820114_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

i'vl"slon of Water Resources
Faci Number z - r Division of Soil and Water Conservation
� Other Agency
Type of Visit: ompllance 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: f t I Arrival Time: w _. Departure Time: County: S��i[o Region:
Farm Name: b S l( t�G.u,.{.So� SLfJJ'1�, 1 it Owner Email:
Owner Name: `Kt'.- M i 1- �. W I U } &VK50..1 Phone:
Mailing Address:
Physical Address: �J
Facility Contact: v,4 } OLv^1) t`C lE Title: Phone:
Onsite Representative: Integrator: r y' r+ r' a'rr_
Certified Operator: eh Nb rV { S Certification Number: Z 7 q Lfb
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
p.
PoId
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
]Non -Layer
DairyCalf
DairyHeifer
Feeder to Finish
324
06
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,ouIt ,
Layers
Design
Ca aei
Current
Pto .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Dischar es 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 [3"Ko ❑ NA [] NE
[:]Yes [] No
[] Yes ❑ No
[]Yes ❑ No
❑ Yes [2-No
❑ Yes �o
D-I"A ❑ N E
D-I A ❑ N E
❑�A ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: IDate of Inspection: 4&1
Waste C filection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D—N-5 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [D-N7C_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑4o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�?<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [fo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2'fio ❑ 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [3No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FXNo ❑ 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): k� e_J'wl kl"i_ _ S 6 0 H �p at I /d-
13. Soil Type(s): . N D IAJGi_ u o = f"
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
03-5o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[B No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
✓❑"No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3-<o
❑ NA
❑ NE
20.'Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[1 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ 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
[2- o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[/] No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: �
24. Did the,facility fail'to calibrate waste application equipment as required by the permit? ❑ Yes 3'N-o ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ql] _o ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes tNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Quo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 fff'No ❑ NA ❑ NE
❑ Yes [E'flo ❑ NA ❑ NE
❑ Yes [9'No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes
�Io
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
[?10
❑ NA
❑ NE
C6mments!(refer to question #): Explain any YES answervand/or any additional recorothe_ ndations or'any, other comments a' ' .
Use;drarvings of'facility'to. better explain iilt"uations (use',udditional a es,as'i�eccessary).
�. U
47 q� X
� t ato - 30?-- 6 fS1
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:9/o- U 3 3�
Date:6 AA�'l 1 g,
214A 15

RS 'XK Ar3iCIL I (50
Type of Visit: (D Com liance Inspection O Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: (Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: AME
Arrival Time: Departure Time: t S County: Regions
Farm Name: (!� j i &Vl.0�0 � '/IVY Owner Email:
Owner Name: JE (� S► , f Phone:
Mailing Address:
Physical Address:
Facility Contact: a:LAF }a�Cyt�G`( Title:
Onsite Representative:
Certified Operator; G rP64-
Phone:
Integrator: 1N/D— tel,4_o
Certification Number: �% qq 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current Dcsign Current
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
z0
Dairy Heifer
Design Current Dry Cow
Dr; P,uultr, Ca acit I;o Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [EKA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
❑ Yes
[] No
[lNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
YNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[?rNo
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
eNo
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit Number: Date of Inspection:
J.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [EF115—_❑ NA ❑ NE
a. If yes, is waste level into the structural frceboard7 ❑ Yes ❑ No [Z�KA ❑ 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 12-10 [] 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 [2-1Zo ❑ 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
BIo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;�
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q.Atb
❑ NA
❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E>o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E;,, "o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): "°l(
13. Soil Type(s): Wk 0 j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 o
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes .Ado ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [;;-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [,]`No [] NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements I] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [5No
❑ 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 [;rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [RINo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacilit yNurnber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2TNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes eNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
V 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
DNo
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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
0 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3No
34. Does the facility require a follow-up visit by the'same agency?
❑ Yes
allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
1Comments (refer to question'#) Explaln any YES `answers°and/or any additional recommendations or any other cimments:.
6,i­d ngs.of facility to better explain=situatinns:(use additional pages as,necessary).
c4dt`o 614,a,, - q - IS'-Ib
4Z
0.13,3
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phonelct
Date: j
2111015

U, Z3 V
Divlsion of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: o liance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r� <<� i#� [ iP Arrival Time: Departure Time: County:
Farm Name: jC`�C 'Jol stt1 Owner Email:
Owner Name: &_OKV5, SALA Phone:
Mailing Address:
Physical Address:
Facility Contact: C_uAkf cS 509vlw4c(r Title: Phone:
[C
Onsite Representative:
Certified Operator: #0W ins
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
rf O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Region: r5
Integrator: ,G g'4t "I ✓' '-1
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Dischart!es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes ❑Ko [] NA ❑ NE
a. Was the conveyance man-made? r] 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 VNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes ��rNo ❑ NA [] NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

An 41
[Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
i a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);r 3 7_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
g2l�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
[! 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
[?*'�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Bio
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 ` o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Oo ❑ 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 Wi ow Evidence of Wind Dr'ft ❑ Application Outside of Approved Area
12. CropT e s : nn Gd`A
��p c7 ` .G
Yr () A`'1 V'�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�J`No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El"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
FJONo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [?No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�Ko
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
[2o
❑ 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 structurc(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
®moo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
EKc
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [,Dio ❑ NA [] NE
❑ Yes [?**r4o ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
[:]Yes r;;rNo [DNA ❑ NE
❑ Yes [�No
[:]Yes ff No
[:]Yes RfNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
We,drawi.ngs of facility to better explain situations (use additional pages as necessary).:
C�
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: 3 � 33 J
Date: 3 g 'q
21412011

ErDivislon of water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Zoutine
ance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: F o County: s�
Farm Name: h) u� ?Asiu &4-� rt-a^ Owner Email:
Owner Name: geA.A cJ l+ -�_ r I -At Phone:
Mailing Address:
Physical Address:
Region: 14zo
Facility Contact: t S Q�vG•+af Title: Phone:
Onsite Representative: t( Integrator: 1;05�(A)
Certified Operator: ��NK M.WO Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
. ,
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Non -La
Pullets
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No ❑46A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
[:]No
&N
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LJ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Z - Date of Inspection- $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes 3[❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [§.*A ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2- yxy
-
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ED-D�@ ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes ['fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Ko ❑ 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
to
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cj`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E]O'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s)' — — 1 �V�� o _ � ,..gt e
('
13. Soil Type(s): _ 12
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I_7 '`'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
' No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[noNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETINo
❑ 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
[2�<o
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r Facil Number: -I Date of inspection: 1Nfa S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Lla ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Q.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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Otherissues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3--go ❑ 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 [jIQo ❑ 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 Cf r o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes i__I 5-o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [!'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EfN o ❑ 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).
-3,L
Reviewer/Inspector Name:1
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Wk.Division of Water Quality
Pacility Number - O Division. of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: QKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
rC�Date of Visit: If Arrival Time: Departure Time: P County:
Farm Name: t[�C 4;+N Owner Email:
Owner Name: ` it "- �� �W - % �i/� Phone:
Mailing Address:
Physical Address:
Facility Contact: ( r
Onsite Representative: !
Certified Operator: ��^ Nrrvt 5
Title: 1-0-
Region: r ^-ID
Phone:
Integrator: S'
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 -La er
Discharies and Stream Imuacts
Non-L�
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes [jR-IQo ❑ 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 [3'910 ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [] -<o
[:]Yes al�o
[:]Yes D<o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

4& J
Facili Number: Date of —Inspection:
Waste Collection & Treatment �c,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L�so ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. 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
❑ 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 Ai mlication
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 ManurelSiudge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): "-"- " C5 V -D
13. Soil Type(s): Q
14. Do the receiving crops differ from those designated in the (rAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[] NE
20. Does the facility fait 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

Facifi Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Bo ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:�,Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
Reviewer/Inspector Name:
❑ Yes L-LYr o ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes E3,14 ❑ NA ❑ NE
❑ Yes [ _Ko ❑ NA [] NE
[—]Yes [3/No
❑ Yes [g�<o
❑ Yes �io
❑NA [:3 NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3

2
ivision of Water Quality
Facility Number ®- ry O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 5rcompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: G10outine O Complaint Q Follow-up O Referral Q Emergency C) Other 0 Denied Access
Date of Visit: 13 Arrival Time: I (j .'WAt0*11 I Departure Time: ,' County: Region: -j
Farm Name: Am J K Owner Email:
Owner Name: �'� F_Re�,� �T�nsen J QAg gr sj>tif 11 Phone:
Mailing Address:
Physical Address:
Facility Contact:
�R'tSS �lAttt,s�r.� Title:
Onsite Representative: C��fs p&WM! _
Certified Operator: Q lFc, tyakk-& S
Back-up Operator:
Location of Farm:
Swine
Wean to Finish -
We an to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
Integrator:iI�RT�r,u,
Certification Number: -
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
ur iry�ouitry
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 &No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: !d
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: si D-ti-I Nc0
Spillway?:
Designed Freeboard (in): 14' 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
❑ 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff 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): I! [tMV 4k t' KA_4 cC. V,_ 0 SLj m r+,eA A(tn 00M � . iNsrkR AnrvuB f
13. Soil Type(s): No A }_.QA b PAT r !W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑/No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes dNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [!(No ❑ NA ❑ NE
Required Records _& Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [TNo [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP [DChecklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

FF 7 'rV
Facility Number: 115ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
25. 1s 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:
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
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ 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
❑ 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
❑ 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
❑ 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
❑ 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
Reviewer/Inspector Signature: Date: 113 01
Page 3 of 3 21412011

a 14S cal` '9 120
Division of Water Quality
Facility Number of - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: igCompliance Inspection Z3 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 1�k Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: q,
.0004H I Departure Time: : 0 County:J�� Region: 2
Farm Name:j�ps(� SS'1!lnDA11 Owner Email:
Owner Name: MjT ��f 1 �QNTSQn .- Phone:
Mailing Address: r,,
Physical Address: 5W HOJtcS/ Ave, Cfi'r r, _.
Facility Contact: 6ien Norris Title: MQ Phone:
Onsite Representative: (n 11Qrr�c Integrator: -FrP4 .Smith.
Certified Operator: Certification Number: a7�yh
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? ([fyes, 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-Dair
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes n[ No []NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes Q]C No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 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
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: W a
Spillway?: _
Designed Freeboard (in): �C( _
Observed Freeboard (in): 3, _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[� No ❑ NA ❑ NE
�No ❑NA E] NE
Structure 6
❑ Yes P No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C-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?
[5 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
(2 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
C' No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land.application? if yes, check the appropriate box below. [—]Yes [B No ❑ NA
❑ 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 E] Application Outside of Approved Area
12. Crop Type(s): l it"id tig-1 &A vd a - +6V JSwl
I arn1 '1 nye rj P,,_ 1Amlg I - �V NP,41w,-RL
❑ NE
13. Soil Type(s): 69 ` nf is
C
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[_] Yes
® No
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
ra Yes
❑ No
❑ NA
❑ N E
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis E] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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
RNA
❑ NE
Page 2 of 3
21412011 Continued

' IFacilit Number: - IN IDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qg No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[B 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
U No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
C NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
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
No
❑ NA ❑ NE
]byes, 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
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ 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 panes as necessary).
-7, pl&r clean gosh of of old- lam . 01 la n a s, beef br L, hftL oc, tin hride
dole ogcL t"es Cc+ back r�, oLis; t��e s o� e, �o�C work ! Goa�L 1 ova,
IS` cove- CYO new9oa,,
'Pl��se chick soil a� ( liv CnI a p p y 1 r'm f_ 1-e named . pleaje- co o I w�_j
I�n wIId j4 SVZ e[d•
IQ, Please. Co is Pr_ Z)009 �p�r�;_1 fltoM �1 T 4'h1FF 'FQ/fi d r G[ d wn r DQG� `�lChi
b wQ YVf-bs; 4-t a)6L k p wry rPcr c(� The coc was -h f� e .
► NQs>e 11JEN
SPiro
rae©S4#a rdy No
e 1 OTJwn C1 u*&-i� v a sd0►in 0F c o
,f .
C/'n Qf `{1trr, .
l I � ,
aS.`rhe old 1a joo, CF+ rs at o, 49 s`dyl o s' Crake vo[u>ze, wr l I nL cbeQna-�
�V �, a yea(i r -ear-h 1^" o" so
Reviewer/inspector Name: Phone: If 0-433,323M tU ct)
Reviewer/Inspector Signature: Date:
Page 3 of 3 /4 r711

� r{ 1
Facilit Y No. S �1 Farm Name (I Date
1.1
Permit COC
Pop. I
Type
Design
Current
OIC NPDES (Rainbreaker PLAT Annual Cert)
1a
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth (ft)4
3S
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
9911TI ra.11111111111WOMM=. -- MIMA M r
Calibration Date —
mmin
Design Flow
fir.
•
������'
Design
to V
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed 1T�ifrX Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-1 --Zn I 120 min Insp. fb
Needs P Weather Codes
C nn Yielri ►^u,., .L LLc Transfer Sheets
" .
.11111LOW..
..
■�
+
o a, 1
■
�
d
P: @
_
-T
5 S No�4 sA
�k n� - sd a
ifv PHONE NUMBERS and affiliations VY� R7.10 (Y G�
Date last WUP FRO 110 � Date last WUP at farm App. Hardware
FRO or Farm Records Id
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
>tih� 3ar4c.�
(nwj ab lv ev-t e_ 6,hA

En�e�- �IMs ia.laslio �'S .
+i�rity'Numbr. $ //
0_111vlsion of Water Quality
.0 Dmilon O�' l_l;nitd !Water Cphservatiort ' : ? f � of
0 Other Agency
Type of Visit ompliance Inspection - O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit utlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Datc of Visit: J(,_23_jAp Arrival Time: � fQ Departure'I'hne: �ilT County: Region:
Farm Name: 1AAWi ..+ S. a—T,,4im p r�Y....._ _. Owner Email. -
Owner Name: _ Ige U.1! i Phone:
Mniling Address:
Physical Address
Facility Contact: _ G te.rst~t Nei rrt's _ Title: - Mv-. _Males& V0" Phone No:
Onsitc Representative: Integrator: two✓ tows 1._. Ste,
Certified Operator: Lz 1• Q- wrAe.`e - Operator Certification Number:
Back-up Operator: -��� I='n _ MAO&, . _ Back-up Certification Number: _
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
12 Feeder to Finisk
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Latitude: Q U = 10" Longitude: = o = . a ..
Design Current Design Current
Capacity Population Wei Poultry Capacity Population
P Layer
Non -Layer .., .... _,........, ,
Dry Poultry. .
Pu
Dlscharaes 8k Stream linpimt
I. Is any discharge observed from any part or the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Cu Trent
Capacity Population
Dairy Cow
Dairy Calf
❑ Dairy Heifer
Dry Cow
❑ Nun-Dair
❑ Beef stocker
ElBeef Feeder
Beef Brood Cow
E
Number of 8tructures C
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 dischargc?
❑ Yes ❑ No ❑ NA ❑ NE,
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
[I NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
'Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
E/T'd LoLo98boT6T:oi
1212VO4 Continued
"eT62SOT6T SWddd HlIWS 13dNdE:W0dJ dbT:bo oT03-,LT-f10N

;agility Number: — // Date of Inspection
Waste Collection e m • t
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): Z Z
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
[]No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ N E
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
[]Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet snicks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Aim
dication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
11. is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window .❑ Evidence of Wind Drift ❑ Application Outside of Area l
12. Croptypc(s) Jr�,wMw i 01-m4cr %OivNV, 16
13. Soil types) 1Aja $ Ajth ,Q 64, TC-
14. Do the receiving crops differ from those designated in the CAWIMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of Nclllty to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name if•'
x:. t t, rtl�Jr �s a a'1 � 1''i!'mrfr Phone: 9ia,�33 336e)
i r� h +r i l p m.'
Reviewer/inspector Signature:
Date: (c ' Z3 — Z o Pp
Page 2 of 3 12128104 Continued
E/2'd 1OZ09900T6T:0i "OT62SO16T SWddd HlIWS 1S3Nd3:WOJd dt7T:t7O OT02-ZT-nON

A. ,
Facility Number: Z— Date of Inspection -�• 1p
Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ 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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the Facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss Assessment (PLAT) certification?
gillEx ISSrIelS
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29..Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher thaii normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
[]Yes []No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
comerer Hera/ jrove, corl)s f�wN ' a,) eKflaw" � VIvo rect-9 odl7d
0/1 adon [ ie'n
A cast 11'Coce rs f�i�., br lb!"e k level YyCr dry e a, r� 1a31ra bv�`' �.r�s et-na?
t % MS � free b #vO-eveLs were l) o so /
as nt i I n ar-ell on l a
�alh
Yy�s �Pn'�P�c� a s a �r� �
gown 1j's 161 WOr d Lrcov ed� r l'Cltr had refir
C,d � J naro delfW-L"<o►r -i�►� g Pis i�1s�t�~ Ilij, `ih� garr evo-jr-e-Schedvij, Iv jJrh Ile M a, ,a t�, Ok Pe4Sfied4 0) )MA(010,
-
Page 3 of 3
12128104
£it'd 'LO1098b0T6T:Ol "BT62S016T SWNUd WlIWS iS9N�I3:WONA dST:t7@ OT02-ZT-nON

Facility Number 8 2 __�
ivlsion 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 ❑ Denied Access
Date of Visit: !O`<<f `O Arrival Time: j �" : ���4.. Departure Time: .3: UD w. County: �d..yosax/
Farm Name: �G,�S�N up�°,vOwner Email:
Owner Name: �� i'fi e- Llie7761J Phone:
Mailing Address:
Physical Address:
Region: Ind
Facility Contact: a%NN Akrr4 & Title: 4�1� AY_• Phone No:
Onsite Representative: / to Integrator: A.%o. 5:�001.s
Certified Operator: C xe� Ay�r3 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = c = i Longitude: = ° = { ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er I IJ
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
"]3ZO
7 ZD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
ICI -Other
-- — - _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Daity Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: IQ
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 orthe State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
A
El NE
❑ Yes
❑ No
[3<A
❑ NE
El Yes
[INoL".<
❑NE
El Yes
3 o
❑ NA
❑ NE
❑ Yes
®<
❑ NA
[:IN E
12128104 Continued

Facility Number: g —//f/
Date of Inspection /V-/—v
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: % Z
Spillway?: X✓o a
Designed Freeboard (in): / C/
Observed Freeboard (in): 7 �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 ffNo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ff5o ❑ NA ❑ NE
❑ Yes EY5o ❑ 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 l_TNo ❑ 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 Vo ❑ 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. ElL�
Yes ' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) /!00//e'A 54., `iya:.✓
13. Soil type(s) �D� WS g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18, is there a lack of properly operating waste application equipment? ❑ Yes
0Ko [INA ❑ NE
[ No ❑ NA ❑ NE
Q<o ❑ NA ❑ NE
�o El NA ❑NE
. " Y�'..:' � •- vy &�{ - LNj s�YMCl�Comments(refer1oquestionft
Ezplalnany YES answers ad/or any recommendaHons;ory other comments. , .
Use drawings of facility to,better explain situistions:'(use•additional pages -as necessary,) ; � �•i a ;E S �,
ectorName Reviewer/insP �`Gr .- . 2 • �`��a Phone: 9��-�33.338D
ia�v�5
Reviewer/Inspector Signature: Date:
12128104 Continued

.
Facility Number: $ Z — // Date of Inspection
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes B o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes B No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B� o
❑ NA
[INE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El yes
L'_f No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�[1io
L7 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
oo
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,L—,T
3 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?
[I Yes
,—,�
11No
❑ 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
�
L_T �o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N�o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
h_,I
No
❑ NA
❑ NE
12128104

di-
t1Ms I)h
Facility Number
VDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
L
f Visit (compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit (�"Routlne 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 6.l L-1 Departure Time: b® County: S Region: _ EEO
Farm Name: W11. 1 onset .Sy''t� `� rckM1" t Owner Email:
OwnerName: m'_ _ r+�f (� I�drii'O'f Phone:
Mailing Address:
Physical Address:
Facility Contact: Co tell N 6rLf Title: N/�Jl4Phone No: -
Onsite Representative: �II y� Wo
�,*i+"I __ Integrator: f f11� a► i
Certified Operator: 6 f.enl* NO r i S Operator Certification Number: _-)74 Y�2
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 I =11 Longitude: = ° 0 d = `f
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
'7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes T�] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
t] No
❑ NA
❑ NE
❑ Yes
(�a No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: $ — 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
[]Yes CR No []NA ❑ NE
[]Yes []No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes MNo ❑ 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? C3 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1K 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
E'No
❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ERYes
[]No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
O PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WI indow ❑ Evidence of Wind Drift [3 Application Outside of Area
12. Crop type(s) 5 Jm nr r nnya 1 "l 1/' i' - An o CO �`1�
I �l/I[ do 1' y . Si'yIl qca Q✓&SP�
13. Soil type(s) �Q d I S ` 7i%r,,� �,� 54C '�S)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[Z No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
8No
❑ 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
R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P,No
❑ NA ❑ NE
Camme:nts(reir"­gstion#)`E�zplai�unyEnswersouny recomm.en�dations or.any other comments.
Use drawingy of1facility�tombetteexplainisituations'`;{us�dditlonal+.pages�as�necessary)::
t.�,z. :. i:t
Reviewer/inspector Name SC E t�.lZ. ' .. Phone: q3-3-33coKLwj
Reviewer/Inspector Signature: Date:
Page 2 of 3 U 12128104 Continued

Facility Number: Date of Inspection �a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Eyes ❑ No ❑ NA ❑ NE
'OWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 1p manual Certification
❑ Rainfall ❑ Stacking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
C' NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[SNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[SNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
t3'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Et 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
�ffNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2�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
OlNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tS No
❑ NA
❑ NE
Additional Comments and/or Drawings:
'PAP -fie cut ch ole badCsl�e �f r' �oa� 1 , Also cvI- ,5m ql j
e� bA lee
O'mvoWn
i c+ 4
4o �r�side slPIP6/v
Goo 9t' coy� ao05: IV v
�l�e COrI� p 10 o rye ram- ,e. S �Q vb D 18 LBS ye
I.� J .
Woo
ol'rq��a�
�Ceed ej- 1 ap
�I, Soij Prnalytis �o� aoro
jzfd#)p- Fq(eovak r*
Page 3 of 3 12128104

Facility No. Farm Name I (11ont&I �rR ate 1alaa 11 Q
Permit COG OIC NPDES Rainbreaker PLAT Annua! Cert
I WME n. M on
.. :rnl:PR pop
fli�
Design - - .. _
—®—��--
Sludge_SurveyDate
tL
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
51A
Soil Test Dateq(a� 601�/0+ We —
pH Fields
Lime Needed
Lime Applied
Cu-I ,� Zn-I �G
Needs P
Crop Yield
e b rAc h s
WUP _
Weekly Freeboard L/
1 in Inspections
120 min Insp.
Weather Codes ./
Transfer Sheets
fay, tv / oa -w lad CM f I011.10*
RAIN GAUGE
Dead box or incinerator
Mortality Records
l i a
■S._
•
�_
��,
�' +/ � rail
SqiI1pNUM,51?' S3IfSiliatio^�}
Verify PFIO,E I3PRSacntl affn's
Date last WUP FRO Io Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lblac; Zn-I 3000= 213 lblac
App. Hardware
smvdse�-
�6�

asKAs e-m k.i-e.d 9 -l7 --zoo S J22
%71 vision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
Other Agency
Type of Visit Q<o'mpllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q'routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: B`� O Arrival,rime: Departure'fime: County: Region:
Farm Name: A)VAT.SsN Owner Email:
Owner Name:, Phone:
Mailing Address.,
Physical Address:
Facility Contact: G'fe-m"l A10rn S Title: Phone No:
Onsite Representative: !!�:/e-AlAl �d�t� Integrator;
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = I = 11 Longitude: 0 ° = 6 =
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: FE
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 2lo ❑ NA ❑ NE
❑ Yes
Q'N o
❑ NA
❑ NE
❑ Yes
91} o
❑ NA
LINE
❑ NA
❑ NE
❑ Yes
LSlvo
❑ Yes
21',,___., NNoo
[I NA
❑ NE
El Yes
[B o
❑NA
❑NE
Page 1 of 3
12/28/04 Continued

Facility Number: J7Z,— //
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier; 40W tX
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
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 31To ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E51go ❑ NA ❑ NE
❑ Yes �31 o ❑ 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 ©'1Go ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Riq'o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes B-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Er1vo— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1
12. Crop type(s) sty+ Afe�� _Wt 4_4_ &Nua s_--
13. Soil type(s) NIfFO/'r �� _
14. Do the receiving crops differ from those designated in the CAWMP? El Yes 1/J No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes 8< ❑ 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
6_©04� P�_7c_a VC S 1
Reviewer/Inspector Name W e.v �,� $ Phone: 9/®. ,433. 3.33C�
Reviewer/Inspector Signature: Date:—Dp—.20019
Page 2 of 3 12128104 Continued

i Ab
Facility Number: $Z — //'f I Date of Inspection 9'Oi-O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
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 1"
Rain Inspections❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
lr 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
2<
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
a No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2Io ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
!!
D o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes.
No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
Yes
El[
34<"
❑ NA
❑ NE
Additional Cummen,ts�anti/o.iDirawln s
A,
Page 3 of 3 12128104

3r,V5 r k,, d 0110 VI2 003
Facility Number I S,
ll ' ivision of Water Quality
'o 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 ❑ Denied Access
Date of Visit: Arrival Time: 19, 404 1 Departure Time: ' County: Region: /50
Farm Name: �,(��hdL'W5&'J Slc/t��c/L / uOwner Email:
Owner Name: IC G,P7*1, �T' J), Phone:
Mailing Address: ,
Physical Address: ../I A��jJ
Facility Contact:I+�0r' 'l S Title: �//__ A aPhone No:
Onsite Representative: GlG,v Alone:s Integrator: S42 ✓1aMd tar M1
Certified Operator: G� �Urls Operator Certification Number: 77��(4
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I =it Longitude: = o = d 0
it
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts,
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: Z
i
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 1P No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[4 No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
to No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection IlZ /8-07
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j 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: w,P.r w
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ fZ �M 3S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I 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 No ❑ NA ❑ NE
through a waste management or closure plan? 19
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) r
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) I
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Driff ❑ Application Outside of Area /
12. Crop type(s)
13. Soil type(s) G'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? , ❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
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):
i
•
Reviewer/Inspector Name 4 J6 ev el.5 Phone:
Reviewer/Inspector Signature: Date: /Z—1 ff— zoo %
12128104 Continued

Facility Number: 231Z —// Date of Inspection Z /�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EgNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes IF 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 T No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes * [A No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g[ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
[I NA
[I 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
(;ffNo
❑ 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/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[7No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility. Number $z /
OW
0 Di
°Oot
in of Water. Quality.
in of Soil and Water Conservation
Agency,
type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S-03- 0w Arrival Time: Q Departure Time: County: Region: AQO
Farm Name: Owner Email:
Owner Name: K e.k'm fiL1i/�uirrSy�t/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Gle-NN /10ryi's Title: /4"4 Phone No:
Onsite Representative: I � ;/c-Av.'J Wortn's Integrator:JF
Certified Operator: a/G^/N N��'v��5 Operator Certification Number:
Back-up Operator:
Location of Farm:
Design : Current
Swine Capaeity"Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 17320
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish i
❑ Gilts
❑ Boars
-.-Other
❑ Other
Wet Po
Non -La
Dry,
Back-up Certification Number:
Latitude: = o = d Longitude: [� ° = ` = "
Design Current Design Current
Capacity Population- Cattle Capacity FopulahonF
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poult
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
pry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
s
E'
Number ofStructures:_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes [ANo [3 NA ❑NE
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
q§ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
Q9 No
❑ NA
❑ NE
12128104 Continued

% $—b3 —0 �v
• Facility Number: FZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I,cA -W LOurw
Spillway?: NO /Y 0
Designed Freeboard (in):
p a
Observed Freeboard (in): 11V 2 S -e;;4 7
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 A No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q1No ❑ NA ❑ NE
8. Do any of the stuetures 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 [rl No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type/fs) ;IlG1. S',w rll �'rwi/►I
13. Soil type(s) G%. /`IrbA . LILS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C§No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PONo ❑ NA ❑ NE
No ❑ NA ❑ NE
(dNo ❑ NA ❑ NE
11No ❑ 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):
AL
Reviewer/Inspector Name I iG t,�lz Phone:�9/4J�/ —3330
Reviewer/Inspector Signature: Date: $-43—?e
Page 2 of 3 12128104 Continued

16
Facility Number: $Z — // ,IDate of Inspection 03-a
Required Records _&_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
❑ Yes Vf No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
P3 No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
�WNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operatlon 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: : 3DRr+ Departure Time: County: _ h _,_, Region: "
Farm Name: �i )t �� s� �—��" Owner Email: __ . ......
Owner Name:i•)_
...-.�...-. � Phone:
Mailing Address: _i 3 X V— It : s z o .SIc .:.. �. A Cf_1 a �
Physical Address:
Facility Contact: 0.444 114a,"t i 1 Title:
Onsite Representative: `, len /u'r���� Integrator:
Certified Operator: l✓ .��Of� Operator Certification Number: APA_c0 i�y6
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
Phone No:
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: = 0 = 6 = 41
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
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 Moo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ONo ElNA ❑ NE
ElYes E No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 52/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 4?60
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):� '� g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [ <o ❑ NA ❑ NE .
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑-Ko ❑ 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 L— No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ed Ko ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Mgo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) E.0 It N.-w4eA_
13.
Soil type(s) 6 'R
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3"No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[PrNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
ENo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[9"No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P'�4o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendatlona or any other comments.
Use drawings of facility to better explain situations. use additional pages as necessary):
Reviewer/inspector Name rt , `f :5: " Phone: !12a Voa,6, / 4j-1
Reviewer/Inspector Signature: "" Date: Y—.2 / — Ole
12128104 Continued

r
Facility Humber: — Date of Inspection
Required Records & Documents ��jj
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [g"No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Wfaste*ppttz7 it M ❑ e oard ❑ Waste-�s ❑ soi_L Aaa.1- s ❑ Waswzrarufess ❑
❑ RatttRtll ❑ swcking ❑ C-m 4e4d ❑ 12-0-Mmum1ri—sp—ecitons ❑ M ions ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[BNo
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
ao
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U�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
[B'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
[9-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
[DNo
❑ NA
❑ NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9,!�o
❑ NA
❑ NE
Atlditio' na' Moinments and/or Drawings:
•n,flr4ea �rr
12128104

I Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number i jDateofvisilt: !d S� t7 Time: 0 : P.D
1. Q Not erational O Below Threshold
,Permitted M Certdied 13 Conditionaily Certified 0 Registered Date Last Operated or Above Threshold:.._.» ..»._ ....
t.
Farm Name: .......t!I�/!. ti�new�T±:�.`�........... ^',`..»............_...........»»............ County:..._..._..» .ram.. !':! r�tY�........
Name: Nae: _W_.3-.l C.t!1!�.�. ....»....... » . + �*<_ »..» .._.».. 'Phone No: _ _ _/o..�?_ ...�.._ ....W.
Mailing Address:.._». _. _....... &A ..... ..11! ._....».......................................... _..... C� ���.... N � .._...._._..... �,�.`J�.`�.�..
Facility Contact: » „._ .. „_ .._ .......... _.. »»........... ___Title:
Phone No:
OnsiteRepresentative:._vv..L.7� . _..... 5......».....i..............»».»..... Integrator:...» »...».........».».»...»».»»........._............._..... .......
Certified Operator:. » �lr „.-, ». _ . , .. P ,,,��tt»._.. _... » »».» Operator Certification
Location of Farm: Cott e^^ No r-q—% S
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 46 Longitude • 4 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes AkNo
F
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J[No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: »...».__ �.._ . »_ _ . .
Freeboard (inches): 3 _._._.. 17 6 _
12112M3 Continued
„" 'L

Faciiity,.Number: iVZ — f f K Date of Inspection Ito S d
001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, " " ❑ Yes RNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes JkNo
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? SYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancermprovement? ❑ Yes 21 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
A No
elevation markings?
Waste Application
I0. Are there any buffers that need maintenancelimprovement?
❑ Yes
5kNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
R No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes
,�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
50 No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
,KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
%No
Air Quality representative immediately.
arrairw a.vr�swawc.s

J
Facility Number: BZ �- j 1 Date of Inspection t3 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the faci 'ty fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ eckl b/desigst!mapa{etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Applicatiqp-,"❑ Freeboard/❑ Waste Analyst✓[] Soil Samplinfj--�
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Forte❑ Crop Yield For*rM Rainfal+lO Inspection After 1" Raiff
❑ 120 Minute Inspectio"Annual Certification Form
❑ Yes 0,No
❑ Yes A,No
❑ Yes ,KNo
[I Yes' ]&No
❑ Yes R No
❑ Yes ELNo
❑ Yes 1,No
❑ Yes 0 No
❑ Yes [9No
,Yes ❑ No
❑ Yes ENo
❑ Yes jia No
❑ Yes IgNo
❑ Yes 19,No
QYes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
y /Ito /0'1 ?-L!Z`
ZI/06( 3
$l 76loif Z.q / 2- 5--
33, 'rim sfuAt S�r`+e� wa,s bu-F 'tie.re weir P� jr
l„t,iiCs, v,s� i�-- wC.�, A&,*- i., -t't,.t r-Gcarvk s . �{C�tg@ �,ti�l�t��
3S. `T�•a+-t waS +%v ram,( Of -4'ts-- 4AnMv0A Gec ►£s�ca.�io,. er -�rr
raPQt•"ior;k .
1211VO3

Tj
Site Requires Immediate Attention:
Facility No. $,Z --LaY
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: :eta
Farm Name/owner: '
Mailing Address: /32,r 4,� ,) sue. Cloo62&1,c
County: S -
Integrator: 44, _A,2n v ,, _ _ Phone:
On Site Representative: / Phc
Physical Address/Location: ae $. of W p 74
da.►,�__��,,.► lid � �c� -%Q Id �� .n,,:/� ����y®w�.+� '
Type of Operation: Swine Poultry Cattle
Design Capacity: 3. Loo��'i,�_ j,,) Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spry "
Crop(s) being utilized:
Does the facility meet SCS minimum sefback criteria? 200 Feet from Dwellings?o§r No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(K)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:
Keg Avev-7G
Inspector Name
No Actual Freeboard: Ft. f3P Inches
;s)? Yes of & Was any erosion observed? Yes ordZ
r No , Is, the cover crop adequate? �& or No
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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