820242_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: UComp lance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner mdil:
Owner Name: S f yna[ Phone:
Mailing Address: ,
Physical Address:
Facility Contact: p��7 r y Z L. a K Title: (I tA.) n rf" Phone:
Onsite Representative: T '�P..�� Integrator: bs = &rJe
Certified Operator: Certification Number: g 4}1 !�� t{ /
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Eapacity
Pop.10
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Plo
Non-Da'iry
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
t?ther
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑NA [:3 NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes a�❑ NA ❑ NE
❑ Yes [j o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 10 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 StrucUwa 4— Structure 5 Structure 6
Identifier: ✓ m:sia
Spillway9:�=c1sc
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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? [D Yes [:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [EI-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 [3-1�o ❑ 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): Col' I Uj
13. Soil Type(s): r-T O 7f L i
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes [f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eal�o ❑ 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 E No
[:]Yes D11�0
❑ NA ❑ NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E! 'No
[] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 o
[] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number:0,2 1 Date of Inspection:
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 00yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey OFailure to develop a POA for sludge levels
[ Non -compliant sludge levels in any lagoon C ,
List structure(s) and date of first survey indicating non-compliance: �p,'t�S (3j •-�(d-r�L)
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1�o ❑ 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 Q'1\lo ❑ 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 [J'f�o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the Facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej oo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
io
❑ NA
❑ NE
- _ s or any other comments.
Use drawings of factl�ty to. better_ explain situations (use additional pages as necessary):
Comments re er to�goesbon xp IR any answers=an or. any additional recor>amen stun
�I �>
]-- � �� � ®t�'�/L � �,CJ .
r�o�� r�
��oa�• .�vrrr - 7
aq 3 & 3 -6 Aga- L
69crfJaa(b'p
P rf- ' Two La o-t•� % �' �5 L� ��� 5/ }hi s r� i H s �1t� i a 1-�r.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: , �13 CD-0)67
Date: 2?0��Al
21412015

ivision of Water Resources
Facilityi Number ®�- Division of Soil and Water Conservation
®Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grgo—utiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Cf/ J Arrival Time: Departure Time: County: ��Region:
r. A4
Farm Name: f ! Di T7ulG-k /5i Awner En ail:
Owner Name: S` pl F11 Phone:
Mailing Address:
Physical Address:
Facility Contact: -5Wrr }-'- 'i Title: Phone:
Onsite Representative: 5' _ Integrator: �mTL
Certified Operator: ��,.�.�_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
DestgnCurrent
Capac ty :Pop.
Wet Poul#ry
Desi
Capacity
enl
Pop.
=137eiign Current
Cattle Capacity Pop.
Wean to Finish
._.
Layer
airy Cow
Wean to Feeder
8qD 7 fit»I
INon-Layer
I
a' Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
I Dry Cow
Farrow to Feeder
D . P,oultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Other
r
r ;:.
Turke s
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?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faciti Number: - Date of Inspection: c—,;4D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: f5,1 7 1 r rb/ /�u� •+'�
�—
Spillway?:
Designed Freeboard (in): / / / 7
Observed Freeboard (in): -1;1? _ � 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C�J_TTo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
1 t . Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �i`/t !�/Ars �flf yfir_ot �s
13. Soil Type(s): tom[-7`r / Lh _
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes C�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ 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 R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LK.No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

,1Facili Number: - Date of Inspection: !
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes [,� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
®,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
�Z_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
[allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
!
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Llo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatuz
Page 3 of 3
Phone:
Date: — r---'ZD/1
21412015

G—
- Division of Water Resources
FacilitMINE
y Number - ;D;It"1onoCI Soil and WaeConservation
OOher Age=cy 0
Type of Visit: <TCompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: : Oti Departure Time: _ , �3 County: fsr Region: ?1:9EM
Farm Name: v 3Y-� /� riekl, ail:
Owner Name: S 1d yl-e y Phone:
Mailing Address:
Physical Address:
Facility Contact: 5;d nr y Title: Phone:
Onsite Representative: �sLr...C_ Integrator: �}.P
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
.
Wet Poultry
Design
C*apacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Dr. P,oultr
Design
Ga aci
Current
P,o
DairyHeifer
D Cow
Farrow to Feeder
Non-DaiTy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey Pouits
Other
Beef Brood Cow
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ®. No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes D No ❑ NA ❑ NE
❑ Yes
[—]No
D NA
❑ NE
❑ Yes
fa No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: - /b
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: iJ't 1 (DZ? F;rLj
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): 7 _
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 allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q No
❑ NA
❑ NE
waste management or closure plan?
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 ZLNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes tA No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes EINo
❑ 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): r� �/'n / 1, I�I�"I.SB �•s r
-
13. Soil Type(s): 6_0 /f- I Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CELNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes & No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E 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?
Renuired Records & Documents
❑ Yes [R No ❑ NA ❑ NE
❑ Yes LKNo ❑ NA ' ❑ NE
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
[0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection: ,tj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J&No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2LNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I& No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ,® No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes PSNo ❑ NA ❑ NE
❑ Yes ZLNo
❑ Yes ® No
❑ Yes Dg-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Nray/.V%, f cJ�ll Look
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 2�l 330 o
Date: 6_
2141201 S

M
Type of Visit: QrCrompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0-1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / ; ti O Departure Time: a County:
Farm Name: Y /vim 14S/j[�k�rlx+n�1T` t O wner Email:
Owner Name: lei p�j7 ��aA� Phone:
Mailing Address:
Physical Address:
Facility Contact: _040 • / Title: Phone:
Region:
Onsite Representative: Integrator: /j?_,�r
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
O 1 iNon-Layer I Dairy Calf
Dairy Heifer
Design Current Dry Cow
Dr. $onitr ` '.Cap- ci P,o Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke 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?
❑ Yes LEr.'�Lo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JKNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5LNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: S
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: ✓ u
Spillway?: _
Designed Freeboard (in): l `
Observed Freeboard (in): "�V_ C)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
[—]No ❑NA ❑NE
Structure 6
❑ Yes E[ No ❑ NA ❑ NE
6. Are there structures on -site which are not property 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
14 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
O Yes
Q'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
[�gNo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g-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): CAD e-#N- 1 Gtllr�
13. Soil Type(s): O✓f Z /_ J-t_ r
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes J,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Fg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes C&No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
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
rMNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z. No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of —Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F.;a No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes P�3_No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [KNo ❑ 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 CAW T?
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 El No ❑ NA ❑ NE
❑ Yes [B No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes
®' No
❑ NA
❑ NE
❑ Yes
jallo
[DNA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
P!�No
❑ NA
❑ NE
Comments.(refer to question #): Explain. any YES answers and/or any additional recommendations or any -other comments ` `ti
Use drawings of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 2%p �3 3�zo _
Date: —O,�/S_
21412011
Page 3 of 3

Type of Visit: omptiance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 1 Arrival Time: Departure Time: j / ; 3 a County: Region: f K o
Farm Name::__t yr_g,i�3 /r_— b _—!f Y 11 + i f (t� 'r�c�% Owner Email:
Owner Name: S.i in Phone:
Mailing Address:
Physical Address:
Facility Contact: Z Title: Phone:
Onsite Representative: Integrator: _00125
Certified Operator: ,$�ac� c� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
y'
Design
Swine Capacity
Wean to Finish
Curren
L t
Pop.
Design Current Design Cnrrent
Wet Poultry Capacity Popr Cattle Capacity Pop.
La er Dairy Cow
can to Feeder
%
Non -La er Dairy Calf
�..r ;, Dairy Heifer
Trent Dry Cow
D . P.oult . Ca a i� " 1'0 . Non -Dairy
Feeder to Finish
Farrow to WeanDesignC`
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
NJ jBeef Brood Cow
Other
Other
Turk e s
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[—]Yes
29-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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
a No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - a-- Date of Ins ection: Tap i q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J2-A F -ff tE L
Spillway?:
Designed Freeboard (in): 19- 19
Observed Freeboard (in): 2:&e— '01-6 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Jallo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CDrn f, +•-�/�f}%��rf
13. Soil Type(s). f ,%4— f ,_/L '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EU No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [}2No ❑ 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 [Z No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21 _ Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield JQ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EZ 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 ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - !fi Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r@ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
EB No
❑ NA
❑ NE
❑ Yes
EZ No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes t.No
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes V1 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments; (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments i ,
Use drawings of facility to better ewlain situations (use additional pages as necessary). -
Reviewer/Inspector Name: �z�tiY [ ' /�s •---- Phone: y3� �C�
oe If
Reviewer/Inspector Signature: - _ Date:
Page 3 of 3 21412011

i ype or v estt: p$�t✓ompuance inspection v qjperanon tceview lJ atructure r.vatuanon V i ecnntcai Assistance
Reason for Visit: �S[Moutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j Departure Time: � County: Region:_
Farm Name: T1Owner Email:
Owner Name:.S' lAfiey �Iad— Phone:
Mailing Address:
Physical Address: V-ntg, 'I�` TflUt1 iVj �IPfJC-
Facility Contact:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Title:Phone:
Latitude:
Integrator: B �y
Certification Number: ' g5-dg1
Certification Number:
Longitude:
D �g it
a Trent �
Dp ` Cu_
Design Current
Swine
Caac
Po �I
We# Poult ry
Ca act tY
Pop.
Cattle Capacity Pop.
Wean to Finish
.�`
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
-
- _-
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
1) . P,oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharp_es-and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ® No
❑ Yes Callo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

• ft
FaciliNumber: Date of Inspection:
J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
§g Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[.�3 No
❑ NA
❑ NE
Structure I Structure3 Structure Structure 4
Structure 5
Structure 6
Identifier: _ Fie P*6 prNir11
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): 13
1 13^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[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
15� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
W 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): Corn . Wheat
r❑
SQ �I I -e 4n f
- —
13. Soil Type(s):
14. Do the receiving crops differ from those designatedjln the CAWMP?
❑ Yes
U No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
Ig No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ig No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
W No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O 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 J�j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes ❑ No jjjj NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E:JNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes f5allo ❑ 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 tS 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 0 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. C& Yes ❑ No ❑ NA ❑ NE
CR Application Field ❑ Lagoon/Storage Pond ❑ Other:. EW& H
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ;E2—No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. 0. p M
Use drawings of facility to better explain situations (use additional pages as necessary).
7. Plea, e. ev if � +�,r on i� srde oe-t a" Srorf) of iat� i}e�er �r eV _
�+
I So 1 +bt roaI+.� wde not -co rh 19(f wl eulo4 yep, rv� rep ��--�-p Lane ald. 74c,
Plea-e ch&k on h fiet so i f aofr -i ,� see.2 mare ct&1ble,
TMo[�ex� -�
The�-h►irnL.►fl�f-
� of VV&k ), Ra+to Is A, o,3%
P�s�,d � p SoDay
d ej freel��ld ard- sr VOAr
fa1131 ►v$'e-sek�-re�a�. fir' 9� � �� c TS �4nd�Pa: a w�24C
Melds are,vt ry+, �ehaw bee, a rna�or M � s Me >Pr V %j I �m as sock ar he. ca,,, Com uo f 1 �'d O
Quo, a� & � �
strl I m-eieIds,
Paf wwk 4o be-iff✓4 Ar- h t it �I� bow(,. Reco.� i�e W"- vr-ewet-
c9
GOLD recods.
Ck0v-,)013-PC-0c_941jn6a, Viodut&alr].
Reviewer/Inspector Name: Man Sr_h& Phone:fo— AQ��
Reviewer/Inspector Signature_ JUM01 ji Date: �� j4 a 013
Page 3 of 3 21412011

i s FaJrm Name S
COC . v
NPDES (Rainbreaker PLAT
Lagoon Name; S for' s t illwa
1
2
3f3T
4 4&kyj
5
B
7
Design Freeboard./Last Recorded in
Observed freeboaed=�
S I u d g aSurve'".Date `:"
Sludge De tt ft .
a
Liquid Trt_ Zone ftI
IN
Ratio Slud a to Treatthe"nt Volume ifi 0.45
Date out of com o liance/ POA?
Design Flr • •
-Actual®�--�---
p����-----
ActualDiam.fr
. �- - --.-----,
Soil Test Date
pH Fields I
i
Crop Yield
Wettable Acres r�
Transfer Sheets
R6"UGE
Lime Needed;
! + ' :
WUP
ad p or incinerator
Lime Applied !
' { i
Weekly Freeboard '
Mortality Records
Cu-I ;Zn-I i -
1 in Inspections,'
Check Lists
Needs S (S-1<5) i ,::...
Nped-g P I 111�1'k i
{ — PAPP
120 min Insp.
Weather Codes FI,.Q
Storm Water
r
17,1 T k
0_1 Oil
Verify PHONE NUMBERS:and affiliations `
Date last WUP FRO ` FRO or Farm Records
Date last WUP at farm! Lagoon # U
App. Hardware Top Dike
Stop Pump i ,� lq
I Start Pump
Conversion- Cu-I 3000; 168 lb/ac; Zn-I 3000= 213 Iblac
i is li `

id ,.,r .A1,.,l
V 1 rt) V v} `b 11111 a,
.'s- - Divistoa of Water Quality
Facility Number $ - fit{ ®Division of Soil and Water Conservation
OQ Other Agency
Type of visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QCRoutine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Timer County: �m Region:Ro
Farm Name: ft rfj DPer PiellIVvr,,�J Owner Email:
Owner Name: $ �� Phone:
Mailing Address: 20 BOX IQ 2
Physical Address: Q01o1% 133A IV 1 I f��Q A,Yg flW y _ ►V 1 1 r01 L - --
Facility Contact: a Title: (Owner- Phone: 53L a66%
Onsite Representative: stl4ellpV$Owl Integrator:— B
�i n
Certified Operator: IM0 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current;
Design Cua=rent
Design Current
Swine Capacity
PopWet Poultry
Capacity Pap. -
Cattle Capacity Pop.
I ILayer
I
Wean to Finish
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current
Farrow to Wean
Cow
Farrow to Feeder
. D : P,oult .
Ca PER P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
&-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ER'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (� i( bHr/ Nil
Spillway?:
Designed Freeboard (in): N
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[D Yes
S] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Rr 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
'' ,❑
Cann-, 12. Crop Type(s):h�hR21 S V heiw
13. Soil TYpe(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Cia No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[$ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
Page 2 of 3
21412011 Continued

�3
[Facility Number: -
Date of Inspection:
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.
�No ❑NA ❑NE
❑ No ❑ NA ❑ NE
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: tj �"} - ��a J�/ 3&(V*5AQrPP1 Q„9 4
26. Did the facility fail provide documentation of an actively certified operator in charge. ❑ Yes R] 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:
❑ Yes & No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [5?No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CR No ❑ NA ❑ NE
g :rrments.
Comments (refer to question-#): Explain anv YES answersrand/or<;any additional: recommendations or any other, com
Use drawings of factl '" to befter-explain situations (use.addrtional pages as necessary). N`
When yov cud- je�c fide p12o-e-heblefde fdj;vt A- pokebfrr r Oecoy-�/
no
a , I�sl� irsfn��la1� r'r accu�rx�e �e pohrs rvltI1 nRod -�V b-9— ckmed ocf - b,e'�
5 � �
WRe am, --,� v (�) �vs
Qb'o1c- „, hay bee, �- �o � w 1(i notmak � , o
copy, Carr �l�[ s I+�+J r}� . 1'� �� r!l `iS � Q'1 n� I l I �'Ei~r)a � J
WAI ty; ��w r6�s'
�',eVj�u- h hr �r n
� � y
JQ'rbcna`,n0teSgkvve1 nl7-a, P16dbce-c0pr7.
Reviewer/Inspector Name
ReviewerMnspector Signature:
Page 3 of 3
DateAA to a Q
21412011

Facility No. ?D-a Farm Name I hp",� } 7 ��, toe 6 t, �
Permit s-.,/ COC OIC / NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3 5FVT
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
i
Sludge Depth ft
, ZI
Liquid Trt. Zone ft
,
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
A
Calibration Date
Ring_Size
bes-ign-U—iam.
��i�------
- n -
.. r
[.;s�i'------
Soil Test Date ak4Crop Yield Transfer Sheets
pH Fields Wettable Acres �_ RAIN GAUGE
Lime Needed - p WUP ✓ Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
"Cu-I ✓Zn-I ✓ 1 in Inspections f Check Lists
Needs S (S-1<25) 120 min Insp. Storm Water
Needs P TF fflyhFPT Weather Codes
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5 3,1�j FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
i�tr
14,E

64
0
E�

:_ k
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: arti Departure Time: County,�>RniqSo"i
Farm Name:
V'V Z"tl rPr Owner Email:
Owner Name: C>ctii� _31A Q Phone:
Mailing Address:
Region: FRO
Physical Address:
Facility Contact: 5x p .tj" -f {� Title: oO i,,�rl Phone:
Onsite Representative: (�y1 _t �i1. n Integrator: M Lt glkk,.1 j�Sftc: L 3zv
Certified Operator: as C!�. k\1 Certification Number: �f� �r S,)14l
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
= Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry'" Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder `i o
1 r_0 1
INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
`- .. '
Farrow to Wean
Design Current
D . P,oult : ,��'�. ;:�Ca aci P.o
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes D No
NA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No L% NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 2 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

I
Facili Number: - J-4 a Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[VNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 0 urrr7
r
Spillway?:
Designed Freeboard (in): f C
Observed Freeboard (in)-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
j�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
7�
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 14 No
0 NA
❑ NE
maintenance or improvement?
��TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): , wl. Zo �S
13. Soil Type(s): iA L k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EXNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? 'T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes q No
❑ Yes PM No
❑ Yes �A No
❑ Yes D6 No
❑ Other:
❑ NA 0 NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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?
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C� No
❑ NA
❑ NE
❑ Yes
[jQ No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued
�l

- 1
Facifi Number: %3, - ,a jDate of Inspection: I1rjJ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�0 No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Co No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
171 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
[ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other con mentsi
Use drawings of facility to better explain situations (use additional pages as necessary). _
A 1_ L ER GI-t1 �'1 uc ME k 01,a1 N= -kl , rs V Ln 'N -v 5 riF >:
\IZz,-E_A0A!VE 00r)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
is.S
Phone: iT%,,�,tr
Date: !rI /ACT
21412011

Division of Water Quality -
Facility Number 0 Division of Soil and Water Consenwation
Q Utber Agency
Type of Visit 4P Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
1 Date of Visit: rr l 2.0 j11 Arrival 'Tf1 iffm��e:,�, D = Departure
Time: * County: f SW Region:
AQV
Farm Name: f* Bi+4l; �u�-ftG� V Rrlj. s r{fr' NUi�iIke5Owner Email•
Owner Name: 5�� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
_
Onsite Representative: r/ Integrator: ! ILwp k &O (AJ h _
Certified Operator: Operator Certification Number:
[6gyg
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 01=1 1=" Longitude: = 0 0 4 a
ig
Design
Current
Design C*urrent Design Current
Swine C►►specify
Population Wet Poultry
Capacity Population C*arile Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Puilets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑Turke Pouits
❑ Other
Number of 5truetures: F
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 EANo ❑ NA ❑ NE
❑ Yes
❑ No
[�$NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
[DNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection I bLl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Df
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): eZ l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes fO 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 [d No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes §0 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) 6�;-j L
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
§9 No
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
[INA
[INE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
1
[I NA
[I NE
17.
Does the facility lack adequate acreage for land application?
El Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�bNo
❑ NA
❑ NE
; - . . 1. - - . - I,- . .1 _:
:. . . . . - . . . ­ I - N ' ' , - , 4 � r'n r .. . .. .. ..
Comments (refer to gdestrons#): Explain any YES answers and/or any recorrtmendations or;any other com>nents
Use drawings of facility, to betterexplain situations: {use additional -pages as necessary):
Phone: fO
Reviewer/inspector Name '� '�" " 3 3340
.,
Reviewer/Inspector Signature: Date: ip
Page 2 of 3 12128104 Continued

• Facility Number:c2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ 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 El Maps El Other
21. Does record keeping need improvement'? if yes, check the appropriate box below. ❑ Yes 10No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IP No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
Cl NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[IDNo
❑ 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
1P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C?DNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'No
[INA
❑ NE
Additional Comments and/or Drawings.
„
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 40 Routine Q Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: -Z,S Arrival Time: �T Departure Time: O = County: S tvJ Region:O
Farm Name: rt\ye- i 1A ,4 4aJr- le- 6f_,e /Ajt Owner Email:
Owner Name: S' 4 hT FoI a'�j Phone:
Mailing Address:
Physical Address:
Facility Contact: s`1 rR1 t Title:
Onsite Representative:
i
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
AIntegrator• ^ P I `f"O ww&I uC-
Operator Certification Number: C4299
Back-up Certification Number:
Latitude: [= o [= 6 = 4i Longitude: E:J o =' = u
Design Current
Swine Capacity Population
Design Current Design Current
Wet Ponitry Capacity Population Cattle Capacity Population
Wean to Finish
][]Layer
❑ Dairy Cow
Wean to Feeder
7
AoD
❑ Non -Layer
❑ Dairy Calf
ElFeeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dty Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
L
El Beef Brood Co
❑ Turkeys
Other
Number of Structures: 3
❑ TurkeyPoults
❑Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 09 No ❑ NA ❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
MNA
El NE
91 NA
❑ NE
❑ Yes
❑ No
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No bNA ❑ NE
Structure } Structure 2 Structure 3 `� Structure 4 Structure 5 Structure 6
Identifier: PtX1'-4Ol ��'0ayL !l x'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes bNo ❑ 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 ICE No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 191 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 JP 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 VINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or i0 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) Gwo 1 � Q6i�j 02"'^ C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D§�No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RSNo . ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
0 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No [INA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
( No ❑ NA
❑ NE
..-.-..- - r - rani �r
Comments (refer to questtan+#) Egplain any YES aniwirs and/or any recommendations or any other;cammen#s
Use drawings of facility to better explain situations. (use additional pages as necessary);
r -
ReviewerAnspector Name Phone:
Reviewer/Inspector Signature: Date: fp 16 COI
12128104 Continued

Facility Number: -- Date of Inspection �s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
r No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
I!EPNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
�a NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
F NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P 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
PNo
❑ 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
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
ll
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
QPNo
❑ NA
❑ NE
aq, 51��rwve� cx�ra��,' W�2�s 40 �e 097;rky(af /41�1_1.
6,J -G, ' , rec"s
I2128104

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_ �Ottheerr ❑ Denied Access
Date of Visit: �j Arriv 1 Tim � Departure Time: Or County: �' ' -' " �� Region: ��
Q
Farm Name: / Q n� u �' Z Owner Email:
Owner Name:
Mailing Address:
/y1a-r/81 Phone:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 4
Back-up Operator:
Phone No:
Integrator: A0h
Operator Certification Number: /626?
Back-up Certification Number:
Location of Farm: Latitude: = e = f ="
Longitude: = ° = 0 u
Design Current
urrent
Mcit7
FGap
Design Current
Swine
C►apacity Population
Wet Poultry_ptiiation
Cattle Eapacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
Wean to Feeder
30
❑Non -La er
❑ Dai Calf
❑ Feeder to Finish
Dry Poultry
-
_
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
ElNon-La ers❑❑Pullets
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
�❑ Beef Brood Co
❑ Farrow to Finish
EGilts
Boars
❑ Turkeys
Other_��
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P1No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
YNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
ElNA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of inspection
Waste Collection & Treatment PNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No n NA ❑ NE
Structure �l ?trgctur Structure 3 t Structure 4 Structure 5 Structure 6
Identifier: M rzifA
Spillway?: i
Designed Freeboard (in):
l
Observed Freeboard (in): 31,4
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 property addressed and/or managed ❑ Yes R 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? ❑ YesZM No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes $1 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Vi No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1 iNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
it
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes;No
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
CRNo
❑ NA
❑ NE
•zs.s �5 .
tComments (refer to ggeshon' #) Eaplauu any YES answers and/or any recom;Paw
mwr commenis.
ry 4¢gse drawings offac 1ityry#o better esplam sttuanons. (use,addthonalpages,as n
of
ReviewerAnspector Name J Phon
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [)9 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
]p No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl Yes
bgNo
❑ 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
C No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
bq No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tlNo
❑ 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
9No
❑ 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
KNo
❑ 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
J&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

24;
0 Division of Water Quality
Facility Number s 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r j Arrival Time: Jl%OI�� WN Departure Time: % - County: 5h�p�� Region: FRO
Farm Name: �' Ve PO [Ir-lelw'r- 143 s r 71 ` Owner Email.
Owner Name: StdYL' a kr t P5 Phone: [phone]
M ail i ng Add ress: 'PC) &0)X �0`l�t f ICY fe_1fs 19 3K- a -
Physical Address:
Facility Contact: vidl So.y B Ind Title: Phone No:
l�
Onsite Representative: integrator: Lt.r�
Certified Operator: lr Operator Certification Number: 1 r
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = fl Longitude: = e = 1 ="
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
7 18fO1 %00 110 Non -Layer
Dry Poultry
Non-L,
Pullets
Ulurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
._tea;
)eS12n "U.]
Cattle Cf
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 No ❑ NA ❑ NE
❑ Yes ❑ No 9 NA
❑ NE
❑ Yes ❑ No Y1NA
❑ NE
El Yes [I No J]NA
El NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
6
12128104 Continued

Facility Number: 5a Date of Inspection (a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes P No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No PTNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Rue POD s wfle Ri 11 Dtc FeU
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D,% X l 14�+
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KANo El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ®No ❑ NA ❑ NE
through a waste management or closure plan'? 11
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 91 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 1PNo
[]Yes �i To
El NA El NE
❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
1 I _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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
�c' 12. Crop type(s) L r h , Wo1 S" 6&.05
13_
r
Soil type(s) & WS� - �jop�" % n J, —Ln
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YN No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name -� f/V� a Phone 1a7
.3:2Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: a — Date of Inspection I tales
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. ElWUP El Checklists El Design El Maps El Other r
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes]
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
- No
❑ NA
❑ NE
Other Issues
I
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
ONo
❑ 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)
T
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rp No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: fmiaspn Region:
''LL r r f ��j E C
Farm Name: Rye Phil. t'f1IGVk' y-�( FL11� _f;%,e doNn ma�t�
Owner Name:
S 11
1 V4P.M Nap Phone: (I, o)
{l,-N
Mailing Address: t C!C ��a��e f rs C- . 4 LI�i °I�� 3 66 a a
Physical Address: �y J
Facility Contact: I'd nP 4 P9 1Q•nU Title:
� vlem 1
Onsite Representative: st
Certified Operator: 14 v
Back-up Operator:
Location of Farm:
Phone No: jj��hh
Integrator: ! ulrllo" O1'wi l _
Operator Certification Number:
Back-up Certification Number:
Latitude: E�] =' ❑ Longitude: = o ='
=
f
Design Current Design
Swine Capacity Populati t� Vet Poultry �.apacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
Layer
❑ DairyCow
Wean to Feeder
❑Non -La er
❑ DairyCalf
El Feeder to Finish -
❑ Farrow to Wean g
-Dry Poultry.
❑ Farrow to Feeder "'`tea
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
❑ Boars El Pullets
- -- - - - ❑ Turkeys
Other E] urkey Poults
_
-
❑ Dairy Heifer
❑ D Cow
El Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
R
Number of Structures:
❑ Other jaOther
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
❑ No
f�NA
❑ NE
❑ Yes
❑ No
�FNA
❑ NE
❑ Yes
M No
ElNA
❑ NE
❑ Yes
$ No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

`Facility umber: 02� Date of Inspection 9-il
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No U9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: DRY R7
Spillway?:
Designed Freeboard (in): �Ly I Ct 11
Observed Freeboard (in): N 5711 `+
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Aipplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
;Window
12. Crop type(s) n , hi Yler" , spy162aL4aS
13. Soil type(s) Gp�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�&No
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or : ny `otlier comments.
Use -drawings of facility to Metter explain situations..(use additional pages: as necessary.)
F,ez.ba" refoAd 4D bk
-Fonf K' r►�r .P�-.� ��t.�titi do��5 F OA
Reviewer/Inspector Name �� e. �T� Phone: !O 33-3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

t
Facility Number: a -- a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [LNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P9 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�§ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1] No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
151No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N 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
E] 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
Pi 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
[I 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival
/Time: Departure Time: County: -SQmAsew
J[A1 S � drylf
Farm Name: / Owner Email:
GI r� 17.4
Owner Name: ��•• H,'l� lsn�Ae/rse..:+t Phone:
Mailing Address: PA Qnx 10`7 G
Physical Address:
Facility Contact: S;r tio, Q�-____ Title:
Onsite Representative:
w%
Certified Operator: _ 5.�.,�J� 161and
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Vrean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to .Finish
Gilts
Boar
Other
❑ Other
Phone No:
Region: -
Integrator: ^'--o12_47)& &QaZa
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' [ Longitude: = ° = 1 [=] u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
7 gOfl . ❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ 3'urke s
ElTurke Poults
❑ Other
Dischartres & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 [q o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
['NO
❑ NA
❑ NE
❑ Yes
9'No
❑ NA
❑ NE
'-d.;
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
DTo ❑ 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: . __ r
Spillway?: tin
Designed Freeboard (in):
Observed Freeboard (in): -�'7%'� `� — 3/ 1'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ ITTo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
DINo ❑ 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
RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
DVo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
13s 14H /ryy
12. Crop type(s) CDrn t✓�,re _ s�+�P�b s
13. Soil type(s)L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No ❑ NA 0'NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA 9 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[91No [:1 NA ❑ NE
pt . _„,
Comments (referato gtieslion°;#) EzpLsun any YES answer's andlorkany recommOdatwns,or any other comments.
Used gsof facility to better,explain:.sitnahans (use addrttonal�'piges as necessary};
Reviewer/Inspector Name ]., k - Phone: 9/v-y to - f d
Reviewer/Inspector Signature: Date: 4f -
12/28/04 Continued

Facility Number: Date of Inspection.
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑-Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropirate box. ❑ Wy_ � ❑ Chec is �❑D�n ❑ ❑Ot
21. Does record keeping need improvement`? If yes, check the appropriate box below. ❑ Yes U-90 ❑ NA ❑ NE
❑ ❑ Wm+ 1,7,1,7) 1. 7 y s ❑ Wa�ste�iamfers ❑ tion
❑-�❑ ng- ❑ Crop Yield ❑ atn ns ❑-Weathei e-ud
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[aNE
❑ Yes
❑ No
❑ NA
[;�FNE
❑ Yes
❑ No
El NA
�E
El Yes
9, o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
DIZE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ❑'flo ❑ NA ❑ NE
❑ Yes 214o ❑ NA ❑ NE
❑ Yes 2To ❑ NA ❑ NE
❑ Yes
(;lo
❑ NA
❑ NE
❑ Yes
9"No
❑ NA
❑ NE
A and/or Drawin
A, ition °Conkments gs:
?. Please vsc •� a� upP'ay�� ItNe/
12128104

f
(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number a hate of Visit: 1"1 B` , � Time: E=
Q Not O erational Q Below Threshold
0 Permitted P Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: - --•-- _. _.
4y I
Farm Name: ..K«►. .... L.p u, t�ksi.kleJxm f.-ALILF....D. K c ; Ca.srU... County:
Owner Name: .a..[ h�� Gia. ....................... -.W .... Phone No:
Mailing Address:.._J_"^Q M 19ox 1Q-7.
Facility Contact:..._...............................,.�.....I.......... ..... Title: ... ..... .............................................. Phone No: W. W
Onsite Representative: �� pc r+ z k � _ ---- W_.. .._.. te€� .....MK.. p.14 - Prow.
``'' ...... .�«....... Integrator: r ..�.................
Certified Operator:.,« ,L? .� Wb fir. f .....s.:...__ Operator Certification Number:
Location of Farm:
Qf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 «
De_sigoCurie
Swine : Capadty.opalas
Wean to Feeder 7 koc-
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
N
Current -
ideity . Popidatinn t
Dai
Nor
Total D ' Ca aid
estgn -Rp
'TOW,SSLIN
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes 00 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No--
2. Is there evidence of past discharge from any part of the operation? jZ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .....lY..> r... �f�.:...... �7�rr��!±�.�'.� - ---- ..
Freeboard (inches): v7Se ` oil 1, r
12112103 Continued

Facility Number: 0.2 — 11
Date of Inspection �O
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes M No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ FAN ❑ Hydraulic Overload ❑ Yes LB No
12. Crop type ,_ s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 50 No
14_ a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes MN,
15. Does the receiving crop need improvement? ❑ Yes ® No
16. 1s there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes [19 No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (9 No
21. Did the facility fail to have a actively certified operator in charge? ElYes En No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes © No
24. Does facility require a follow-up visit by same agency? E4 Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
E3 To violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #i) EYplata aay YESwsasR s sadlor an�Jjy recvntmeadatwas—or aay, other oommtnts. m
Use drawtugs of factty to better ezptatn situattans: (nse addtrsansb pages fts a ecessary) ield Cory El Notes
F=
_W
hOUJ Gp h�a Way FG 1 C�►(G i t(o++� T�t 6aG`` - Ce�rr+Gr. G
SeCL&*% - is 7LAG%v%L�C sb ��C i y`v��tG ��a`w1.� OT ��4n �CP[� Y+O), 40h� bi" �C,
SbY,G 4 i4 ,..e, Lc,aIL Wa] .«c� W%'+L
+� G�C—L
aP
Reviewer/Inspector Name _ _
Reviewer/Inspector Signature: Date: —�I?- OY
05103101 1 / r
Continued

Site Requires Immediate Attention: *0
Facility No. 8Z - Z 41
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANML4,L FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z 3 , 1995
Time: i3;i5
Farm NamelOwner: be c r iPi t_ 1 d /t%urs
'Mailing Address: /W Bad _la7 h
County: 4 S"V
Integrator' A'ghva
On Site Representative:
Physical Address/Location: w z
G
Phone:
Phone: /a S3Z. - z&G
Type of Operation: Swine Poultry Cattle
Design Capacity: 2600 Number of Animals on Site: z 600
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) Yes or No
Was any seepage observed from the la oon(s)2
Is adequate land available for spray? e or No
Crop(s) being utilized: Row -Crops
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
Actual Freeboard: 'Z Ft. b Inches
Yes or Ng Was any erosion observed? Yes or(g)
Is the cover crop adequate? es or No
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. TZ - 2-*Z_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A"- s ,' Z 3 , 1995
Time: 13 ; 2.s
Farm Name/Owner: wa c K l e. b e r r y #, // /ilu rs'tv H % 5,v nre y &/. d
Mailing Address: PO 5 07 %larrc_//s ,
County: S_ 'X-02 s ON
Integrator: u FQ '- Ga,vows Phone:
On Site Representati e: Phone: < 9/OJ .5.3 Z - Z " 7
Physical Address/Location: Ifs,,., 4Lz l E, o f tfa rr c/ls z %z. o v
Type of Operation: Swine -_Z� Poultry Cattle
Design Capacity: 2 &oo Number of Animals on Site: -Z, (,00
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: 2 Ft. o Inches
Was any seepage observed from the la oon(s)? Yes or(&Was any erosion observed? Yes oX19
Is adequate land available for spray? or No Is the cover crop adequate? (& or No
Crop(s) being utilized: Ciro s pad e sAl
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes Ord&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or®
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? ®or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.