE
❑ Yes
❑ No
Cy NA
❑ NE
❑ Yes
❑ No
[g NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes [:]No dNA ❑ NE
2. Is there evidence of a past discharge.from any part of the operation? ❑ Yes (I No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 4No ❑ NA .❑ ONE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

r �
Facility Number: - Date of Inspection: , 1 e1A
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [VNA ❑ NE
14 ?%3 Fwaxn ago Faar^
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AKI� a a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ef 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
[�fNo
❑ 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
Qf No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, qry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes [2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lrl No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s). . C V' tat atC?thu0a. Irla Pws-luw�� S. C� D
.,
13. Soil Type(s):�AyScsLl1L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Rf No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[S(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the•irrigation design or wettable
❑ Yes
[(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!�'No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

1•acili Number: Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ByNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [gNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [g(No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
dNo
❑ 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[RrNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[1/10
❑ NA
❑ NE
33. Did the Reviewer/lnspectoi• fail to discuss review/inspection with an on -site representative?
❑ Yes
[r]No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�rNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other commentsz ":
V#�
Use drawings of facility to better explain situations (use additional pages as necessary).
�1.Agz� PEA\.(53� C� 4oa 1�0 S
►�Oog inAr� tJoc O V �c�i� P a �! E Co V 4 A. \\ I`c. a� V tD
%Z�GSW3 Laws Zov,'cs � %or vm_ ONL- 9EA- zr -
*6 a MIL\
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: RWO'%-LeS,31 _
Date: 'a
21412011

Type of Visit: CDoCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Qcj;DO Departure Time:�A County: �'rgm Dn Region: rAO
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C u' LrTS -bR4k W: C K Title: Phone:
Onsite Representative: � po \ Integrator: 1`R�tRptiu jQo�(1
Certified Operator:Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C*urrent. :? M Design
Current Design Current
Swine Capacity Pop. Wet Poultry Capacih
Pop. Cat#te- C*apacity Pop.
Wean to Finish La cr
airy Cow
airyCalf
Wean to Feeder
Non -La er
�AjFeeder
to Finish
aa.1a
M, ..
Design
Dai Heifer
Current D Cow
Farrow to Wean
Farrow to Feeder
Dri;oul_tr, C+_a achy
P.o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
NJ I Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
Turkey Poults
OtherI
L10ther
Discharges and Stream Impacts
. 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 Q No
❑ Yes [�No
[2NA ❑ NE
EeNA ❑ NE
[VNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

f
Facili Number: Ff a - -7q= jDate of Inspection:, - 14
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
EV NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
gNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: #Z
Spillway?:
Designed Freeboard (in): [ 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[g�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[fNo
❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
[YNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
63""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
j"NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
E�fNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2"'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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? ❑ Yes ❑ No ❑ NA E3NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No 0 NA g'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA Cg-IqE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E2 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
53"NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑ No
❑ NA
EUAE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [-]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes yNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
dNA ❑ NE
[ 44A ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - -7 Lj Date of Insl2ection. 14
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:'No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check
[:]Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
gNo
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [5No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes [9"No ❑ NA ❑ NE
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes [3"No
❑ Yes M No
❑ Yes [?(No
�� �a�SE � �mol�-Stis? � � SZ �Q�p+C.-e_fl �.�-h iv �w hZr-� rj�►e lid
L�Spc,tJ zS C�\os�.� , NO �o� was-�►� ��r�� �,o �.+�oc>�
�lucir�E �utt�€.�1 L.l1,�5 £vAlvc��p tre-� t_�osv(Ze �tt~n�occ,
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
thS5 'SS kin 0\U k"250 \r'F_P'0 \SOS �ov5� \��4aJc cx�N
Reviewer/Inspector Name: � _5 Phone: lS�
Reviewer/Inspector Signature: �,_ Date: 1 }
Page 3 of 3 21412011

ivisiioti°of Water 'uality
Facility Number - © on of Soil and Water Conservation
DQQther AgeA ncy
Type of Visit: l�rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ($)rRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: Departure Time: County:�Q�11
Farm Name: L nO omd, q-s N,°Zv Pam Owner Email:
Owner Name: L("A opd- HaW rA Phone:
Mailing Address:
Region: 'Fro
Physical Address: y5'0 O G fro wa-k LLh p A't/'y P i I10_
FacilityContact: S f eve Rowa-6t Title: M0804Phone: 540-a 07Q
- G
Onsite Representative: C&y-0— Integrator: f 3
Certified Operator: S+eye f0WOA— Certification Number:,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
u =Design Current°
4,_ HDesign 'Current
Design Current
Capacity Pop.
We#fPoultry. Capacity P.op.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
�4a `� a *
Dairy Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
3Desigm—urrent
C
Cow
Farrow to Feeder
s ..
D Poult . LCa aci P-,o
Non -Dairy
Farrow to Finish
La ers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Gilts
Boars
Beef Brood Cow
Turkeys
OuterMIT.?
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 'R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
-❑ NE
❑ Yes
�? No
❑ NA
❑ NE
[:]Yes
C2�No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

[facility Number: - 7 Date of Inspection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level inlgtpe structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes fl;2No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 5-gf No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EINo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo ❑ 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 CropWindow
J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
fJ
12. Crop Type(s): cUAOLE in dear L Q P09-6p `S/na11 oral-) ove'_J 'f3?C
13. Soil Type(s): AVIj I S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[S No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[gNo
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
f>_3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5j No
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
❑ Yes
4A No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
tg-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. �cYes ❑ No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
El Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J�t No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
CE.NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 1 jDate of Ins ection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(RNA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
[:]Yes J'No [DNA ❑ NE
❑ Yes CRNo [DNA ❑ NE
❑ Yes No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: S Ch n J Phone:-4V0tri(&
Reviewer/Inspector Signature: AADate: Q
Page 3 of 3 21211

Facility No.qa-1 Lf Farm Name anOQA �` V8--FDate
Permit ✓/COC OIC NPDES (Rainbreaker
Pop.
Type
Design
Current
PLAT Annual Cert )
G1[ �1lii��
rar_,nr ,
Lagoon
1
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
�-�
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
L' [�AffI�! Cdli
Calibration Date
1
2
3
14
5
6
7
8
Design Flow
Actual Flow4x
Design Width
Actual Width
S3-
Soil Test Date /
pH Fields
Lime Needed
Lime Applied
Cu-1 Zn-I
Needs P
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp_
Weather Codes
Crop Yield ✓ Transfer Sheets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt I15/1000 Gal
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
12k A/
i
Verify PHONE NUMBERS and affiliations
Date last WYT FRO Date last WUP at farm App. Hardware
FRO or�Fdrm Records 35��19 3 _�U � 35Qfa 80 3
Lagoon # 50 , rj51(Q1� k r jv� f�j �.
Top Dike�y ©hnlr/ �_��
Stop Pump 14%•
Start Pump 3'y-7g
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac ��, ;(pp ►�{S �0! ��n use-,
C ( Use
3'�( ga4�o

�s
3
AC
a 4S 10/ ?00
Ifly
1
Q --�— a oco
73
7 1,-7 A c-
( 5&.3) �aiecW
007p hone—
IcoArJcoLr-,,-%ioA 0nky he1kcthov+ 4a0q QCt�if�S
l J
0
E

BIN
z-oq- z010
Type of Visit ®'
,C
�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Q-1 Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2 - 0 Z - IQ Arrival Time: /2 : O S' Departure Time: County: S-4,0—p 5'0-1 Region:
Farm Name: L10/012yW h ula4q_ e Sc„,%j Oyf� iJ Ar+I Owner Email:
Owner Name: L✓ n�U� ✓c� f>k' .Ja vd (S� f�7 +-lav� So ►�+ Phone:
Mailing Address:
Physical Address:
Facility Contact: Cuy-frs' a�'W �`�� _ Title: SPt Phone No:
Onsite Representative: Integrator: Or, 11u v- t .s
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e [= f = u Longitude: 0 ° = 6 a it
Design . Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design
CM011111111111111111111111URapaeLty
❑ Dairy Cow
❑ Dairy Calf
Current
Population
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑Non -La er
E Feeder to Finish
14q10
Dry Poultry
❑ La ers
on -La ersPullts
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
EBoars
eGilts
❑ Turkeys
❑ Turkey Poults
❑ Other
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
L'7 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[I No
,�,/
LEA,/NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
ElEI No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
LK NA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
B�oNo
❑ NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
ERNo
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

I �
Facility Number: $2— 7 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L"J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes DINO ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes
N/o El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
,
DKo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
E3`No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Gl< ❑ 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
Blo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yeses
-'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
2rNo ❑ 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) (j r n+ a �..�rr� if l ✓.t: u KD
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LT No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EYNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L"f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Milo
❑ NA
❑ NE
CExplain asersiandorayrcmmndatos onvents ree tuestion an YES other Co
¢Userilrawtrn s of factL to better ex lam situat�ans IISe,addltlonal pages as necessary):
g ty P (_ P 1; )
Reviewer/Inspector Name Rckj1Z C:V .e i S � �33 33a p
�.l Phone:
Reviewer/Inspector Signature: Date: Z— 0Z- - 2 0/O
12128104 Continued

Facility Number: 82 —71�1 Date of Inspection 2-o2—JO
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0<10
❑ 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?
ElYes
LH'No/
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
B No
ClNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E?1'go
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[E o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B�<,o
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
19<0
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tvo
El,lam NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B-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
L',�
�"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
ElBJ Yes
,.
o
❑ 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
, ��,��
Leo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA ❑ NE
12128✓04

iq 5 cN rtwcd io -a a - zQoy
Type of Visit f5r'Compliance Inspection O operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Dale of Visit: 9?%'O�i Arrival Time: Departure Tune: /a%LS� County: Sdt j4_-r0 ✓ Region:
Farm Name: 4-1�Owner Email:
Owner Name: L i•Nnai c/ 11oftkea! — Phone:
Mailing Address:
Physical Address: /
Facility Contact: '`"' d Title: SDI Phone No:
Onsite Representative: integrator:Gt'��
Certified Operator:
Back-up Operator:
Operator Certification Number:
P).T
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 = Longitude: = ° = d [� 45
Swine
Design
Capacity
Current
Population
Design C►�rrent
�'�'et Poultry Capacity Population
Design Current
Cattle Capacity Population
to Finish
❑ Wean
❑ Wean to Feeder
Feeder to Finish ��f/a S!�j Z
Discharges &Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharges &Stream Impacts
i. Is any discharge observed from any part of the operation?
❑Yes
t_TiVo
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
❑Yes
ElLJ Na
�,,�
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
2<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
[I Yes
❑ No
3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
D-iZo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Na
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

r
Facility Number: 82 Date of inspection
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 Ib o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / I
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 property addressed and/or managed El Yes
3< ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Lr 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
ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
O<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
00 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) c I,- - d A— t' Gr 5;0"11 a,`,�
13. Soil type(s) Ar} v.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Lam) N/o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ETNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesErNo`�
❑ NA
❑ NE
Reviewer/Inspector Name F/TQ' R 9t. 3.3,�3S1
y�fS Phone:
tr
ReviewerlinspectorSignature: ...�� Date:
Page 2 of 3 12128104 Continued

Facility Number: 82 —% Date of Inspection '2I- a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gf No ❑ NA ❑ NE
the appropriate box, ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M hio [I NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes l <o' ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes BIN._ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ffNo ❑ 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
a ❑ 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
[i'NO ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
����
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
LfNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
3<0 ❑ NA
❑ NE
12128104

--
Type of Visit O">rompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q'20'0 S Arrival Time: /2:jZjW I Departure Time: 1: SAS' County:
Farm Name: L i AW ra, LJe r d '; Son/ t�iiiilFiaiJ%v Owner Email:
Owner Name: LrNoar� IS�:.�ar� s Phone:
Mailing Address:
Physical Address:
Facility Contact: �ur��ts Ef-�-Li Title: ,/1 Phone No:
Onsite Representative: I Integrator: C 44-V i R.—
Certified Operator:
Back-up Operator:
Region: �/ZO
)I; r"_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ . ❑ 4i Longitude: = ° = I
g F --
Desl n Current
Design Current.. Design Current
Swine
C•ap ty Popuklabon W�efPoultry
Capacity Papulat'0 Cattle Capacity Population
o Finish
❑ La er
❑Dai Cow
Feeder
❑Non -La er
❑Dai Calf
to Finish
/D Z
❑ Dai Heifer
to Wean
V
Dry Poultry
❑ D Cow
to Feeder
Finish
❑ La ers❑
❑ Non -Dairy I
Beef Stocker
to
❑ Non -La ers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cowl
- -
❑Turke s
❑ Other
h Turkey Poults
❑ Other
-
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ NoLl
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
ElNo
�NA
D-TIA/
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
,��
ETNA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
P<o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B1vo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 81— ]
Date of Inspection 10 `20 _061
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 30
5. Are there any immediate threats to the integrity of any of the structures observed?
Oe/ 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 El"No ElNA ❑ NE
ElYes IdNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ YesISNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ISNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 3"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ehlo- ❑ NA, ❑ NE
maintenance/improvement? ,�,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L71Va ❑ 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) 8ee14.,,_. , 6raiu 60, s,
13. Soil type(s) 4,t+vcl u i I �t
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EKo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes E3�Io ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1 o
El NA
El NE
El Yes
,[
L7 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):
C9 +7-3;.S 4 VD ct loot 1.9L.f aZ1 N 10 o GCS 45,-4aT
Reviewer/inspector Name R; C_V_ R C V d_3 Phone: ` /0, Y.33. 3330
Reviewer/inspector Signature: a..J Date: g Za zco 9,
12128104 Continued

Facility Number: $Z — "] �} Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B-,Pgo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3"11`0 ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps. El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[--]Yes
[3-Ko'
[]NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield [1120 Minute Inspections ❑ Monthly and I"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
, /E]
E o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJIN�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3<o
❑ 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
EJON"o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 3"No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
t_T �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
,�
El"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
E3 o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
�,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�ETNNo
L7 No
❑ NA
❑ NE
Additional _Comments an&' r Drawtn 5 $ c x
- AIR -. �.g.. aK. ,.z
r
f
Page 3 of 3 12128104

® Division of Water Quality y
Facility Number SZ % O Division of Soil and Water Conservation
_- _ O Other Agency
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit ® Routine O Complaint O Foliow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: //fSOA- I Departure Time: �'d County:
Farm Name:=L�^�a�✓�r Scsn/ t'/Va.�1 F r.K� Owner Email:
Owner Name: — 7�� + OL ✓cL Phone:
Mailing Address:
Region: A-"
Physical Address: A,
Facility Contact: Ct- F'/ 4-c E�i+r� ,`� �C Title: �-�Jt/• , Phone No:
Onsite Representative: n -v45 p5aywr LK- _ Integrator:
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
Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 4 = 1f Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
- T ❑ Non -La ei
Other
❑ Other -
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys�
Turkev PoultsPoults
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current �'''
Capacity Population-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: j
P
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 QfNo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
W No
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
[j3 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Z — %V Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [SNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes �No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�`�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9 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
ID 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
q 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
[2 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) A314lkKCu_ I% c J SlWllaa�li✓ ( D. 5
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
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
`Comments (refer to question #): Egplam a`ny>YES answers and/or any recommendations`orjanylother comments
as s ;
Use drawings of facility to better explain situations. {use additional pages as necessary)s
Reviewer/Inspector NameIN, I � � I Phone: 9/0. V-33. 336
Reviewer/Inspector Signature: Date: /V —O — ?go 7
Page 2 oj'3 12128104 (;ontinued

r' .
Facility Number: SZ —7 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pernvt?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
� No
El 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
�NNo
❑ 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

i ype of visit (0 Compliance Inspection U Operation Review U Structure Evaluation C) Technical Assistance
Reason for Visit ® Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit S-'DZ- 06Arrival Time: Departure Time: County: Region: F2O
Farm Name: Li m000-d Ha:ya&-d f Sci.? Meta Awm) Owner Email:
Owner Name: _ L NoaYd N o"1Y d Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: CtAV41 �.�aVIAJ i t--iL
Certified Operator:
Back-up Operator:
Integrator:
i jPhone No:
Coav1z
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e 0 I = 11 Longitude: E__1 o = I = "
De sign Current Design
Curren i Design . Current
Swine .
,
Capaccity Population , .. H'et Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
w` ❑ -Dairy Cow
❑ Wean to Feeder
: ❑ Non -Layer'
❑ Dairy Calf
® Feeder to Finish
Z
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder,_
❑ Non -Dairy
❑ Farrow to Finish
a ❑ La ers
t
❑ Beef Stocket
❑ Gilts
❑Non -La -Layers
El Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Cowi
...........-
❑ Turkeys
.� ❑ Turkey Poults
❑ Other
[] Other
=Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[}R No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
%No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
® No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
CR No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

y
Facility Number: — 7�
Date of Inspection S-0Z-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural Freeboard?
Structure 1 Structure 2
Identifier:
Spillway?:
�r
Designed Freeboard (in): l q�
Observed Freeboard (in):
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 [% No ❑ NA ❑ NE
❑ Yes f4No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes tN No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1!4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [VNo ❑ 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 [25No ❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croph'Pe(s) t3t'rwtS"41/ Gmir4 i O,ites.eA i
13. Soil type(s) K LI4 y Lr,'1 f L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes [� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any atlter comments.
Use drawings of facility to better eiplain situations. {nse additional pages as necessary):
Reviewer/Inspector Name 9 jLL — Rt=v a �s Phone: ('110) 8,6 -/5"V 1
Reviewer/Inspector Signature: Date: $-- OZ ` Z00%
12128104 Continued

Facility Number: g2 — % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes TNo ❑ 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
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EKNo
❑ 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
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R1 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
RjNo
❑ 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
,�S
nj 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
91 No
❑ NA
❑ NE
Addihona! GommentsAand/or;Drawingsy�
_
&
:.r s
—
12128104

VA
5 0
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit; }b os Arrival Time: : 3 4 Departure Time: County: Scar , o Region: _ FRO
c
Farm Name: a.A 5>.+. Owner Email:
Owner Name: _�►r,o. rO ___Aawar� Phone: _ __--
Mailing Address: _11 73 „ P owa r�k 0 .7�12 •
Physical Address:
Facility Contact:
Title:
Onsite Representative: C L� V ' C_L
Certified Operator: _ _ S+ay_t, G . "n -.,.se. r
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 y
0
Latitude: ❑
Phone No:
Integrator: C- Q � a
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er r
❑ Non -La ei __ T
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
TurkeyPoults
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?
Longitude: ❑ o = i ❑
is
Design Current
v.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
51 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection 3 ilo os
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[N No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 14.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):,�'•'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(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?
Rf Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® 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
R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN >: 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) C��
s v t S G .
13. Soil type(s) ��*k„ r +(
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
T No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
Q� No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FXI No
❑ NA ❑ NE
C�OA1+'1huG
-1-o woe IL d([7Aj
a CD.v
k-e-a-
Sioo''S.
Ova pr
4- .c" tSS
4,0 �: rti+ r0✓ c h y G S
Reviewer/Inspector Name E
Reviewer/Inspector Signature:
Phone:
Date:
12128104
3-/O--d_T_
Continued

Facility Number: rJ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
® Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking N 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
® 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
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 91 Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
[j]L No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes]
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
d}diEional Comments'and/ot;YDra " #: r� g w3 i y i�
a ! - _S 44 v t U LL Cr • s ja `l C (A For
�b PP ra4e- a,,j 4crnnuGac' �iY 144L,a�p� h'^aC 46 "SC
z t d T a 7S C a M r c A't 0+ s W c 4r Cf t-r[�ILa�G
PGt T-s �[�r��1 �Or►A-%IC� T �^1� Q�G„ /� 0�/C►^G?dpllC{'C�t�h
I�c00_ +-Q�:_h f3lQC_C'
12129104

(Type of Visit WCompliance inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit (routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Date of Visit. s �5 Time:
tE7$�! Facility Number 3
Q Not Operational Q Below Threshold
© Permitted [3 Certified © Conditionally
Certified% 0 Registered Date Last Operated or Above Threshold:
Farm Name: ...........4�rv3 /JCounty'
Owner Name: ..._. L oedat l.�b _ Phone No: .�i72 .ak.� .
':Mailing Address: - �1� -- - -�..�. _ _..._.- . Ni"
�Ngpr pf' bdMC T Phone No: Facility Contact: .......................�..........................�__._.........._Title:.........._....!�.............._._...................................... .....-- .... ...... .............
Onsite Representative:._.0 `S, _ tom+ ._ .._.__ W .W -- Integrator. _J2aLf..i.c ------ .....____......____--
Certified Operator:...... ...W_.._ O r�. Operator Certification Number:.-_.)L 112..
Location of Farm:
ERIw-ine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 4�4 Longitude • 4 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9011�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [;do
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [ fo
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiCer.
�7 3 .-
Freeboard (inches):
12/12/03 Continued

Facility Number:
Date of Inspection E1029
' 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
` seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Pounding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type DC/►w. Am _ L /�,cf�r . Sn+� � � L %>v (eh G i
13. Do the receiving crops differ with those designated in th&Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
I& Are there any dead animals not disposed of properly within 24 hours?
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional
Air Quality representative immediately.
`% r�Aoa 16Y.,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes Er!No
❑ Yes [jrNo
❑ Yes I 0'
❑ Yes 9?1�0
❑ Yes Rgo
❑ Yes Gflo
❑ Yes ffNo
❑ Yes [moo
❑ Yes G?No
❑ Yes RoRo
❑ Yes ETrlgo
❑ Yes Frio
❑ Yes Q No
❑ Yes dNo
❑ Yes [fio
❑ Yes [91110
52ofield Copy ❑ Final Notes
Date:
12112103 / ] Continued

• Facility Number: I&A _ Date of Inspection
ly-
Ree uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ETNo
[:]Yes Qq4a
❑ Yes M- b
❑ Yes 214o
❑ Yes 2140
❑ Yes VNO
❑ Yes RNo
❑ Yes &No
❑ Yes U^o
eYes ❑ No
❑ Yes Q<To
❑ Yes �io
❑ Yes G^o
❑ Yes LINO
❑ Yes RrNo
12112103

Facility Number: �2 -_2�j
General Information
Farm Name: L r A o :
Owner Name: L i n
On Site Representative:
Mailing
Physical
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:.
Time: 2 i o
No:—S 6, -7 --e� J,
'- aL,!!
Latitude: 35 1 0 ��� 95 Longitude: 18 / 3'f / _
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
0 Nursery ❑ Non -Layer O Beef
0 Feeder
otherType of Livestock (,I r * 5 Number of Animals: y I C7
IN Umber of Lagoons:_ (include in the Drawings and Observations the freeboard of each lagoon)
Facility Insnectio
Lagoon
Is lagoon(s) freeboard less than 1foot + 25 year 24 hour storm storage?: Yes ❑
Is seepage observed from the, lagoon?: Yes ❑
Is erosion observed?: Yes ❑
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need' rovement)
Crop type:_ Ql 5 Acreage.
Setback Chieria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17,1996
Yes ❑
No p
No O
Noe4
Now'
Yes ❑ No Z
Yes ❑ NoJU
Yes ❑
Nop
Yes ❑
No
Yes ❑
Nop'
Yes ❑
No-2
3(

_ —Maintenance
Does the facility maintenance need improvement? Yes ❑ No
Is there evidence of past discharge firom any part of the operation? Yes © No
Does record keeping need improvement? Yes ❑ No rY
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes O No
Explain any Yes answers:
cc: Facility Assessment Unit
Drawings or Observations:
l
AOi -- January 17,19% 4
Date:
Use Attachments if Needed