820156_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit:() -Com Bance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: eRoutine Q Complaint O FoHow-up 0 Referral O Emergency O Other O Denied Access
Cld
Date of Visit: +� � Arrival Time: Dt Departure Time: /t � County: %Jfr Uri Region:
Farm Name: L, C�t C -.'N C- Owner Email:
Owner Name: E yt P- t,' i 41.1 p u.J Phone:
Mailing Address:
Physical Address:
Facility Contact: (24, -1 --Tr) Title:
Onsite Representative:
Certified Operator: G! e ox NO r r '`3
Back-up Operator:
Phone:
Integrator:
Certification Number- X7'4 �{7
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ No
Design
Current
Design Garreat
Swine rA,t. Capacity_ Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I I JI-ayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish 3 ai
Design
Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
D , Poul
Ca aci
P,o P.
Non -Dai
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
lBeef Brood Cow
Turkeys
Turkey Poults
OtherI
10ther
Ift- mtiF...•-. -_:: w._ .fL.l._:.,..: :->.: ::".i";i.� ..
S�tWM�.1.wA161YWeN .ce.w�sef.:v
sW:va -
Discharges and Stream Impacts
1. Is any discharge observed from any part of the_Qperation?
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 NA ❑ NE
❑ Yes [::]No
[:]Yes ❑ No
[:]Yes
❑ No
❑ Yes
[-No
❑ Yes
C3'Ivo
aNA ❑ NE
[� NA ❑ NE
[a -<A ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2015 Continued

•Facili Number: /,56 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:
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in): a s
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
30110 0 N 0 N
❑ No D -IgA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [D.tdo' ❑ 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 L 3 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�Io ❑ 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 Cj No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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):
'e4h u—b' 13('0 f'R&_
CC, '
❑ Yes
[' No
❑ NA
❑ NE
13. Soil Type(s):
❑ Yes
[ No
❑ NA
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
021qo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[DIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ I o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FTN o
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[' No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
t_3 ""'
❑ 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?
E3Yes
Q o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
0"'No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

.y
Facility Number: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? I f yes, check ❑ Yes to ❑ 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 0N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q'1�io ❑ 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?
iv -� O g= t � Sf
Reviewer/Inspector Name: 0 ► k V_ j3
Reviewer/Inspector Signature:
Page 3 of 3
/a.-3r-I�
❑ Yes [2'1�o [DNA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [5"No ❑ NA ❑ NE
❑ Yes QNo
❑ Yes dNo
❑ Yes [!(No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:wa
Date: - f I 1
2/4 01 S

r
i�� � �+...�� a Nb �w `"' !► ur tt 7 x'i`°"" a � �� y 'ssry y, - .. {ew'Lyf�.--r w � y �s. � � � -
'�'1
tl�•-
Type -of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: mg4m Arrival Time: Q ' [S Departure Time: County:— Region:
Farm Name:
Owner Name: a V-f4s
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: -�-`lies cio_(< Title: Phone:
Onsite Representative: t e, Integrator: 2a -d-
Certified Operator: 0'e.L 0p a Certification Number: 2-7 D
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design�Current Desigjn Current3 _ `Design Current
Sw7ne Capacity Pop Vet Qouit ;., *Capacity Pop Cattle Capacity Pop.
Wean to Finish Laver Dai Cow
Wean to Feeder Non -La er '':.ti Dai Calf
Feeder to Finish Y60 Dai Heifer
Farrow to Wean ,: Destgn Current ?'� D Cow
t
Farrow to Feeder D Poult Ca aci Po - Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts = Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
-Turkevs
Other in .— �
sea „{ Turkey Poults F,
Other . Other
z �
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Er5o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E� NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
L3 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 DWR)
❑ 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
E] Yes No
E] NA
C] NE
of the State other than from a discharge'?
Page l of 3 2/4/2015 Continued

Facility Number: F- f Date of Inspection: etj 11,67tq
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R'LVo
❑ NA
Waste Collection & Treatment
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P'15o
❑ NA
❑ NE
' a. if yes, is waste level into the structural freeboard?
❑ Yes
E4 -K°
E3-NX__C] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[j?No
Spillway?:
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Required
Records & Documents
Observed Freeboard (in): 51
19.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LJ -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a"No
❑ NA
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
5],-3�0'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[j Yes
["1 o
❑ NA
E] 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
ga'<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[� +�lo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;�,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 ❑ Application Outside of Approved Area
12. Crop Type(s): � v V—o (4ec.y
13. Soil Type(s):
❑ NE
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R'LVo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑Xo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[j?No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
FIN
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
Ej�'No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a"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 ❑'1Go
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [3"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: RQ - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1lo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E to
-thin 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 P�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R<o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑'leo
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
ET<o
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
0N0
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
PI'No
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;klqo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[?r -No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No
r-
i
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to question.ft Explain any YES answers and/or any additional recommendations or�any other comm6it** 1
( 9 .. )
Use?4rawin sof faces to betterex lain.stuatsons use additional es as aecessa;. M;,
g t3' p pag t'y)� � n��
c0—
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:l(/) q jj._
31
Date: - kin 1f,
214 01 S

Type of Visit: ErCompliance inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: idRoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: . W Departure Time: c� �- County: 9 ' ' 'L Region: IZ—?
Farm Name:
OO
�C//LL
Owner Email:
Owner Name:
f�� Sf
S,0 ,A .Vile '
Phone:
Mailing Address:
Physical Address:
Facility Contact: CWA A S Title: Phone -
Ll( I,— A -
Onsite Representative:
Certified Operator: CLet#4 AWj s
Integrator: C
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [glZo ❑ NA ❑ NE
❑ Yes [-]No
[]Yes ❑No
❑ Yes ❑ No
[]Yes [3'1No
❑ Yes ETNo
[-l4'A ❑ NE
[q -NA ❑ NE
Q NA
Des n Current
ig
❑ NA
DesigCurrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacety Pop.
:.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
�
-
- F
Da' Heifer
Farrow to Wean
_
D . P,oul
Design Current
Ca aci p j
1'0M.
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
*,
Ttuke s
Qther
:..,
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [glZo ❑ NA ❑ NE
❑ Yes [-]No
[]Yes ❑No
❑ Yes ❑ No
[]Yes [3'1No
❑ Yes ETNo
[-l4'A ❑ NE
[q -NA ❑ NE
Q NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page l of 3 21412011 Continued

Flacili Number: Ds ection:
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
En''` o ❑ NA ❑ NE
❑ No E3<A ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[-110
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
E No
❑ NA
❑ NE
waste management ar 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
E!'<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �' 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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �s ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RrlVo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes [frNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ea"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 [PTo ❑ NA ❑ NE
[—]Yes 62,ivo [DNA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes G�J<0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�o ❑ NA [] NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes E3"'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CJ�No
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 3 214/2014 Continued

Facility Number: M -T
3 jDate of Inspection: Ts A
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [I -Ko
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes �o
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ED -No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes L2090
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 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA NE
0 N NE
�NA NE
NA NE
Yes Ido 0 NA [:] NE
0 Yes �o ❑ NA ❑ NE
Yes No 0 NA [:] NE
Yes [ErIL ❑ NA 0 NE
Yes EfNo
❑ Yes EfrNo
[:]Yes [ *(No
NA NE
�NA NE
NA ONE
Coittments grefer to q tion #} Ex lain;any YES (savers and/or any
additional recommendations, or,,any oth omments `� i
Use.drawtn s of facilityto better explain situations use additional a es as necessary).,e
_S(U4_0!3� -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C- r ��' foolr f./cel- l ZE91
LO Phone: ' S 3— 3 3 3E
Date: ,Z
2/4/2011

I rvi s a 6 rko h is
Type of Visit: QKompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outine ��0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `b_ &Arrival Time: ; ca Departure Time: / ! S County: cj 1
Farm Name:&Qd4Owner Email:
Owner Name: _ �+�c�?-L, f�Q,y `r s 7(--e, G Phone:
Mailing Address:
Physical Address:
Facility Contact: 64"/j &'4.0`w ci7e Title: Phone:
Onsite Representative: �r Integrator: Q ('J
Certified Operator: . 6 1 rl"-A Quo,,,,, U
Back-up Operator:
Location of Farm:
Latitude:
Region:
Certification Number: '2 [
Certification Number:
Longitude:
Design Current DestgCurrent Design Gnrrent
Swine Capacity Pop. Wet Poult CapacttyJ Pop _ _. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er Dairy Calf
Feeder to Finish a 20J 3 oaO Dairy Heifer
Farrow to Wean
Farrow to Feeder D . po Des,gnCurrent D Cow
ult -Ca aci # Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets I Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E3<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
ETNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2<
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facility Number: - S Date of inspection: alS
S
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
Waste Collection & Treatment
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g_bLu__ ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No [;�NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes C9 No
Spillway?:
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [D No
Designed Freeboard (in):
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No
❑ NA
Observed Freeboard (in): rte
acres determination?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z_b1a ❑ 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
[A446'— ❑ 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
Q-tff— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:Jo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E;'ro ❑ NA
❑ NE
maintenance or improvement?
Waste A lication
N
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
Ej ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 01'ro—
❑ 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): S6 "0
_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes C9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [ ONo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ONo ❑ NA ❑ NE
Reauired 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 I_ - ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below_ ❑ Yes [2 fPb ❑ 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 d ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L'J 'moo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -Date of Inspection:
24. Did the ficility fail to calibrate waste application equipment as required by the permit? [-]Yes E3 -Nr✓❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q;NT�❑ 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 E3<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E 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 ❑ 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 L`J No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes .E N ❑ 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 �.�in ❑ NA ❑ NE
Use draiawgs,of faceLtyto; better explain. situations (use additional; as necessary);.^ mmeiits.
Comments re er to uestion Ex lain an YES answers and/or an additronal-recommendatrons or.. an other ca
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
m
1;--3(-1 7
Phone: 33 q
Date: ;� S 1r IM'k L5
214/2014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 011ioe'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival
Time: Departure Time: Td County: ' RegionF2
Farm Name: µac J FQ!'!it C Owner Email:
Owner Name: r e Phone:
Mailing Address:
Physical Address: , -
Facility Contact:K Title: ( Phone-
Onsite Representative: j Integrator: 4_:�' i _
Certified Operator:
ar-r4 I'%aYf I�f Certification Number: Q�
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E(No ❑ NA [] NE
❑ Yes
❑ No
[ff NA
❑ NE
Yes
❑ No
[�NA
E] NE
❑ Yes
❑ No
[3 -KA
❑ NE
❑ Yes
R . No
❑ NA
❑ NE
❑ Yes
[2�No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
M1 aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Iia Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D40,
" 0 ❑ 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 M 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
[]�X6
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
[:]NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
�No
❑ NA
0 NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
45,No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
Waste Application
❑ Yes
D o
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
M, N o
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[3 o
❑ NA
❑ NE
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [[Ejel�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 WindowB ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e_, d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P,4'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ip'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
0 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
D o
❑ NA
❑ NE
Required 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
[ZjAo
❑ 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 o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
p Rainfall ❑ Stocking [:]Crop Yield [:]120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yeso
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Faciti Number: -L3 jDate of Ins ection:Rd
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
0-71o' 0 NA ❑ NE
L7 1"O ❑ NA ❑ NE
❑ Yes
E3- leo
❑ NA
❑ NE
❑ Yes
Qo
❑ NA
❑ NE
❑ Yes
Q,AI6'
❑ NA
❑ NE
❑ Yes [aDjo ❑ NA ❑ NE
❑ Yes [R'Iio ❑ NA ❑ NE
❑ Yes <No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes EJWv ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [;PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2'NTo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES. answers and/or any additional recommendations or any, othe r,couinwfifi
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name: 1 (fit Phos to 3
Reviewer/Inspector Signature: Ok-DatellAo
liq
Page 3 of 3 2/4/2011

a
Is
Type of Visit: 1E) Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: `hla. Arrival Time: '1430 A Departure Time: -! County: � p as,,,� Region: Fko
Farm Name: Et1 W Z 1 R i- Owner Email:
OwnerName: tRtttIM Phone:
Mailing Address:
Physical Address:
Facility Contact: �uRP^i9 �Aitw-TeK Title: FAracA Phone:
Onsite Representative: CVR &ARC+ _ Integrator: t.Rnt_<W 4;WNz+t1
Certified Operator: alt -IN" eKr p_w Certification Number: 'd..'1%AgQ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? -(If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes allo ❑ NA ❑ NE
❑Yes
DesignCurrent
❑NA
Design •
Current
Design Current
Swme
.
Capacity Pop, x
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-La er
I
Dairy Calf
X Feeder to Finish
2aaO
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? -(If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes allo ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑Yes
❑No
❑NA
ONE
[:]Yes ❑ o ❑ NA ❑ NE
[:]Yes 90 ❑ NA ❑ NE
[:]Yes W ❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

i %
Facili Number: lu - /S Date of Inspection: !c3 1
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:
CdNo ❑ NA ❑ NE
[-]No ❑NA ❑NE
Structure 6
Spillway?:
p
Designed Freeboard (in): � 1
Observed Freeboard (in): 95
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?
U 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
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
d 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
CJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): Q, tlt��4 !]lt+� I 1--s .G , C)
13. Soil Type(s): 0— AZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &f 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 ❑ Yes dNo ❑ 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 G2(No
[:]Yes []/No
[] NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes CgNo 0 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 [�V0
❑ 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 [B"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ 'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 2/4/2011 Continued

r k
❑ Yes
[�No
❑ NA ❑ NE
Facility Number: jDate of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2/No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3�4o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Yes
[g"No
❑ NA ❑ NE
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
❑ Yes
Eg�`No
❑ NA ❑ NE
List structure(s) and date of first survey indicating non-compliance:
❑ Yes
[2/N0
[DNA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E�`No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ff 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
[2�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
[g"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
Eg�`No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[2/N0
[DNA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]4o
❑ NA ❑ NE
Comments (refer to question ft ExpWn any YES answers and/or any additional:recommendations^or any otl7er'co'mments
Use drawings of facility to better explain situations (use additional pages as necessary).'.;
,
C0RAX(\V is �'Mk�ar-s Of� bARI= at� NRO.If. L.A6a,,^
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
Phone: CM 10%"6 A51
Date: ��x�\,�
2/412011

type of visit: V t..ompuance inspection V uperatnon tcevtew V structure Evatuanon t_j t ecnntcai Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:�Qp County pry,
Farm Name: Elwell ccLa % }— Owner Email:
Owner Name: VfAP �-�'I�IIT h Yri/m I�V Phone:
Mailing Address:
Region:
Physical Address: wLt dwell U , Geyl aid -
Facility Contact: TQ((3 S Title:pgpl' Phone:
Onsite Representative: Old Integrator: &rteif silt t`%
Certified Operator: lel.en N©rf [.S Certification Number: a`7gq
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Desi n
g Current
Capacity Pop.
V1'et Poulin:
Layer
Design
Capacity
Cterrent
Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I INon-Layer
D_ry P.oultry
Design
Ca acity
oui rent
P,o P.
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to inis.
I 11-ayers.
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C!J"No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
[:]Yes No
❑ NA ❑ NE
E] NA ❑NE
E] NA F] NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facili , \umber: jDateof 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:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
152 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
[2 No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
r'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): 1 ve-
13. Soil Type(s):
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
151 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesIn
No
❑ NA
E]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
[R -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 ] NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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 [3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No & NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Dumber: Date of Inspection: TIAX 11
.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C'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
n] 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
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 tR No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes [.S�No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes 10 No
❑ Yes 5j No
❑ Yes F�g[No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to -question ft Explain any_Y,ES answers)andlor any additional recommendations or-any"othe o�mmen'
Ilse drawings:of facility to better explain situations_ use additionall; a es as necessa
work at, al -e_ ba-- oohrde. Cftne-ela- cam) wale MoAof 1ajoot hz�r9oat
lS<
`uh f- OM- D�seaL h as Cc4' a- b 1-� 14 Sll o�ll, please a* cC b, say ,9-1
Vf -e + s lad 1� y oL* bPfmGd a_ . N a►�e-e- &,Q/a- -R etols cr �e #? 6a/_
Shore, (0��)-
@1, Plf&,e E6e- Cutt& T U a lis �'<�i H'o� arra sus D1 s ra
�y
fi h 7s a_ rm
pAV v a f � WTf- (lt(ed , rva��e a�Q y,�e1 y
leaje_ Veja, f le- ASA P.
A-ej& 4 remcis rie-fe Pi q ad.,r Ofe,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
M,MMM.;"M
Phone: T0_yM _133(0(A())
Date: a
/4/2011

Facility No. TD,-jge Farm Name Date
Permit ✓ COC
In
W *7 - - - 1 -
FRO
Lagoon 1 2 3 4 5 6 7
Spill a
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
i40001l
Nor- 11 -MV -111.11
9- so . W�--- ---
Actual Flow
Design Width
Soil Test Date jq([ Wettable Acres ✓ plityvRecords
GE
pH Fields WUP �/ ad or incinerator
Lime Needed Q4 -i ] Weekly Freeboard Mo
Lime Applied 1 in Inspections
Cu -I 120 min Insp.
Needs P Weather Codes
Crop Yield11 loef Transfer Sheets
Waste Analysis Date t t l la? la
- 60 Da
+ 60 Da
N Amt lb11000 Gal y. '� 3, a,R 31,71
H
.. ..
R Man
IM
3n �j a• �
Verify PHONE NUMBERS and affiliations
Date last WUP FRO T ]qG Date last WUP at farm
FRO or Farm Records C a��
Lagoon # �I�. U' Q` lOV;d�-
Top Dike ) rU
Stop Pump 4qN
Start Pump
Conversion- Cu -1 3000= 108 Ib/ac; Zn -1 3000= 213 lb/ac
yam_ 1,081 .
P=
App. Hardware
f(q
r
�-av, -

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outme O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: $. 30k*, 1 Departure Time: 3.d0 ,_ County: �''' �- Region:
Farm Name: 16511lr[11 Z-4141- �r^'r Owner Email:
Owner Name: L �'NGS� SiiJ�
Mailing Address:
Phone:
Physical Address: /
Facility Contact: G%✓�✓ /, 41 VI 15/ Title: '0 ' A4 r' �+ Ph/one No:
C9�GN�✓ /�Oy"i't
Onsite Representative: ,, II integrator:
Certified Operator: ��� /vBYY75 Operator Certification Number:
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
Longitude: Q o= 1 0 W
�DesignCurrent
Design Current
Design Current
Swine C*apacity Population
Wet Poultry Capacity Population
Cattte Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
I
❑ Dairy Calf
eeder to Finish 32 UD I2 p b
E3<o
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
1 —M"
El Turkeys
Other
FO—Other
❑ Turke Poults
❑ Other I
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Eg o ❑ NA ❑ NE
El Yes
[I No
El NE
❑ Yes
❑ No
,�A
IT lqA
❑ NE
D A
❑ NE
❑ Yes
❑ No
❑ Yes
E3<o
❑ NA
EINE
❑ Yes
ETI 0�❑
NA
❑ NE
12128104 Continued

Facility Number: 82—�'C(p Date of Inspection gyp -/f '0 9
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: X49
Spillway?: /JD
Designed Freeboard (in): / 9
Observed Freeboard (in): 29
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes L, 1o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes D - Ko ❑ NA ❑ NE
❑ Yes L7140 ❑ 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? El Yes 3No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B 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 LI-<_ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Q<o ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L'i 1ro ❑ 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 El Application Outside of Area
12. Crop type(s) � -skur d o._. C f�^x %4a r4 3 e.J elo, s,
13. Soil type(s) (. ac:>
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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
[�No ❑ NA ❑ NE
o
i0N El NE
L7 N/o ❑ NA ❑ NE
No ❑ NA ❑ NE
EM -0 ❑ NA ❑ NE
b' t .44 4 ,rj� y: � �
Comments {refer to queshoe :#) Expl�aen aoy1YES `answers and/or any irecomtnendations or. any oth�ecommeatsII
Use drawings of facility to better explain situations: (use additional pages as nnary)
y
f
Reviewer/Inspector Name <0 S
,r Phone: 1[f%, ;G33, 330V
e,V
Reviewer/Inspector Signature:
Date:
12.128/04 Continued

Facility Number. 62 --/S Date of Inspection id -iy—o 9
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 El Other
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L'I No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,�,
L?NNoo
El NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B -Coo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E1'N�o
El NA
[:1 NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
Other Issues ,�,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EB Ivo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3<
❑ 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
L7 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
O'No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ YesNo
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
o
❑ NA
❑ NE
Additional Comments audt Drawings:
7 WOWHw
12128/04
12128/04

L�
if
B,Lrly .S to k-icj of - 4q-- 20043 V2—
Date
Q r —
Type of Visit (3'Compliance Inspection C) Operation Review U Structure Evaluation U Technical Assistance
Reason For Visit (31routine 0 Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: $`cara�r. Departure Time: County:a�,I 4. >_! Region: «�
Farm Name: �511wCJl L 4 ke— Owner Email:
Owner Name: je;-.VeS f S:t : w Phone:
Mailing Address:
Physical Address:
Facility Contact: CIC.lAf A10rr-i S Title: �'" r. Phone No:
Onsite Representative: 61e_..iA/ /Varv._3 Integrator: 6arle'VC1
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =' [=]" Longitude: =0=, ❑
Discharges & Stream Impacts
Design Current
Design Current
Design G*urreut
Swine_
C�apatity Population
Wet Poultry
CapacityPpulation
Cattle Capacity Population
FWeant:Finish
❑ La er
❑Dai Cow
a. Was the conveyance man-made?
Wan to Feeder
"1
❑Non-LMer
El NE
❑Dai Calf
[3 Yes
Feeder to Finish
200
Dry Poultry,,
..,ma
__ '
�""'`
❑ Dai Heifer
❑ D Cow
❑ Farrow to Wean
❑Farrow to Feeder
d. Does discharge bypass the waste management system`? (if yes, notify DWQ)
❑ Yes
ElNo
El"
❑Non -Dai
❑ Farrow to Finish
2. Is there evidence of a past discharge from any part of the operation?
❑ La ers
ETNNo
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Pullets
LJ <o
❑Beef Brood Co
Other ';
other than from a discharge?
❑ Turke s
,
Page I of 3
❑ Turke Poults%
❑Other
Numberpf Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
,�,�
LTNo
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
"1
❑ NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[3 Yes
[o
L a No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (if yes, notify DWQ)
❑ Yes
ElNo
El"
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ETNNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LJ <o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28104
Continued

Facility Number:—/f
9-49,9-e?
Date of Inspection I r -w
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L7 No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2 -No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
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 LSNo ❑ 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 thrpat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require El❑
Yes 'Ivo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, -or compliance alternatives that need ❑ Yes U(No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Qr<o
❑ NA EINE
❑ 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) ^- f 6r.��� � _�yr.:i Al 20.5. ,
--
13.
Soil type(s)
14,
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ErNo
[:INA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
EJ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
�0'No
IBJ, Ngo
[:]NA [:1 NE
18.
Is there a lack of properly operating waste application equipment? [I2 Yes
o
❑ NA ❑ NE
Reviewer/Inspector Name I lel e'vs.l3 Phone: l/O. ¢r33. 3.33 D
Reviewer/Inspector Signature: Date: 9 -d$— Z D--> g
Page 2 of 3 12128/04 Continued

dr
? -v9-v8
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No El NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes LM No ❑ NA ❑ NE
Other issues
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
[INA
❑NE
L" No ❑ NA
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
and report the mortality rates that were higher than normal?
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Weather
Rain InspectionVNN
Code
22.
Did the facility fail to install and maintain a rain gauge?
C1 Yes
E No ❑ NA
[INA
❑NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
C1Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7NNip"
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N
❑ 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
E No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L" 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
E 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
❑ YesNo
❑ 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
dNNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
[ vo ❑ NA
❑ NE
Addiitiona! Comments and/oiyDravvtgsr ;
P".
Page 3 of 3 12/28/04

BI MS 64"-.t o f loYlzoog
43ff rivision of Water Quality
Facility Number Z / S� 0 Division of Soil and Water Conservation
— 0 Other Agency 1 �711
Type of Visit @rfompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z�S—D7 Arrival Time: / Departure Time:%3 County: Region:
Farm Name:L✓/ _ _ Owner Email:
Owner Name:e__V `iSSC • Phone:
;Mailing Address:
Physical Address: ( &I l
Facility Contact: Title:
Onsite Representative: G1 r.✓ Morn's
Certified Operator: 6 I e -Al- /{COrYI'S
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
Phone No:
Integrator
Operator Certification Number: _Z-7
Back-up Certification Number:
Latitude: [=0 ❑ 4 [� Longitude: = ° = t ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑L
e se 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
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co z
Number of Structures: FTJ
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 M No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[ No
❑ Yes
1� No
❑ NA
❑ NE
El Yes
� No
❑ NA
❑ NE
12/28/04 Continued

f
Facility Number: gz—/„S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[1 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-Y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[)ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2fNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[*o
❑ NA
❑ NE
mai ntenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JONo [:INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
� / ❑ Evidence of WindDrift❑ Application Outside of
Area
12. Crop type(s) Ecdo. [ /T�y r�5�w�~+L J Si�f�c� GYrii✓ C �) S,
13. Soil type(s)
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 EM No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [j No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [9 No ❑ NA ❑ NE
Comments (refer to question #): Explain: any YES answers andlo any, recommendations or any other comments M .
Use drawingsaf facility to better explain situations. {use ai3d�honaI pages as necessary):
Reviewer/inspector Name F�Zr`e_ Phone: f1j9-$1S_3,330D
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

L i
Facility Number: —/�r(o Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,n No C3 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 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
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Vj No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
riA No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VrNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
( No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
/ No
. ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
�HNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
lU No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 49 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: �-bj -D Arrival Time: RTJ-19 Departure Time: /Zi County: sei'"pSa�_ Region: �2+�
Farm Name: joE: ed '44-5— yc:0 ice..; Owner Email:
Owner Name: J �I�r�r. Phone:
Mailing Address:
Physical Address: ■�
Facility Contact: &I GAvN !�I n rVJ`S Title: �a+ n r �Si� . - Phone No:
Onsite Representative: Integrator: G av-11W d r,... Sa A-%.,
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O [=4
=" Longitude: =11=1 ❑
Discharges & Stream Impacts
11 Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
a_ Was the conveyance man-made?
El Dairy Calf
Feeder to Finish 132 00 1DO
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl 1-71
2. Is there evidence of a past discharge from any part of the operation?
❑ Turke s
[XNo
Other
❑ Turkey Poults
Dumber of Structures:
❑ Other
❑ Other I
❑ NA
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
qq
IN No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:
Waste Collection & Treatment
03 -d (�
Date of Inspection Da- 4
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[VNo
❑ NA EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[jNo
❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: A 1
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Spillway?: NO
[TNo
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
5(] No
❑ NA
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[14 No
❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ yes
10 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
14 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
[)9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside
Area
12. Crop type(s) �c�wtcr d �asic%� t�rP'a�n/ �O✓cySc�[
\of
J --
13. Soil type(s) C0.. S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V2No
❑ 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
[TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5(] No
❑ NA
❑ NE
Comments (refer;to question #): Explain.any YES answers and/or any recommendations or any other comments .5
Use drawings of facility to' better explain situations. (use additional pages as necessary):,.
A,
� ���C9/o X33 33a o
Reviewer/Inspector Name - % t vGL-S Phone: V3.3--3330
Reviewer/Inspector Signature: Date: $-0.3 —2o0 (P
Page 2 of 3 12/28/04 Continued

Facility Number: fZ —/ Date of inspection 5-03 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [7No ❑ NA ❑ NE
the appropriate box. ❑ wUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes V3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [21 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ( No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes D9 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes�[�
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
La 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
M 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
[9 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
WNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
[U No
❑ NA
❑ NE
Additional Comments and/or Drawings: s f
Ilk
H
Page 3 of 3 12/28/04

0 Division of Water Quality
Facility Number
�41
/S O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -/ .ter Arrival Time:///O.'!� h Departure Time: '� County: co Region: FRO
Farm Name: .. , I�Lf ze, „La k P Owner Email:
Owner Name: Phone: 26:2
Mailing Address: ^YV /V . _ ira�P E P Z_&
Physical Address:
Facility Contact: l Title:
%J
Onsite Representative: _ r] I t
Certified Operator:. _e art ! VArri t
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: ,,2? "/mei
Back-up Certification Number:
Latitude: [= o = d = « Longitude: =0=g
o=g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Non-Layet
Feeder to Finish 200 12
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imimets
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ll2 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[] No
❑ Yes
L'D No
❑ NA
❑ NE
❑ Yes
P"No
❑ NA
❑ NE
12128/04 Continued

• - a
Facility Number: g —1� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EK ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [B"No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ,,��,,!!
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes tL�wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail 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
OL 'NO
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[BNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
09'&o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5�</o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[��
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,K�o
LIXNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EKo
❑ NA
EINE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
Egi�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
BNo
❑ 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
[�Vo
❑ 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
[a<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
g�3.'3q�r��
Add>hotial,Commen#s�and/or�Drawin � ,-
12128104
12128104

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UI�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 EkNO ❑ 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 ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [gNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes i"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Flo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
GINo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tf No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
Et'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA
❑ NE
Comments(((refer to queshon!� ,� Explain aoytYES�answers and/or; any recornmendahons or apy other comments.
Use drawmgs�`of faulty to�better4 ezplam srtnationsz (use ad?d[t�onal pagesias,necessary).• ' � .,* '� � ��",
da- - .`' z... •.�;t �.. s.r vn� n " s"�[ .k . _.. -. , +?�`' � i'u w , '�§r ��. �. �..�343�"�°'33�' -
Reviewer/inspector Name f, - `,� Phone: It U
Reviewer/Inspector Signature: - Date:
12/28/04 Continued

of Visit JR Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: jOl t Time: : t70
Q Not rational O Below Threshold
13 Permitted ;I Certified 0 Condit''ilIon--ally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: _ . . l it W elft La1� _ _ _ County: �y5 Sot^ ...... , . .. _ .
Owner Name:=%A t:-. 'Phone No: � I d - S7 q 71-31 ,
Mailing Address: Q � •mac � � t � t� � _ � G -- . .. ? �_
Facility Contact: __ ---__ Title:.... _ _ -
Onsite Representative: 0!2 EVE Z 4
Integrator.
Phone No:
,
Certified Operator: G I Ems C i'r1 S__ Operator Cer[i6cation Number....,�.��.
Location of Farm:
aswine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 Du Longitude ' �u
iTicrha�ues & Stream hupaLis
I. Is any discharge observed from any part of the operation? ❑ Yes g5 No
Discharge originated at: ❑ Lagoon [I Spray Feld ❑ 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 E9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Stare other than from a discharge? ❑ Yes CKNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 59 No
Structure l Structure 2 Structure 3
Identifier: __ ..J_
Freeboard (inches): Z
12112/(!3
Structure 4 Structure 5 Structure 6
Continued

>F Qity,Number: 6Z -- GS Date of Inspection �O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes KNo
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or enviraamental threat, notify DWQ)
7. Do any of the structures need maintenanceliimprovement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes C,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 4No
elevation markings?
Waste Apylication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type "6'k . 1Q'( ua roLS S 0 we'r-see-A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes a No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 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 9 No
16. Is there a lack of adequate waste application equipment? ❑ Yes 14 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ja 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 ja No
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
ReviewerAnspector Name _
Reviewer/Inspector Signature:
»ir7m7
Date:
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�asf` �r-� dopy
ReviewerAnspector Name _
Reviewer/Inspector Signature:
»ir7m7
Date:

Facilite Number: Date of inspection IQ D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLIe,-checklistfesiqtl!:mapiro�etc.)
23. Does record keeping need improvement? If yes, check the ap
prophate box below.
❑ Waste Applicati&O"❑ Freeboarll-"O Waste Analyske❑ Soil Sampli*,"'
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, f=board problems, over application)
27. Did ReviewerM Spector fail to discuss review/mspection 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?
NI MES Permitted Facilities
30. Is the facility covered under a NPDE,S 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 FortAtff Crop Yield Form ❑ RainfdKO Inspection After I- R wt,--
❑ 120 Minute Inspectio" Annual Certification Form
❑ Yes ELNo
❑ Yes O'Vo
❑ Yes 1KNo
❑ Yes 14 No
❑ Yes IR No
❑ Yes DLNo
❑ Yes IgNo
❑ Yes RNo
❑ Yes [RNo
Yes ❑ No
❑ Yes RNo
❑ Yes RNo
❑ Yes KNo
❑ Yes RNo
R Yes ❑ No
❑ No violations or deficiencies were noted during this visit. You wi71 receive no farther correspondence about this visit.
-�0..� '�....-
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35 . P��st Pc�o•i�@, r-erp �; al� �r,+�. Ow`� a.v�r..le�t Gee�t�ea�e� '�e�S
t,aiti� - Otti-s G �'e �or+►��. ; 4&1
12/12103

s N
Site Requires Immediate Attention:
Facility No. gz - /.sem
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: L 1995
Time: Z ` S�
Farm Name/Owner: 6Rjcsr�.�, i�,u l�T�f2�a � - E"twg rl EA- Am.
;Mailing Address:_ Oo 3ox 74/ G�.z d_ AJC ZS -JV/
County: nsvtiJ _
Integrator: E. �+r s -- Phone: 91v - .SZ P - 9_ _73 I _
On Site Representative: WIA4eorl�� Phone:
Physical Address/Location: a /rsr'. S
Type of Operation: Swine x_ Poultry Cattle T
Design Capacity: 32 SO --A,,v Number of Animals on Site: 3Z 2F
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 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) �or No Actual Freeboard: Ft. Inches
Was any seepage observed from
a
the 1 oon(s)? Yes o�Was any erosion observed? Yes or No
Is adequate land available for spray? (Yes)or No Is the cover crop adequate? (yes)or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from WellshZ:f(;s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or M
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 recon (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?es or No
Additional Comments:
J�/aaO AQEr9—t-r7_ir'__
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.