820109_INSPECTIONS_20171231

NORTH CAROUNA
Dqmd=M of Environmental Qual

(Type of Visit: UCoro'U'tvine
nee Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit; 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : Da Departure Time: County:
Farm NameEat n., Owner Email:
Owner Name: ZZ el 1+4x- ��a`J a Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: d _yy` Title: ifw N Phone: I
Onsite Representative: ��r.,��. Integrator: VI;17
0.
Certified Operator: � — Certification Number: g/ 3 lc
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
sl
Capacity Pop.MI&W011Poultry
er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
LE[La
Non -La er
DairyCalf
Feeder to Finish
3
D , Poulh,
Layers
Design
Ca aci
Eurrent
P,a
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other
I
10ther
Discharges and Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
[—]Yes 5� No
[-]Yes [g No
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: S-171
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ �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 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 23--go
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D-tIo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3 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, n / LUk,r I. fyg k,, / /(2i¢ Z-5enE
13. Soil Type(s):-
14. Do the receiving crops differ. from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3`�0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
❑ Yes [y No
❑ Yes [J]No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
['(vo
❑ 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
E31No
❑ 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
�To
❑ 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

[Facility Number: -Z,62 jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑✓ NO
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej_�o
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 [D] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [3"No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes 2-101 ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes [T No
❑ Yes [2r<0
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain Any YES answers and/or any additional recommendations or any other comments.
Use drawings.of facility to better explain situations (use additional. pages as necessary},
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:'
21412015

4
Di"vl-sion of Water Resources
Facility Number ®- Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other Q Denied Access
Date of Visit: r Arrival Time: Departure Time: ; Oa County:. Region:
Farm Name: ,� yip 1 �, �l at t[,m� Farms Owner Email:
Owner Name: [/ �Ci� Phone:
Mailing Address:
Physical Address:
Facility Contact: tr, Title: Lo Phone:
Onsite Representative: `j'��Yc r� Integrator:
Certified Operator: y'�-� Certification Number: �36 �O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Wean to Finish
Design
MIR op.
Wet Poultry
Layer
CF13—acit-VINPop.
It
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
E]
Dairy Calf
Feeder to Finish
y
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I t—q
a aci
P.op
Non-Dai
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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �RNo ❑ NA ❑ NE
[]Yes [:]No
[]Yes []No
❑ Yes ❑ No
❑ Yes J2. No
❑ Yes ®.No
[DNA ❑ NE
[3 NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Faciii Number: Date of Inspection: b—
Waste Collection & Treatment
tL 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 53.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): J 7
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [� No [3 NA [3 NE
(i.e., large trees, severe erosion, seepage, etc.) T�
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes CRLNo
❑ 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 CR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes allo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo
❑ 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):
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
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[&No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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
ZkNo
❑ 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 J�allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [3 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes JS No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes ELNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �oo
L
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 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?
34. Does the facility require a follow-up visit by the same agency?
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes Jallo ❑ NA ❑ NE
❑ Yes ja No ❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes _5Q No ❑ NA ❑ NE
❑ Yes Iallo
❑ Yes MNo
❑ Yes Eg-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments; (refer+:to question #.) Explaintany YESRan'swers,and/or:any addltional recommendations or�any other comments , : ¢s
Use dra► rigs.of_fac.ili to b6t(6r�ex lain;s"atio.ns (u§e'additianal; a es.asinecessa )
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

la /a rb
ivialon of Water Resources
Facility Numher ®- Divislan of Sail and Water Conservatian
O Other Age, ARM
Type of Visit: ,�omppliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (911outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,' D Departure Time: County:. Region:
Farm Name: Lug � Owner Email:
Owner Name: G(/a - aft 7-a��•--- Phone:
Mailing Address:
Physical Address:
Facility Contact: 121ank 7�,!'1 „„— Title: 01 Phone:
Onsite Representative: ��'� Integrator: ►-,yy�t_.,./
Certified Operator: ^l�a..� Certification Number: l 1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
ElesignMeu4�ent
Swine CaacitPa
Wean to Finish
Wet Paultry
Layer
RNon-Layer
Deslgn
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
DairyCalf
Feeder to Finish
Farrow to Wean
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,onit�, _ C•a acl P.o
Layers
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Furke s
urkev Poults
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CZ�No ❑ NA [] NE
[:]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes J,No
❑ Yes Jallo
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: - p Date of Inspection:
l Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5Z.Dio ❑ 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): Ig
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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
ZLNo
❑ 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
Q 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): , y/'nr./ .1,7
13. Soil Type(s): d.-
14. Do the receiving crops differ from those d signated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PINo
❑ 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
allo
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ 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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
' 0 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®-No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit?] Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r 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
[:]Yes
[] No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[t] No
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
A ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
Reviewer/Inspector Name: Phone:/D3 3l� Q
Reviewer/Inspector Signature: Date: xe
Page 3 of 3 21412015

- /Z-31-15-
_I
(Type of Visit: OCompliance Inspection O Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit: outine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ,�Arrlval Time: Departure Time: County:
-�-
Farm Name: 'T_2.0_T� .rltcrn- �yrrJ'�-f Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r �_ ����.�..._- Title: _g2-�n rr.� Phone:
Onsite Representative: A.. Integrator: M 71
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certifieation Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Cattle
DairyCow
Design Current
Capacity Pap.
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish 7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►►arrant
, P.oultr, C*a aci I;o
]Layers
DNon-Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impact
Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes II No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [-]No
[:]Yes J,No
[:]Yes RNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 03 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in); [.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes rNo
❑ 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 r"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rg.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
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ®. No ❑ NA
❑ Yes 5a No ❑ NA
❑ Yes ®. No ❑ NA
(—]Yes ® No ❑ NA
[-]Yes [S-No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R[No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[?�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design []Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jr
2= / 0 Date of Inspection: IS-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes K No ❑ NA ❑ NE
s 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 ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 5�[ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CZ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes RNo
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3. 33Dc7
Date:'���-lSf _
21412011

/ti
Au
Facility Number
Y
CT Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I I p C> I Departure Time: _c- County: Region: 5:1711"W1_
Farm Name: -+,r.- _/✓+�� Owner Email:
Owner Name: �g �..�,I(� W �R r� Phone:
Mailing Address:
Physical Address:
Facility Contact: l>1f�/� �--- Title:
Onsite Representative: f Integrator:
Phone:
Certified Operator: I_::? 0-1_ Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes RLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2,No
❑ NA
❑ NE
[:]Yes
allo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facilit Number: Date of Inspection:
j Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
[KNo
❑ 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
fR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21 No
❑ NA
❑ NE
maintenance or improvement?
I I. 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
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?
u L"
❑ Yes ® No
❑ Yes Z[No
❑ Yes [0 No
❑ Yes R No
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?] Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections. ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ®, No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: ZL - Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes [RNo [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes L No
[:]Yes �l No
[:]Yes ®..No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j _ soz)
Date: 4 :
21412011

�vs f olaa�l �� ►� � MS
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: EF Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
ON
Date of Visit: 0js rrival Time: Departure Time: '�� County: Region:
Farm Name:�a►ai d._ Qti/IYl Fj:Q/Iy)
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ME TfIz Title: M&04r• Phone:
Onsite Representative: Integrator: H—,B
Certified Operator: Nark A. TatVm Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swinc Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop,
airy Cow
Wean to Feeder
Non -La er
airy Calf
airy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Eurrent
D , P,oultr. Ca aci P
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes ® No ❑ NA ❑ NE
❑Yes [3 No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [X No
[:]Yes [% No
❑ Yes fR No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
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 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): 1—
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 CR No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? tj� Yes d No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 151 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 allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C;(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo
❑ 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
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�R No
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes �R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes '�;-No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)-? No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Callo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No M'NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR 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 ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No r5j NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CRNo ❑ 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
[Z 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
[51 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
0 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
12 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.! `
Use drawings of facilitj to better explain situations (use additional pages as necessary).
-7. Nhe, Cut Wck WLA eh backside c-(- one sloe a�- IQ4JaM)
Seff a 0 13 er rdt, 00-, Peof sqol I 46� Ok
Reviewer/Inspector Name: 73-bim S:bn6k _ .„ _ Phone: of 0-q3.3-3_VD (Lff ke)
Reviewer/Inspector Signature: Date: �� IS A0 13
Page 3 of 3 21412011

Facility No.14--Ing Farm Name �OL Ta1tA,_ Date 10 [td.1.3
Permit ✓ COC OIC NPDES Rainbreaker PLAT Annual Cert Dail Pi e) i Y p
Lagoon Name S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Slud a De th ft
Liquid Trt. Zone (ft),
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
. . . •
01 orzpIm-am-
���----
�M
Soil Test Date 4113 Rla')Ila,
pH Fields
Lime Needed
Lime Applied Cu-I f Zn-
n-
Needs S (S-1<25) W1U--
Crop Yield
Wettabl Acre{�^-
WUP r��= --
Weekly Freeboard ✓
1 in Inspections
120 min Insp.
Transfer Sheets fl
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
a
% r
WRr + IT.
., NO
� 1 �
-._...
—._...
Ve fy HONE NUMBERS and affiliations
Date last WUP FRO I11(100 FRO or Farm Records
Date last WUP at farm Lagoon # 0
App. Hardware Top Dike ��'
Stop Pump q(wo
Start Pump 41,0
Fa PL4y p MI. wa=�.v
F3�� I H 0I? 17 j
FS K117 -9 f S I =z &_) Ni_
N wP 10-rr
tilk)
n �'
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ibla

Date of Visit: Arrival Time: Departure Time: County:�T
Farm Name: �o�pi��/M /� Owner Email:
Owner Name: co aId TAym Phone:
Mailing Address:
Physical Address:
I D'(I
Facility Contact: 1 T"U/Y� Title:
Onsite Representative:
Certified Operator: D&VId- Tatum
VM
Region:
Phone: V f;_CJ
Integrator: H—"
Certification Dumber: 167y7
Back-up Operator: Certification Dumber:
Location of Farm:
Latitude: Longitude:
Desi n C•urrent
Design
Current
Design
C►►arrant
Swine Capacity Pop.
Wet Poultry
C*apacity
Pop.
C*attle
C+apacity
Pop,
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D_r, I;tiultr,
C+_a ucit
PLo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
I 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 Ef No ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
f>_�No
❑ NA
❑ NE
Page 1 of 3 J 21412011 Continued
W
I

Cacilit 'Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 11
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No [3 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
�R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
jx;�^No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ 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 [!�;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 Drib ❑ Application Outside of Approved Area add�7
y� ,, I 1, _ coti�ciio,
12. Crop Type(s): L,11 17t'l/n'j&, sWhet, GNK )V e J
13. Soil T e s : tCd� ' � Q 60H2 n 4y ed�pl' n0
yp () O&&i, 3 s *A 8 �, Nr blk IS V D P CI a�
14.
Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
allo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[,;R No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r5�No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
15il No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[SiNo
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S.�-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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W 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
CRNA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: jDate of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tRNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CS -No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[�JNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
W No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[5�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
MNo
❑ 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
P-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[5rNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®' No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5;1'No
❑ NA
❑ NE
Comments (refer to question #): Explain Any YES answers andlor..any additional 'recommendations or:any ther cdin_mcnts
Use drawings of facility to better explain situations (use additional pales us nec'essary).
an, N-ew wo)� eta, aj o(L &or ao � 1 I I
�: eV Yve e, oVeLk-pls row
1 beoyJ 0 r 4' 0"L O - l
re yj
Cr�7 t Corn, 9r�`�,soi end s
d, 'e'6- 0) r6e,('
yr f V h[f 1
r ov CdAvk fteo
V
kWi ot Z. -Gzj• to josd-shap,
ReviewerllnspectorName: �D/fi����r Phone: UM
Reviewer/[nspector Signature: Date:
Page 3 of 3 21412011

`Facility �a-� No. Farm Name &vI f
—ra�^ Date I�
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop.
Type
Design
Current
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
3
Liquid Trt. Zone ft
53
Ratio Sludge to Treatment Volume
4k,"W. ►!TPRO 'PAVAM
--
Design Flow
Design •1f�-----�-
Actual Width
413.3 ✓
Soil Test Date
�
Wettable Acres RUGE
pH Fields
WUP ea or incinerator v
Lime Needed
Weekly Freeboardortality Records
Lime Applie S r (j
1 in Inspections
Cu-I Zn-1
120 min Insp.
"`�
Needs P
Weather Codes
Crop Yield
Transfer Sh ets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt (lb11000 Gal)
0.
17i
at)
1
�rtir���L���RL:
� 92' 1-i%/,�
=
y
i
Verify PHONE NUMBERS and affiliations �` } Tj-��''��;; rr� )�%� k�
Date last WUP FRO Date last WUP at farm Hl(I App, Hardware
FRO or Farm Records
Lagoon #
Top Dike Cj^�L S'f1©IC
Stop Pump m a-xh#YL
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac 01
sub 1 0�d AIIi
b i °�
�r ay ��
fb�4 6tcR PlV6 a4 )
doe ab�

DIMS OW `TI11lk
' Division of Water Quality
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 9) Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ®County:
Farm Name: �Q� p l� �U fyM Owner Email:
n rr
Owner Name: U26 i6_ T1LV_A_1 Phone:
Mailing Address:
Physical Address: ­741(p -Fa r
Facility Contact: Title: Phone:
Onsite Representative: Integrator: ► l',3
neb
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Dry Poultry
Layers
Non -Layers
Pullcts
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Region: Fko
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 12 No ❑ NA ❑ NE
❑ 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 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
�] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
B�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit Number: -6. - Date of Inspection: AWq
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes X1 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes n No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
® Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ra 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 in,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 12 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes] No ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pennit readily available?
❑ Yes
15� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1p 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
g No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
KNA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ WE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No JRNA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes tR No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes �@ No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
fp No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CSNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej�No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. ;Mt
r t.. .
Use drawings of facility to better explain situations (use additional pages as necessary).
C (T} brac t Dr ✓s rw 421 0j_ 9f ht-t^ wftif y fOw'7i �`�� 47 � 4�1407 h7eiJbr,_
avmhslk), Ad vhe f6om�
Ol1r I 1 epje r , ) Rpas al en of seaeo n
ol$lh�p�, -Iv�i� a���►�r o`o�,Cn�+oI�;
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
1

Facility No. IDJQ ' Farm Name D'-)IdYj Date
Permit ✓ COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name S for spillway
1
2
3 i
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Al1
Sludge Depth ft
3
,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Sail Test Date �I�O 1 �7
Crop Yield
Transfer Sheets ndo—
pH Fields
Wettable Acres v
RAIN GAUGE
Lime Needed
Lime Applied
Cu-1yZn-I :
Needs S (S-1<25)
NPariC P K k-)
WUP ��
Weekly Freeboard
1 in Inspections
120 min Insp.-
Waathar rnriac
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
,
r
.1
_
Verify PHONE NUMBERS and affiliations
Date last WUP FRO I 1I(010(' FRO or Farm Records
Date last WUP at farm j)q Lagoon #
App. Hardware Top Dike
Stop Pump
4 Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
5

lys D I nos )2 1010
"Division of Water Quality
Facility .Number Q 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: W= Arrival Time: � Departure Time: i��, 4J County: Region: F
Farm Name: DC4,01 J - "�'t i "� "72MI Owner Email:
Owner Name: JM Phone:
Mailing Address:
Physical Address: �1
Facility Contact: Ii �'l (k � TAM Title: r[� Phone No: �
Onsite Representative: MA 2 i "2 Integrator: H-0 Certified Operator: Li2ld Tff Operator Certification Number: 16-7q-?
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
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = o = i =
il
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
.a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
l
❑ Yes E;�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
SNo
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

N
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Eallo ❑ 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 CErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fRNo ❑ 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 JgNo ❑ 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 f,;k1Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�;No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tRNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: LQf�]'�.33�X333�
Reviewer/Inspector Signature: Date: C `b� of I Q
papa 2 of I 12/2R/04 Continued

Facility Number: Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [5�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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
[5'No
❑ NA
❑ NE '
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
U NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
RNo
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f5rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
MNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E@No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
ETNo
❑ 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
;allo
❑ 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
SNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C'No
❑ NA
❑ NE
Addifi4i nal Comments and/or Drawings:
34, uo
•
% NPW -G-elds added,,- i $ Ac- so,+hside mCIC*M
I51 Pvtls n��>°� if rvVC, j�ml°t� �n S�rih� aD[A
ay , Nose 9A�+ wdek d I OW40- 01 Ca U blaf ions ,
604 - 'qvm (I r,e c&dj - ,
W+ �&m - or bockup 01 C ,
Page 3 of 3 12128104

J Facility No.ID-V Farm Name I. OW Date
Permit COC OIC� NPDES (Rainbreaker PLAT Annual Cert )
v�
Lagoon
1
2
3
a
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Soil Test Date 1 11a 0 ` dt)�e �&V-Wettable Acres '� RAIN GAUGE
pH Fields WUP �— Dead box or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records
Lime Applied 1 In Inspections
Cu-I -'Zn-I ✓ 120 min Insp.
Needs P Weather Codes.
Crop Yield Transfer Sheets
:.�
..
..
Verify PHONE NUMBERS and affiliations `a(l-.Sc�t.,�' -5t) Us My
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
Sib)
rid.?3
App. Hardware 'fib a'
wa
,a s �

0Iks
Type of Visit ;Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r 0, Departure Time: l County:5,om Region:
Farm Name: Dourld 12 /o P24 Owner Email:
Owner Name: Ochald Phone:
�` ^7 �n_e:
Mailing Address: 33f nJ �-w Glh�ry,
aSB
Physical Address: u �,/
Facility Contact: I ILV T il? Title: r lM04-P%° Phone No: Va 8Y3 �C
Onsite Representative Ulport,h,' ) Integrator: W
Certified Operator: Operator Certification Number: 1&7 q7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6 014 Longitude: 0 ° = 4 = [{
Uesign Current
Design Current
Design
Current
Swine Capacity Population
VVet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I ❑ Non -Layer
❑ Dairy Calf
Feeder to Finish] C
❑ Dai Heifer
❑ Farrow to Wean
I)ry Pouitry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
ElBoars
❑ Pullets
ElBeef Brood Cow
El Turkeys
Other
❑ Turkev Poults
❑ Other
❑Other
Number of Structures: EE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. 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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection 13
Write Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure: I Structure 2 Structure ; Structure-1
Identifier:
❑ Yes t5kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Frechoard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EkNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes D?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? R Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C$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 'RNo ❑ NA ❑ NE
maintenance or improvement?
W Iste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes !L;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 Window1 _❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop types) OVU Oelm4'L� t - pQJ IVif�� S� D1
13. Soil type(s) IV
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
� Yes
�5X'go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%[] Yes
D?No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewertinspector Name �Gii'�IJ �`jCfIMCi EPhone r 33' -W
Reviewer/inspector Signature: 2b Date: Via. q). Q
1212810e Continued

Faci ty Number: $ r 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 1P No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21, Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ERNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IgNo
❑ 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
7�91 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IgNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q 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
9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
itS No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
7, Fif o I; ; t d L c k b,/I h n'd
La f� yr�c s=hG ,P =o n►rrk J
y
ih; [ 1 fi'= wt olap a teal ) ref') �'elyr vhkil rr� � t`F
u(Ordr4.Sfo7 6etd r.
Page 3 of 3 12128104

Facility No.Sa-10� Farm Name
Permit COC ✓
r-
&64 �a � Date
OICNPDES (Rainbreaker PLAT Annual Cert }
Fq Props­
to-
I
limb 4
Lagoon
1
2
3
4
5
6
7
S iliwa
Design freeboard
Observed freeboard in
Sludge Survey Date
j
Sludge Depth ft & %
Liquid Trt. Zone (ft):
S
a W-
Design Width
Soil Test Date
Crop Yield
120 min Inspections
pH Fields
Wettable Acres
Weather Codes
Lime Needed
Lime Applied
` P
14 ��
_
WUP L.�`
Weekly FreeboardR
Transfer Sheets
UGE
Cu ..��
Zn .�"
Rainfall >1"
ead or incinerator
Needs P
_2
1 in Inspections
1
IT-f�r�89 �htt'r P/j
000 _�
7 U q"5-
r!T—Tr- �:► j
Mom..
..
t
Verify PHONE NUMB RS and affiliations
Date last WUP FRO IIII(,IoDate last WUP at farm Ij
FRO or Farm Records
Lagoon # l'riml-r��p�oa'fD�e �Q6�
Top Dike( 0
Stop Pump 46
Start Pump 4e'0
App. Hardware
Solir�pr¢��

Q I Ids -7I�L1ft 0-16
�.. WDivislon of Water Quality
Facility Number Q Division of Soll and Water Conservation
O Other Agency
Type of Visit VCompliance Inspection O Operatlon Review 0 Structure Evaluation O Technlcal Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: *��� Departure Time: 07; � � County: S
Farm Name: bOA41A1
_ T�fUM t kdf Owner Email:
Owner Name: haw Id Phone:
Mailing Address:
Region:
Physical Address: Facility Contact: Hik Title: F IM 01%nor PhoneNo:,526—B436 CC1}}
Onsite Representative:: Integrator:kv/Aawwa
Certified Operator: Dihald— _ __ Operator Certification Number:AWA I67Y
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
Other
❑ Other
Back-up Certification Number:
Latitude: =' =' =" Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: FT
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 5j No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

r I FaciHty Number:$ —101 Date of Inspection L ilea
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 [kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes OTNo ❑ NA ❑ NE
❑ Yes 9No ❑ 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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JRNo ❑ 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [--]Yes [,'j�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CRNO ❑ 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)Co" I )4&A da_ l T7Q 1'! . 96 d
13. Soil type(s) lyiig
1 ST1S
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
C'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5rNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
5iNo
Cl NA
❑ NE
Reviewer/inspector Name IX t - - - - Phone 3
Reviewer/Inspector Signature: Date:
. ».11 .1 _ ,. _. - .

l~aNlity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes CRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes r;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 'IgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [--]Yes ❑ No IRNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I --] NA❑
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rRNo
L2rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CRNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
L1n Orraed In �1 i
•
P_VVer .
Rjf_*i2, 9rtl-eddow4 105f
Cb+ hay IaTf week,--el'al CU1ti� _
�S1l
o%$'Sled 5ilt"t lrQr d� htmjxc t ads° In �l� id' Pd �13?e
y�e �e ��, aoo�. y aIC M
b�� Qd a I r" is la w,
ca e (Otd
S rv�rr a IfeO. to `�o �rP � � oa, � I Page ��
Q712.`�sat' � 4 ma�we r p� �
�Cr o
0� cr1�i� bawe_ sets On �P �� �
l if le- ��� o�olwts a� �dP� . �o� nu-f�, �tlr!;
Arr d +refj (X
. .
cod- 1 �067 cover oV&V .
Page 3 of 3 12128104

1 l ;
Facility No. O'a-� Farm N e 0fhed Tan A Date
Permit ✓ COC OIC^ NPDES (Rainbreaker
-.. .-
PLAT Annual Cert )
FB Drops
.. . . ......
Freeboard
Design Flow
Soil Test ,}/V;I��L L,M — � Wettable Acres Rainfall >1" ✓
pH Fields pH Lagoon Crop Yield 1 in inspections
Lime Needed dlrlft' Rain Gauge 120 min Inspections
Cu Weekly Freeboard Transfer Sheets
I 'tU'M I -D'A "/ )ir
Pull/Field
Soil
Crop
Pan
Window
3
S
F
r
If
4r
—OWb0.0
�.�Jmr *0(43")
1*1Z 4t-t (A") ?
Vd� hrOaAtok-

I
V Division of Water Quality. }
Facility Number 0 Division of Soil and Water Conservation :.
0 Other AgencyTV
w
Type of Visit (♦ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑- pDenied AccessA,-,
Date of Visit: i l Arrival Time: M Departure Time: �� S County: ON Region:
Farm Name: Owner Email:
Owner Name: Donald W' I cxL
Mailing Address:
Phone:
Physical Address: Facility Contact: k -70-7L t Title: Phone No:
U
Onsite Representative: Integrator:
tr
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede.
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= o [= 4 ❑ Longitude: = ° = I ❑ 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
341 ❑ Non -La cr I I :::::d
Dry Poultry
Non-L;
Pullets
Poults
Dischames & 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
Number of Structures:'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
■
❑ Yes 5,No ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[iLNA
❑ NE
❑ Yes
❑ No
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
'E] No
❑ NA
❑ NE
12128104 Continued

Facility Number: p Date of Inspection 1 '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No [I NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes 1❑ No 09:kA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): If
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1�?No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[�4No
❑ 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
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
O No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
fqwo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
&No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or ] 0 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)
13. Soil type(s) t�p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RO No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: io 3-3 tO
Reviewer/Inspector Signature: Date: 11 0

Facility Number: - T p Date of Inspection +L 1171 Q'LJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ❑ Yes YNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ig No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)jNo ❑ 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 M No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1 No El NA El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EB No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
G�No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IgNo
❑ 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
Z 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
4 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
�INo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
r7No
[I NA
❑ NE
al Comments and/or Drawings:
12128104

Division of Water Quality
r==Ffyumber O Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� : Sr�aM County: s0`1 Region: PAO
Farm Name: ;^� Owner Email:
Owner Name: Yoha lot Phone:
Mailing Address: 1335 7-(e-r grip4 NC a2aa
Physical Address:
Facility Contact: _ /&VP— 7t 4tM Title:
14
Onsite Representative: ) I
Certified Operator: IDorka (e 7�p"
Back-up Operator: r `' wk
Phone No.4!�D) 5ftqr�7
Integrator: T f�lX p u
Operator Certification Number: ryG] r��
Back-up Certification Number: j 7 ` 1 I
Location of Farm: Latitude: ❑ o = 11t Longitude: = 0 0 6 ❑
it
Design
Swine Capacity
Current Design Current
Population Wet Foultry Capacity Population
Design Current
Cattle C►►opacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
❑Non -La er ❑ Dairy Calf
LJ ❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑,Non-Dai
❑ La ers
❑ Beef Stocker
❑ Non -Layers
El Pullets ❑Beef Feeder
ID Beef Brood Cowl i
❑ Turke s
❑ Turkey Poults
❑ Other I umber of Structures:
Feeder to Finish I 1492L317
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
N NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
®NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z 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?
Page 1 of 3
12128104
Continued

Facility Number: OR— f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5jNo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No CZNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.
Spillway?:
Designed Freeboard (in):
1�
Observed Freeboard (in): d�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(X No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
5d 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
I,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes
C&No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Z 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 El Evidence of Wind Drift ElApplication Outside of Area
�
12. Crop type(s) kr'�, C4S4"O) 1 5n^& `( &2�- � aA4,,�-tel
� '��OLd. /A ,
13.
-
Soil type(s) No k�la
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(6 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
(9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(S 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 other:comments
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
Reviewer/inspector Name G { 1 Phone• 9i0y A>
Reviewer/inspector Signature: Date: P/6-96326
Page Z of 3 12128104 Continued

Facility Number: Sol, -!0 Date of Inspection 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VS No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[;�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
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

1 , <:
to
J
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: d (/ Departure Time: County: �T
Farm Name: Z_&&t2 f d la �& "l Owner Email:
Owner Name: 730u4 1.,,' 141 �,;., Phone:
Mailing Address:.
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: �� y w. I �w L .
Phone No:
Integrator:
Region: rr�d
Operator Certification Number: 14 ?
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Boars
Other
❑ Other
Latitude: = o = f = Longitude: ❑ o = d = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1, IEJ Non --Layer.
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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 Luf No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
EeNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
12128104 Continued

"tif
Facility Number: Q'a—(Q4 Date of Inspection _ —4
Waste Collection & Treatment ,,,.��,,
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes M<O ❑ NA ❑ NE
a. lfyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in): j q
Observed Freeboard (in): .0- Co ,,,
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes Mlk!!o ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) ,--,,�`
6. Are there structures on -site which are not property addressed and/or managed El Yes E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ hlo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D'�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 El Yes
,,,``
RN' o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
YNo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
MAo
❑ NA ❑ NE
❑ Excessive Pond ing ❑ 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 [I Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � v au ti _ GTfI<•, s t L� N & : •`
13. Soil type(s) W,It /Va
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
G30ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
M'ffo
❑ 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
2,"No
❑ NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes
03 No
❑ NA ❑ NE
stlon.#) EaclilaiR any_YI
kR9We1'S,;arld/oC�
Reviewer/ins ector Name "9!0 to l 1
Reviewer/inspector Phone:
Reviewerlinspector Signature: Date: S
12/2"4 Continued

. :,.
Facility Number: — Date of Inspection -O
Required Records & Documents ER"
No Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ER No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ED, o ❑ 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
❑ W tsEeA p pl-'-& en ❑ week -f eebeard ❑ Wfiste Arnftry t ❑ oil Analy` ❑ Waste Transfers ❑ A i mid CrertiftvItion
❑ kaimft� ❑ Stot-Icing ❑Q4p—Yield 0120ZLizaLinspections ❑ ns ❑ W4k-thur_C.Qdv_
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[1,2_1No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sladge-svrney as required by the permit?
❑ Yes
ED44//
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
_o
L/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L_T'N*�o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
21No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D 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
UN
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,/
t_y No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
[ No
❑ NA
❑ NE
A'ciditional:Comments and/or Drawings:
2 /, /lBa s e .4 r er 7 o k ' So . 14.��.1y � .`s �v %�4 y o ar, 1 e e oywer
12128104

K
Bate of Visit: �� 9 0 Time:q,'/�
Facility Number ID
Not Operational 0 Below Threshold
[permitted Certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: �� _/Lt�✓an ^ FGr �►� _� County: SGT seh 2
Owner Name: 100. d TeX 111',22 Phone No: / y�
Mailing Address: 7339-- 7crTc�
Facility Contact: Title: Phone No:
Onsite Representative: 'Au' ( 1 , Integrator:.
Certified Operator: Operator Certification Number:
Location of Farm:
wino ElPoultry ❑ cattle ElHorse Latitude 0" �• Longitude
Design ' Current' . ;. ,Design Current ,Design Ctirreot `
i$4 lne . ,Ca acitv .,population Poult t .., . Ca achy. -'Population . Cattle Capacity Population
t
E
t '
t
E,
E.,
❑ Wean to Feeder
seder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Layer - ❑ Dairy
'' Non -La er' ❑ Non -Dairy
4: ❑ Other
Total Design Capacity,
,...� E
Nninber of�Lagoons' t '' '�� ❑ Subsurface D
iing.Pondsl;Solld Traps`;z0 [} No Liquid W
Discharges &-Stream impgos
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
OSIO3101
❑ Yes
G o
❑ Yes
Q-Ko
❑ Yes
Elm
❑ Yes
❑ Yes
,[D-No
I TNo
❑ Yes
❑ o
❑ Yes
011 S
Structure 6
Continued

Facility Number: —1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes I_ - o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes t,3-NU
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑-P'o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑-No-
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑iq'o
elevation markings?
Waste Application ,��
10. Are there any buffers that need maintenance/improvement? ❑ Yes <�No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑1+1(5__
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ber�►aacj� T_7Jaall �/a;n fvc�r�sc��` &A irrarey
��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes -11,0
14. a) Does the facility lack adequate acreage for land application? ❑ Yes &fqo
b) Does the facility need a wettable acre determination? [IYes 9-�No
c) This facility is pended for a wettable acre determination? ❑ Yes 2' o
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes ©N6"
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9-W
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes B i5o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes BNo
Air Quality representative immediately.
{ irnUTLU{IL S€rP It .€trdtf 1 X.`lSIN N i- C r. n F`' �- `♦t r t tlt.R' 7 1- f[:' -- 's - i
t,Comments (referato question:#), Explain any,,YFS answers a! d F,,4ny recommendado&,,dr any other co-mme ti
Use drawing, of,facultytto+bybetter expla 6 Atuatlons (use'adiiit�onal pages'ss necessary?' i€ A• tL�--� Co Final Notes
f .4;�jM l �,+, h€pil, { $L' i 'C� f I;f II h II "� �it f, j ! r 4 C ,. ," 1N '� •.' € �3 ¢F s'i; ss in`!F i -+'sG+U Copy
I� � l[r���,yy.Y{�?�J{j�=� f L
fii�'" iI. lirlE i� �;f 1f.iWY �i.q.Y .l lY�:�..Se ttIE.1;YC:.<J*"�. ��... i`
u
G" � T ��+ r, lr+ 1 la l � 5 I
1s
iL1,e NGo/4 A-9ronom,'( Aqe.7-7L Fcr SG,,Ison
;r • a+rxr�n°�:�i�.f?�-��I'M�. '�/%J ����' �';Ai -P'L sReviewer/Inspector Name 11 m/Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: ,� — Date of Inspection
Required 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/,W,,T,, c4weists, de i , . , etc.)
23. Does r ord keeping need impr vement? If yes, check the appropriate box below.
rite Application reeboard ante Analysis oil 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.
❑-Steeki�— ❑£rep -Farris"' �pection-After-1 R�airr~
Ole
charts ❑
❑ Yes [}NlT-
❑ Yes
❑ Yes QNe
❑ Yes p-KO,
❑ Yes
❑ Yes Ca-15,0^
❑ Yes ElO___
❑ Yes ❑ No
❑ Yes EP6
es ❑ No
❑ Yes
❑-Nis'
❑ Yes
tt-vo
❑ Yes
❑
❑ Yes
►[�3�
❑ Yes
[t]-Aiar
I2112103

Mai �> .. :. .....A..»...-.".-... .:.i. �..aF,..a`�.::s�i,.�:, a :,. :,; u::nr a:��:::�w,�::,t°.<:,;;,':,fi..:�,w:s,.t•;:�+ '"c '';"�?� �� - .. a
❑ Division of Soil and Water Conservation [] Other Agency
® Division of Water Quality
r�
10
Routine O Complaint 0 F011ow-u of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection tav 24 hr. (hh:mm)
© Registered 0 Certified l0 Applied for Permit 0 Permitted 0 Not Operational Date Last Operated; ,,,,,,
Farm Name: ........ +1,e.M,AI�G.....�tt>....!'.. „ County: ...............�.
` ..... `. 'eli;r...61 .............
Owner Name. .............. ! ,t ...1..J�f/`�'r`..' Phone No: /d� S�Z.-...... ......................
.
Facility Contact: ......... ..:..... 01..;� ., Title: Phone No:
Mailing Address:....,...7, , ... Al f.�...�i ...... r! .'6 ,�•........,..el, 44"..y<.,.N ...,.. P.. ^..................................
� "`' a'Y
Onsite Representative:.......... rF!.. , ........................................ Integrator:..,....
Certified Operator,..........,t !+7.. � � p .... ..................................................... Operator Certification Number s.........................................
Location of Farm: �,..... %„ /./., 41 z/ /O
L
Latitude Longitude
�,Desfgri 1.1
Current£ DesignCbrrent Design Current
Swinen F Capacity:: Papuiatton :Poultry `Capacity Popttlahan Cattle t Capacity Populatipu :f
Wean to .10
eder Layer airy=
❑ Feeder toFFinish JEI Non -Layer I JE1 No Dairy
❑ Farrow to Wean .
El Farrow to Feeder ❑ O[her
❑ Farrow to Finish x Total Design Capacity,.
❑ Gilts
❑ Boars Total SSLW
,Number of La ogns / HoldEn Ponds, ❑ Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
;' ° 4 ❑ No Liquid Waste Management System k
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
10 No
2. Is any discharge observed from any part of the operation?
❑ Yes
JU No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
KNo
b. If discharge is observed, did it reach Surface Water'? (if yes, notify DWQ)
❑ Yes
KNo
c. If discharge is observed, what is the estimated flow in gal/min?
.d. Does discharge bypass a lagoon system? (If ycs, nlify DWQ)
❑ Yes
M No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
CR'No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Q No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
19 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued
on back

i
Facility Number: Z — f
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures lea oons 11oldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ....,2.. i�. L..�......
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes IgNo
❑ Yes '(No
Structure 5 Structure 6
................................................................
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of rWMP, or runoff entering waters of the State, notify DWQ)
5. Crop type....................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For ertified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violitians•or deficiencies were notedduring this:visit.;.Y.ou.wili recei-Ve ni 6Airtlier
. corres'poitdeko 6bout this; visit;
❑ Yes 19 No
❑ Yes P[ No
❑ Yes 19 No
❑ Yes rKNo
—
❑ Yes XNo
.......................................
❑ Yes
D!LNo
❑ Yes
P No
❑ Yes
to No
❑ Yes
IN No
❑ Yes
CANo
❑ Yes
IgNo
'P Yes
❑ No
❑ Yes KNo
❑ Yes jj" No
❑ Yes ,RrNo
gmments (refer,to question #i} Explatn=any'i'ES artswers and/ar any recommendations otany other comrtnentsi
u arawin of,facility to b�tter explain"sit iatioo� �(u idditional puge,5,asn eces *ry) 3 3 §max
IV V4e -I
7/25/97
t` _.
Reviewer/Inspector Name �.�yy a R ern rx
4R,..< k,' :i k . to rwn ii-.'..'�i'�E� v'^, r. < t,,. . �v. r�..a. ry n, ...
Reviewer/InspectoeSignature: _ Date: /Q —zz-,9?