820367_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

i'vision of LW;Merl Resources
Facilid Water Conservation
Other Ageucy
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ()1ko'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: fJ / Arrival Time: Departure Time: ,' County: r--- Region: 71�D
Farm Name: 2 rcz/YT -mi. Owner Email:
Owner Name: Z2,a,,,k '2' G Cu Phone:
Mailing Address:
Physical Address:
Facility Contact: Z Phone:
Onsite Representative:
Certified Operator: _55 0 .--
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: l 7 $b
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop.:. Wet PoultryIapacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
on -Layer
ji
Design
D . P,ou! Ca sci
La ers
Da' Calf
Da' Heifer
Feeder to Finish
Current
P,o
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other _ Y
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [D<o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [::]No
❑ Yes e"rTo
❑ Yes [a-N-o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214,12015 Continued

Facili Number: ? Date of inspection: la //— /
Waste Collection & Treatment
k 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 I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [E j 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 C] <o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation Poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [21�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 10 ❑ 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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): f_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? D Yes [3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [JNo ❑ 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 [3-15o ❑ NA ❑ NE
❑ Yes [�'�10 ❑ NA ❑ NE
Re uired 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 ❑ No [DNA ❑ 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 ❑'1-o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 111V0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3-90
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection: p / --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [J-15
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes CTN
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 ❑'lqo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ ]Vo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �o [DNA ❑ NE
❑ Yes [�'l�o ❑ NA [] NE
❑ Yes D-N-o ❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
0 Yes
E3-lVo
❑ NA
❑ NE
Use dra�wtn ai iacdity t better ela n situateoris fus%slid do al oases as pieces ari} ndations or an other comiiieiits.
( question) gP Y. Y Y
7 ��•-temp r�_s C Laj-zf T Tfr d G-ayflo r•-- �`� .
Reviewer/Inspector Name:
Reviewer/inspector Signatul
Page 3 of 3
Phone: p 3s�f'
Date:
214,12015

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O 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: 70c� Departure Time: �County:- Region:
Farm Name:u (f ;z_izf/!1f
Owner Name: /71 G
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 0--L'7k 0,1_L�ILf/�yt Title: �VUlh,ey Phone:
Onsite Representative:. Integrator: �hriJ7`
Certified Operator: Certification Number: j
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
MDesign
Swine
Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Best
Cattle Capacity
Current
Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
(a
Design Current
D P,oul Ca aci P,o ,
Dai Heifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ❑ No
[:]Yes No
❑ Yes �o
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: r�
y Waste Collection & Treatment
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fA No
❑ NA
❑ NE
a. If yes, is waste level into the structural fi-eeboard?
❑ Yes
❑ No
❑ NA
0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cg No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:)Yes
% No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
2 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
QNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes E2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare -Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)
13. Soil Type(s): t-_-5
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 allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Eit No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a Iack of properly operating waste application equipment?
❑ Yes U�-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 [2-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER -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 CE]�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LD-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - G Date of inspection: s d
{ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JgNo
.25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ig No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1�4 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/lnspector 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 [K No ❑ NA ❑ NE
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes M No
❑ Yes [!gNo
❑ Yes fH�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refe&b question #): Eaplaln any YES ans�rers and//or any additional recommendations or�anyratieer comments:
Use drawings_o f cility to better explain situattons(tise additional.pages as necessary), a;
Reviewer/inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date: ef-- Zf p`3 j 17 _
21412015

i ype or visit: tytiompuance inspection U operation iceview U structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (� /S / Arrival Time: Departure Time: a: ~J O County: _vim—ROoon:
Farm Name: d— z_ F=i�l/'H'1J' Owner Email:
Owner Name: ca G /x C .0 ��,�,,,� Phone:
Mailing Address:
Physical Address:
Facility Contact: -_5-7'0� )f% (!47d Title: Phone:
Onsite Representative: S Integrator:r-�
Certified Operator: Certification Number: / 7r<4 6-
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Carreat
Design
,Cnrrent
Design Current
Swine m "Capacity Pop,
Wet Poultry
Capacity
Poi.
Cattle Capacity Pop.
Wean to Finish
Layer
Non -La er
Dai Cow
Da' Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P.onl
Layers
Ca act
Po ,
Non -Da'
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
IN
-
"J::jjer
TurkeyPoults
Other
Dlscharpes 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)
e. 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 121 No ❑ NA ❑ NE
[:]Yes [] No
❑ Yes [:]No
[:]Yes [:]No
[:]Yes [allo
[:]Yes ZLNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

' Facility Number: - 3olo jDate of inspection:
Waste Collection & Treatment
i4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&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
jallo
❑ 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2!�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z
13. Soil Type(s): r�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No D 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 0 No ❑ NA ❑ NE
❑ Yes U, No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g 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
allo
❑ 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
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[::]Yes
C3,No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Dumber. - Date of Inspection: (o�
( 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S_No
e
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo
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 allo
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes MNo
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 a 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 allo
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [0 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P9,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 gvesthin', : Explain any YES answers and/or any additional recommendations or any 'other coniinents ¢
Use drawings facility to bettei explain. situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �jD —y33l.D
Date:
21412011

ivision of Water Quality �� ggga
Facility Number ®-1O Division of Soil and Water Conservation G/F{
s0 Qther Agetcy
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: el routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i J Arrival Time: !Oct Departure Time: ! J County: .& Region:
Arl
Farm Name: arYM S Owner Email:
Owner Name: �a 1-k In e- Phone:
Mailing Address:
Physical Address:
Facility Contact: '��C44 me_ Title: Phone:
Onsite Representative:-����.�� Integrator:
101,
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'IljiljlnllllDesign Current
ine111�Cap. 'ty p.
act. Po
DesignCurrent Design Current
koultry �^ ,Capacityy Pop. Cattle Capacity Pop.
Wet r ,... ,
an to Finish
rlvwevc
La er Da' Caw
an to Feeder
Non -La er
Da' Calf
der to Finish
/� �/
Dr Heifer
Farrow to Wean
Dest Curren
"'gn t
D Cow
Farrow to Feeder
.:;,; Ca aci P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imoacts
1. Is any discharge observed from any part of the operation? [:]Yes Q3.+Io ❑ 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 [� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E�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:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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
[a 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
10 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 M 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/'--
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes Wo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ['_�j 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 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 51No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

` Fa, Number: 0, Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [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 No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes [ No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4 No NA ❑ NE
Yes (4 No NA ❑ NE
0 Yes EA No NA ❑ NE
Yes
ffj No
NA
NE
Yes
� No
NA
❑ NE
Yes
f4 No
NA
❑ NE
Yes
® No
❑ NA
NE
IComments (refer_to question ft Explain any YES.answers and/or any additional recommendations or anyother comments': ,
ts-e-Arawi-Inks�of:fa6lity to better explain situations (use.additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: = 301a
Date: 61 •—;z '_ /&
21412011

Type of Visit: (EJC_ommfiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (YRoutiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ib Arrival Time: Departure Time: County: T Region:
Farm Name: p�pcf y�lJ Owner Email:
Owner Name:` )/%{ `%(��e'� �Ll Phone:
Mailing Address:
Physical Address:
Facility Contact: e_� WLCf Title: OW -- Phone:
Onsite Representative: l( Integrator: -e—
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Finish Layer
n Current
Cable ty Pop.
F6apW
Dai Cow
Dai Calf
Feeder
Non -La er
o Finish
o Wean
to Feeder
o Finish
E
.__ _,
cJ �
1) , Paul
La ers
,. __
Design Current
Ca aei P,o
Dai Heifer
D Cow
Non -Da iry
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
urke Poults
Other
Discharges and Stream Impact
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 M% No ❑ NA ❑ NE
[—]Yes
0 No
❑ NA
❑ NE
[—]Yes
0 No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [L�No ❑ NA ❑ NE
[]Yes F�(No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - db Date of Inspection: ,
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): R -
Observed Freeboard (in): IRS'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes eNo ❑ NA ❑ NE
[:]Yes PRINo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EKo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 02"�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes R?'<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 [3 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): C
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5 'ho ❑ 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 Q 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?
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
6140'
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [E 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 �io
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [t"No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 6/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of InsDeCtiOn:
24, Did the facility fail to calibrate waste application equipment as required by the permit? '
a
❑ Yes
❑t <o
❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
as l"o
[DNA C] 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
03' o
❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ErNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
BlNo
❑ 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 ED 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 �o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes FT o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? [:]Yes Cp- o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ®�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:)Yes 1 No ❑ NA ❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date: T-v
21412011

t-ac»+iy No- --V 2- �� Time in c�} Time Out Dale ���> ;- _._
Farm Name ���. rr� cam ' "� _ integrator_
owner Sile Rep
pperatar {�_ C"[kJ` oL�^ - - No -
Back -up N o-
COC Circle: General - or . NPDES
Wean — Feed
Desi n
Current
Farrow — Feed
Desi n
Current
Wem - Finish -
Farrow -- Finish
Feed — Finish
Gilts 1 Boars
Famm -w Wean
Others
FREEBOARD_ Design
Sludge Survey /
Crop Yield
Rain Gauge L�
Soil Test PLAT
Weekly Freeboard I Daily.Rainfall
Spray/Freeboard Prop
WeaMer Codes 120 rein Inspections
Waste Analysis:
Date Nitrogen (N)
•�- tom- - ���
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker
Wettable Acres
1-in lnspections
Date Nitrogeni (N)
Pulffiteld
Soil
CMP
Pan
Window
. - .
�Tl.1 L.�4I.1 ��ti` }a��,a.'��3y.���i.IMY�: �-,�•. ••
-
01

I-acihi No. ��` A9 Timm- In � T � S A(eaw
,?
Y Tirr1� Out Date
Frar<rt lame C) u'/--` s//,� Integrator
0%vner Site Rep
p�eratar
No,
Back-up No. ~
COC Circle: General or NPDES
Desi n
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow -Finish .
Feed -• Finish
O
Gilts / Boars
Faffmw = Wean
Others
FREEBOARD: Design
Sludge Surveyy
Crop Yield
Rain Gauge
Soil Test / PLAT
Weekly Freeboard Daily -Rainfall _
Spray/Freebowd Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
TIT -
Observed
Calibration/GPM /
Waste Transfers
Rain Breaker _
Wettable Acres @�
4-in Inspections
Date Nitrogeri (N)
PuWttceld
Soil
Cro ..
Pan
Window
%}
.77

1
ivision of Water Quality ! �✓
Facility Number 'Z - 311 % 0* Division of S&I and Water Conservation
Q Other Agency
type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /S / Arrival Time: Departure Time: / t v County: r^ Region: F5� 0
Farm Name: rD(3— ra,,►' 3 Owner Email:
Owner Name: :�- c K /y( G CPhone:
Mailing Address:
Physical Address:
Facility Contact: � 7,, G �= %�� �ii ���,. Title: ��� 4- r• Phone:
Onsite Representative: ,� «�, Integrator: 1e %a
J
Certified Operator: �.. tj Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
- .Design Current
Design Current
Swine M apacity Pop.
Wet Poultry Capacity Pop.
IS
Cattle Capacity Pop.
Wean to Finish
Layer Iry
Cow
Wean to Feeder
I
INon-Layer Iry
Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D > P,ouitr C_a act P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -La ers
Beef Feeder
Boars
I
Pullets
Turke s
Beef Brood Cow
Other
Turkev Poults
Other
Other
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 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 C3.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - 3 (p, 7 Date of Inspection:
Waste Collection & Treatment
I 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z 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
0 Yes
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
0 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
[DNA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
ONE
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):ryu,
13. Soil Type(s): QT
14. Do the receiving crops diner from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
0 NE
the appropriate box.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. [:]Yes F No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Z 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

Facility Number: - (o Date of ins ection: — 5 = /
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes
�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
[]Yes ® No ❑ NA ❑ NE
❑ Yes No
[] Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comrreeat5 ( efer to question,# Eirplain�ra#y,'YES*answer—;and/orany additiarialRr-ecommendation`s o>r "auy other comments.
Use drawings,of facility to bdfU explain situations (use addrtrona! pages as necessary).
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: `6— ,r,;b /.-2-
21412011

Type of Visit: ompliance 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 0 Denied Access
Date of Visit: Arrival Time: c7 Departu re Time: r / D .' D U 1 County:Region:
10*11
Farm Name: JJ Owner Email:
Owner Name: a yL Phone:
Mailing Address:
Physical Address:
Facility Contact: 1ijC-4!fU1,1e,, Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
�Des�ga Current
Design Current
Design
Current
Swine Capacity Pop.
Wet Paul kC pacit} Pap. Cattle
Capacity
Pop.
Wean to Finish
er
DairyCow
Wean to Feeder
ELa
Non -La er
DairyCalf
feeder to Finish
G
DairyHeifer
Farrow to Wean
mw
Destgu Ctirrerit
D Cow
Farrow to Feeder
D , P,ould Ca ace Po -
Non -Dal
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
'4
IM Other �,
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C,No [] NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
[:]Yes [:]No
❑ Yes [4 No
❑ Yes EINo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): JU
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
LK 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
[K No
❑ 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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ 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 ® No ❑ NA ❑ NE
C] Yes fo 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
® 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 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
❑ 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 [allo ❑ NA ❑ NE
i
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes o No [DNA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
ONE
❑ Yes
� No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments -
Use drawings offfacili toibetter explain situations use additional pages as necessary). m w ;: .
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone:�p-33�3�aa
Date:
21412011

1
Q'wision of Water Quality �� ��� � O v
Eality Number = 3 ? Q Division of,
f Soil and Water[Conservation
Other Agency
Type of Visit
ompliance Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
0-9-o-utine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: r� Arrival Time: Departure Time: �, a Q County: &" Region:M
Farm Name: L7 E�-QirA s _ Owner Email:
Owner Name: uG Phone:
Mailing Address:
Physical Address:
Facility Contact: 00 No �' �����- Title: &S&2i^ Y Phone No:
Onsite Representative: _ - ---�—
Certified Operator: _5 ^ -
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E::] o E--] ' E=1 Longitude: = o = f
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑Dairy Calf
Feeder to Finish
❑ Farrow to Wean
Dry Poultr*Y
Dairy Heifer
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
Other
❑ Other
❑ Pullets
❑ Turkeys
_
❑ Beef Brood Co
Number of Structures:
❑ Turkey Pou its
❑ 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 DI -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JE No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 29Date of Inspection 7710
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XLNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): _ 9
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 JR No ❑ NA ❑ NE
S. Do any of the stuctures 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
JANo
❑ 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
[gNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ze-r'n? ad a f�y cruet YrJ
13. Soil type(s) 6) P
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DR -No
❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RLNo
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
�g.No
❑ NA ❑ NE
Comments (refer to question #) Eiplain any YES answers and/of any recomm�endaboas or any othercomments
Use draNtugs of facility to be[ter explain Situations,(use additional pages�a` s" a essary:)•
LL
Reviewer/Inspector Name ,,
4 �� ' yf� ' °3°` �,,�_
Ph one.
`f
Reviewer/Inspector Signature:
Date:
ZL2 2_21__;2D/0
Page 2 of rlilniW c.onrrnuea

Facility Number: G Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J9 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 E[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 9No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�gNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[5� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0,No
❑ NA
❑ NE
nments and/or Dra'
Page 3 of 3 12128104

type of Visit ()Compliance Inspection O Operation Review ('Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral mergency ther ❑ Denied Access
Date of Visit: `%� Arrival 'Time: ; p D Departure Time: t) O County: �'`� Region:
Farm Name: A-whco�c1`Z. 6ao, vn--S Owner Email:
Owner Name: — )yy ay (1u Phone:
Mailing Address:
Physical Address:
c
Facility Contact: Z—zrrA Title: &art mod'' Phone No:
Onsite Representative:
Certified Operator: �—
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o [=] ' = « Longitude: 0 o =, 0
Swine
Design Current Design Current Design Current
Capacity Population Wet Poultry Gapry Population Cattle Capacity Population
❑ La er ❑ DairyCow
❑ Wean to Finish
❑ Wean to Feeder
a
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ DairyHeifer
-
Dry Poultry _ ❑ D Cow
❑ Non -Dairy
❑ Layers ❑ Beef Stocker
❑Non -La ers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Cow
❑ Turke s
❑ Turkey Poults
IEJ Other Number of Structures:
❑ Farrow to Finish
❑Gilts
❑ Boars
Other
❑ Other I
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
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 DLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Rzjo
❑ NA
❑ NE
Page 1 of 3 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 E[No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ER 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 5.No ❑ NA ❑ NE
8. Do any of the stuctures tack 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
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E!jNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
10 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) Z p-
13. Soil type(s) Or Z5
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M-No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(j� No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®.No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R-No
❑ NA ❑ NE
& � rt�-r 6DoAlf i
7 6 11 b D .
Revt wer/Inspector Name i _ Phone:
Reviewer/Inspector Signature: Date: %_/ ,o2/z>
Page 2 of 3 12129104 Continued

Facility Number: —36 Date of Inspection
s Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6vo ❑ 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
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility faiI 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
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
[9,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O�No
❑ NA
❑ NE
Addiitional„Comments and/or Drawengs �M".��p'.,
Page 3 of 3 12128104

I
t
Type of Visit leFiVompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: a`_ Regions-�
Farm Name: 22 2—' re7e Owner Email:
Owner Name: � G C C . n a Af e2 Phone:
Mailing Address:
Physical Address:
Facility Contact: ` G Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:„�1
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I ="
Longitude: = ° = 0
urrentulation
MiPoWet Poultry
Capacity
Population
Fettle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
54 Feeder to Finish G
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ N ers
El Gilts Non -Layers ers
❑ Pullets
❑ Boars
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Other ❑Turke Poults
❑ Other ❑ Other
Number of Structures: a
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 EXNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2,No
❑ NA
❑ NE
❑ Yes
P-No
❑ NA
❑ NE
12128104 Continued

Facility Number; — Date of Inspection
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stntcture I Stnicture 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 6
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes jai No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 .NO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [.No ❑ NA ❑ NE
maintenancelimprovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes [kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)--
13. Soil types) Z5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,10 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Q�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ZNo
❑ 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 �-� Phone: "97O L/33 3t
Reviewer/Inspector Signature: Date:
1ut61tw c.onannea

Facility Number: �, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QLNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EZNo
❑ 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
PZNo
❑ 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
A No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RkNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
JRNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[:]Yes
J.No
❑ NA
❑ NE
12128104

Type of Visit VoCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral 0 Emergency Q Other ❑Denied Access
Date of Visit: Arrival Time: t p 0 Departure Time: County: V'�' Region:
Farm Name: _,Z IIP'hL5 Owner Email:
Owner Name: If e'q Phone:
Mailing Address:
Physical Address:
Facility Contact: t�-L Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: =I ° E--] , = "
Design Currer►t Design Current
Design Current
Swine
Capacity Popuiatforpr't'set'Po Itrypacity Populat�iffin
❑ La er
Cattle Capacity Population
❑ DairyCow
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
lh"Do`.
Dry Poultry
"
❑ D Cow
"` �'
❑ Layers
- ❑ Non -Dairy
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Boars
❑ Pullets
Beef B rood Co
❑ Turkeys
Other
❑ Other Y
❑Turke Pouets
-10 Other
.Number afStructures:
h
❑ Wean to Finish
❑ Wean to Feeder
�FeedertoFinish
�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Discharges &Stream Impacts
. Is any discharge observed from any part of the operation?
❑Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑Structure El 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? (1 f yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
[KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: —, Date of inspection
1� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ 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 J,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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q�,No
❑ NA
❑ NE
Reviewer/Inspector Name �,� Phone: �/� l�Z,_
Reviewer/inspector Signature: Date: (� `
rage -1 of s 1161'Z61v4 t.uminuea

Facility Number: Date of inspection L,` k`
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ESNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
§?,No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;kNo
❑ 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
CKNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tgNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
IR 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
ER No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additiotial,Comments and/or Drawings:
a'i !
Page 3 of 3 12128104

CTuivision of Water Quality �G
Facility Number (, 0 DiAsion of Soil and Water Conservation 1j
0 Other Agency 9 : //'
Type of Visit"compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival '1 ime: • �' Departure me: rf'� County
Farm Name: �D( ,7t, �Q f'✓� S �y1 l _ Owner Email:
Owner Name: 2 a C Iy �C �(l&/2 H.- _ Phone:
Mailing Address:
Physical Address:
Facility Contact: C �� Title:
Onsite Representative:.
Certified Operator: ,
Back-up Operator:
Operator:
Location of Farm:
Swine
Phone No:
Integrator• C �
Operator Certification Number:
Back-up Certification Number:
Region:,(.)
Latitude: 0 0 [= - = « Longitude: = ° =1 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
R1 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Disehar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Cui`reut',_,,
Capacity: Population.
j.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: r
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 JANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
C-No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: Date of Inspection �o
{{
1 Waste Collection &Treatment
_
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�1No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): 02_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;K 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
91No
❑ NA
❑ NE
through a waste management or closure plan?
irany 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
CA No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [R 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 CK No ❑ NA ❑ NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No Cl NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes C9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cropj Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ('9 .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[XNo ❑ NA ❑ NE
[X No ❑ NA ❑ NE
&No ❑ NA ❑ NE
IComments (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):
091 r ar`C i� f� d2 ems l��i x�n N� u� tLAOL-- r9r7cZ1 ys 3 l �s
IReviewer/Inspector Name e-vc ��--� Phone: Z/Ql1_ 33 iJ_3 L I
Reviewer/InSpector Signature: Date: gr % v� I
!L/Ld/U4 t onanuea

Facility Number: Date of Inspection_ %
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [KNo ❑ NA ❑ NE
the appropirate box.
❑ WIJP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
5d Waste Application ❑ Weekly Freeboard 0 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
Wo ' ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CONo
❑ 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
[R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t, No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
OQ No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit t;Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: Arrival Time: 7J b Departure Time: i 3a County: Region:
Farm Name: {� _�`_ _Lr�� Owner Email:
Owner Name: 20 e C� G C Phone:
Mailing Address: �_��� Y%?h C�7i l n-tw" '+-- /V C-
Physical Address:
Facility Contact: Z 0 l' ��l,Ciil�/Y/�- Title: Phone No:
Onsite Representative: � titi�— Integrator:7,ASP -r-_
Certified Operator: ��� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other - --
Back-up Certification Number:
Latitude: = o = ❑ Longitude: ❑ o = = N
Design Current Design Current
Capacity Population Vet Poultry Capacity Population
❑ La er
�: ❑ Non-Layet
• � - Tea--� ----- --- -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Cui-i-eutw .
Cattle Capacity Population ;.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockez
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:EC], .
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes INo ❑ NA ❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
,P No
❑ Yes
R No
❑ NA
❑ NE
EJ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
h 4. Is storage capacity structural plus storm storage plus heavy rainfall less than adequate?
S P h' ( P g P Y ) q
Yes
KNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[6No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): : ;2,5—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
;4 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
0 No
❑ NA Cl NE
& 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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;R No
❑ NA FINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
Z No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fijNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes]
No ElNA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f ]\ No
Cl NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
1 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recomimendations.or any other comments,
-Use drawings:of facility, to better explain situations. (use additional pages as necessary):
0
&pod-�./�r✓L� � �rcaTr�AL
Reviewer/Inspector Name _ 7F.4/C `- Phone: 5- T
Reviewer/Inspector Signature: Date: & ��eo
Page 2 of 3 12128104 Continued

Facility Number: 6 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes K No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 5tNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rM No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
2&
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
491 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
MNo
❑ 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
rQ 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
MA
VV'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0,No
❑ NA
❑ NE
A�dditionali vents an;dlor=DTawtiegs:
r -• � •i
12129104

® Division of Water Qaaltty _
ber 3 G ? 0 Division of S. d W oand. ater Conservation
�. Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4PRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: 1410110rj Arrivall Time: Departure 'Time: County: M+ e� Region:
Farm Name: RJ_ Z Far r-.-S _ Owner Email:
Owner Name: Z_ac-k- Phone: 451n) S'33- 3ySa
Mailing Address: ! D SS L.J...r.v C N /1! .283 �24
Physical Address:
Facility Contact: Title: O Phone No:
Onsite Representative: Z a Gk- __o0 f Cµ//CAJ 3K. Integrator: Pry &Aa 9_C
Certified Operator: _ Z ___ -c.AL. �%7 `_C� ile,u rU _ Operator Certification Number: 17.g G T
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o ❑ I = Longitude: = ° ❑ , ❑ u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish GD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La yet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Call
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes, notity DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �j
d. Does discharge bypass the waste management system? (Ifyes. notifi, 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RC No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

J �
Facility Number: — G 7 Date of Inspection G 0;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1% No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:-�
Spillway?: L CA ed c�es,Y�.,a i m
Designed Freeboard (in): S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [0 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 6d No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [y No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
1 I _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) A'o--41uA-
13. Soil type(s) or A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[X No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
m No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
•J@ No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
_® No
❑ NA
❑ NE
` ..�.. _ ... � � .a •ram�.
Comments (refer�to qu'est,on #)�xEz &n any YES answers and/or any recommendations or any other comments.
d",- _
Use drawings of facility to betternexoIam situatons.(use addrhonal pagessas necessary):
?� s xs � i Wft
Reviewer/Inspector Name- ��. ¢;.: Phone:
Reviewer/Inspector Signature: Date: '/a//,IJ
12128104 Continued

.4 ,
Facility Number: —gG? Date of Inspection
Re, uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
.7.3
❑ 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
[A 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
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NJ 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
[5d No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[' No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
TNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Abddthonal Conimenis and/or Drawings
12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation f
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number (Date of Visit: �•O Time: �u
O Not Operational O Below Threshold
�rmitted O<erffied © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ....... _.
Farm Name: ....... ...5t _.. ter r ri 1... W. -I - ......._........_ - - - - County:.... 5 t,- 9 4 2 V .»---...W_.........r'P�
Owner Name' Z ac% 1.�..���l.Cn ZZ _ 1 Phone No:..C`11.�� S-3 3. r 3
Mailing Address:.. ��-9 ._._!"C�r "._? _ 1 Ca!t------ /V L--.._.-'2
Facility Contact: Z.�& k _.. % t �� /e% h .. _--- Title:.. -------.--• Phone No:
Onsite Representative: _. ZQ 5� ... m....`'��r..---- --....-.-..--.-.-....--------- Integrator:...
Certiified Operator:...-_�.12 �.��...... m.G_ u Iler.......... . .................. Operator Certification Number:
Location of Farm:
Q4wine © Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • ` "
Discharses & Stream I_ mpacts
1. Is any discharge observed from any part of the operation?
❑ Yes C3No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes G-No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes B'No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �o
2. Is there evidence of past discharge from any part of the operation?
❑ Yes EWo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9-No'
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: .............. ................. ........
Freeboard (inches): 3 `'
12112103 Continued

FaciNty Number: ,q —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes G'Ko-
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑iro
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0-N-o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes Q-W
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [I Yes nwo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes R-No-
I I. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes allo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
/ 9rGZC 9rare
12. Crop type �s,sral
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan {CAWMP)? ❑ Yes E #M
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? `s
,a
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
r
❑ Yes [v]No
❑ Yes
❑ Yes EI- o
❑ Yes U No
❑ Yes �o
❑ Yes ❑ No
❑ Yes 2'Ko
❑ Yes ®-No
❑ Yes O-Na'
Copy ❑ Final Notes
Reviewer/Inspector Name
ReviewerAnspector Signature: In '6 Date: If -�
12112103 Continued

Facility Number: B2 _3G Date of Inspection
Re aired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! W1P _checklis desi ems, --)
23. Does record keeping need improvement? If yes, check the appropriate box below.
7-iN
❑ Waste Applicati� ❑ Freeboar� ❑s•Wastey�Analysao-�ts[] Soil Sampling
/, ti , 41,
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Forn>' Rainfall'] Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form-'---
['Yes ❑ No
❑ Yes ElNe�
❑ Yes B-No
❑ Yes �O
❑ Yes G-M
❑ Yes
9-Moo-Yes [gNiy
❑ Yes ETMo
❑ Yes DW6-
[3-Yei s ❑ No
['Yes ❑ No
❑ Yes ❑-iCo
[des ❑ No
❑ Yes P-No
❑ Yes B-Mo
12112103

Type of Visit ® Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine t) Complaint Q Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number
hate of'Visit: ' 8 _-0 Time: C
S'ct 3G
Not er tional 0 Below Threshold
JAPermitted [g Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold-
'
Farm Name: _'Z Fa rh c County: / 5 I`6­1 o)v
Owner Dame: Z-. G k M C C u+ t to,, Phone No: l 9! 0/ S133 — 3 4 SU
Mailing Address: N R _ r / /4' iQ ,u ` fV_ G S�
Facility Contact: Title: 0 L,._r r► c r Phone No: S Q..-
Onsite Representative:� C,Integrator: Pr r <4 i,or-
7
Certified Operator: �O G e— k %'j'? C� z. %fe Operator Certification Number: A9 78 6 7
Location of Farm:
56Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude ' •
Desjgn Current -
`Desga Curreat , -
Des�grt _- Current
wine_ =
Ca sate =Po uiation ,=Pou!#r� ..
_
Caacity 'Population Cattie '.
Ca Po ulatmn �-
9
❑ Wean to Feeder
'
❑ La er
Dairy
® Feeder to Finish
D
d
,
❑Non -Laver
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
7 otal Destglt'Capacih
/ C)
❑ Gilts
6�
❑ Boars
TatR SSLW,
f
__Numberof Lsgoons =0 ❑ Subsurface Drains Present Lagoon area ❑ S rav Field Area
Holdttig Ponds / SoHd7raps `.` r ❑ No Liquid Waste Mana ement System
Discha *es & Stream Impacts
1. Is any discharge observed from any pare of the operation?
❑ Yes MNo
Discharge originated at: ❑ Laaoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If ves, notify DWQ) ❑ yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min? N 114
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
?. Is there evidence of past discharge from any part of the operation? ❑ 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:
Freeboard (inches):
3ar�
05103101 Continued

Facility' Number: g — 3 G 7
Date of inspection -O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notih, DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes Q0 No
❑ Yes ® No
❑ Yes M No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
5 No
9.
Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
Ni'aste Amplication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
EN No
12.
Crop type--
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
m No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[� No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15,
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[13 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/ W13P, checklists, design, maps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ 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? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coatmetsts (refer,ta question #) Explaen any YES:answers and/or, Iany recommendations or any: aiher eomtneats.
_ -
_
lJse drawings of facilrty to better e=ptam situatilgas: (nse addtt:onai pages as necessary} _ Field Copv ❑ Final Note.
[�
3 S C Cd S S cx Q pp ,a.s %VI Q� 01).k + A e: n C c-dC
[t
(t s--ea�'+ o I s
rrQ�iau Sti ,2,0A,
P�.�p ,g
� f 4- -f i •,-. o X' ;IV r e e_'E ► o �, � if e 4 s 1 o� a 4 a a� c�Q
C'OC N4 a,� st, 4 C a c p � p CW_r
Cam. oC-,\ c., excecX% PA6 d
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued