820383_INSPECTIONS_20171231

NUH f H LAHULINA
Department of Environmental Qual

' ' - " on of Water Resources
Facility Number - �, 0* Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Co liance lnspec n 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C45IKoutiue Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: T County:
Farm Name: ����0 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region
Facility Contact:�J or" Title: Phone:
Onsite Representative:j ` Integrator: �._!LJL
Certified Operator: i `C O"I„� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes [, J o ❑ NA ❑ NE
[-]Yes ❑No E5 -NA ❑ NE
❑ Yes [:]No B -14A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No []"NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes [;3" -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes d ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued
Design C«urreot
Desigu
Current
Desigu Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pog.
Cattle Capacity Pop.
Wean to Finish
La er
RN
Dai Cow
Wean to Feeder
Feeder to Finish p p
Farrow to Wean
-on --Layer
Dai Calf
Daig Heifer
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Plo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Other
Other
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)
❑ Yes [, J o ❑ NA ❑ NE
[-]Yes ❑No E5 -NA ❑ NE
❑ Yes [:]No B -14A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No []"NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes [;3" -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes d ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility Number: jDate of Inspection:
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-M-0 NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No f!j-Ni( ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
[:]Yes
Identifier:
❑ NE
Spillway?:
❑ Yes
Designed Freeboard (in):
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q_Nv- ❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes E4I10 ❑ NA
❑ NE
waste management or closure plan?
❑ Yes
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? es ❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �i ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D Ko- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windoo�w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): `V
13. Soil Type(s): 1j1J
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 ❑ NA ❑ NE
Tr
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes B-N�G ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[-Ale- ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[IrWo` ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[-hio ❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [] Yes NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and i " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes[:]NA [3NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes N ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
24. Did thefacility'fail to calibrate waste application equipment as required by the permit? ❑ Yes NA CINE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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:
i
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes '-'/ J ❑ NA 43-W
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes '�'/ ❑ NA-IE3-N�
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes V] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ❑ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes ❑No
❑ NA ❑ NE
-7— C t >&4- 'i c- Lam- r� �r.OV Ve c-��i � CCJvL' %� FJ ✓L j alr7 � �Rct �1
4U
1
e�U gta 30 �_ 6&.S
Reviewer/Inspector Name: �1
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
cw 33
Date:
2912015'

�W�
<21
Division of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820383 Facility Status:
Active Permit: AWS820383
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
0212112018 Entry Time. 09:00 am
Exit Time: 10:00 am Incident d
Farm Name:
James Frank Williams
Owner Email:
Owner.
James F Williams
Phone:
910-624-7966
Mailing Address:
8044 Maxwell Rd
Wade NC 28395
Physical Address: S River Rd Autryville NC 28318
Facility Status: Compliant ❑ Not Compliant Integrator Murphy -Brown LLC
Location of Farm: Latitude: 35° 02' Longitude: 78" 38'56"
From Autryville blinker, N on Minnie Hall Rd (SR -1414) 2.2 miles. NW on South River Rd (SR 1424) 1.4 miles. West, then north on
farm entrance rd.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col, Stor, & Treat Waste Application
Other Issues
Certified Operator: James F Williams Operator Certification Number: 16760
Secondary OIC(s):
On -Site Representative(s): Name Tide Phone
24 hour contact name Frank Williams Phone:
On-site representative Frank Williams Phone:
Primary Inspector. Bill Dunlap Phone:
Inspector Signature: Dale:
Secondary Inspector(s):
Inspection Summary:
No pigs for several years. Mr. Williams is not well, daughter may dose out farm_
page. 1

Permit: AWS820383 Owner - Facility : James F Williams Facility Number. 820383
Inspection Date: 02/21/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 1,200 0
Total Design Capacity: 1,200
Total SSLW: 36,000
Waste Structures Observed
Disignated
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 82-383-1 99.00 60.00
page: 2

Permit AWS820383 Owner - Facility : James F Williams Facility Number. 820383
Inspection Date: 02/21/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
No No No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
Structure
❑
❑
M ❑
Application Field
❑
❑
PAN?
Other
❑
❑
M ❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
d_ Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yos
No No No
❑ ❑ ❑
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
❑
PAN?
❑
B. Are there structures on-site that are not properly addressed andfor managed through a
❑
M ❑
❑
waste management or Gosure plan?
❑
Outside of acceptable crop window?
❑
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
■ ❑
❑
maintenance or improvement?
Waste Application
Yea No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820383 Owner - Facility : James F Williams Facility Number: 820383
Inspection Date: 02/21/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
Crop Type 1
Coastai Bermuda crass
❑ M ❑ ❑
(Nay)
❑
WUP?
Crop Type 2
Soybean,
Wheat
Design?
Crop Type 3
Maps?
❑
Lease Agreements?
Crop Type 4
Other`?
❑
Stocking?
Crop Type 5
page: 4
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
M ❑
❑
16. Did the facility fail to secure andlor operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
E ❑
❑
18. Is there a lack of properly operating waste application equipment?
Cl
M ❑
❑
Records and Documents
Yes No Ha He
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ M ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ M ❑ ❑
If yes, check the appropriate box below.
❑
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other`?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall'?
n
Stocking?
❑
page: 4

Permit: AWS820383 Owner - Facility: James F Williams Facility Number: 820383
Inspection Date: 02/21/18 Inpsection Type: Compliance Inspection Reason for Visit Routine
Records and Documents
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Crop yields?
❑
❑
and report mortality rates that exceed normal rates?
120 Minute inspections?
❑
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
Monthly and 1" Rainfall inspections
❑
❑
contact a regional Air Quality representative immediately.
Sludge Survey
❑
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDES only)?
0 ❑
❑
If yes, check the appropriate box below.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below:
Other
Failure to complete annual sludge survey
❑
If Other, please specify
Failure to develop a POA for sludge levels
❑
32. Were any additional problems noted which cause non-compliance of the Permit or
Non-compliant sludge levels in any lagoon
❑
❑
CAWMP?
List structure(s) and date of first survey indicating non-compliance:
33. Did the Reviewer/inspector fail to discuss reviewlnspection with on-site representative?
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yos No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
■ ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewlnspection with on-site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

;�D
I ype or visit: U Uompltance inspection U operation xeview U structure tvatuation U t ecnnleal Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:} Arrival Time: Departure Time:[JI / 7i/ County: 54A Region:
Farm Name- `ter f �f 1&z z Owner Email:
Owner Name: V Phone:
Mailing Address: V tx�� �� f ( 1 �� j , Z,
Physical Address:
Facility Contact: Fiy-4 V, uko+ tf Title:
Onsite Representative:
Certified Operator: tt
Phone:
Integrator: .&Z
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters ofthe 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 g2l<o ❑ NA ❑ NE
❑ Yes
❑ No
[N/A
❑ NE
❑ Yes
Design Current'€ _
Design
Current -- Design Current
Swine
Capacity Poph met Poul
Capacity
P°�», C+apacity PoP-
Wean to Finish
Layer
Dai Cow
Wean to Feeder
i 6� ©r Non -Layer
Dai Calf
Feeder to Finish_
Dai Heifer
Farrow to Wean
5•
Design
Current Dry Cow
Farrow to Feeder
+� Dr Po ut' Ca aei
Pop. Non -Dairy
Farrow to Finish
t La ers
IBeef
Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other;
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters ofthe 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 g2l<o ❑ NA ❑ NE
❑ Yes
❑ No
[N/A
❑ NE
❑ Yes
E] No
E3<A
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
ffNA
❑ NE
❑ NA
[] NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

goo 0 A4
Facility ]Number: E56L Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�J�o
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2<o
❑ NA
Observed Freeboard (in):
acres determination'?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
/
E !moo
❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
nNo
❑ NA
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
[:j'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2 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
E2 -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 2!rNo ❑ 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 []QEvidence of Wind Drift ❑ Application Outside of Approved Area
W �+� e"� A
12. Crop Type(s): ?i A_rL S
13. Soil Type(s): 1 1J/L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�J�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2<o
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ 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
nNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
EZf 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
❑ 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 d No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F7�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: -I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EJOINo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [� o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [TNo ❑ 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
[?rNo
❑ 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
[D"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ff No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
21'No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CSC 7,!0 -3ot U -q
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ACV
Date: QJ't
2141201 5(

A l GCs
3D
type or visir: om fiance inspection U Uperation meview V structure evaluation V technical assistance
Reason! Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 8 County: L1� Region:(~!?�
GG �
Farm Name: - , �t�[� .3 � ce", Jr Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �11A 'i1. ('Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
c(
Latitude:
Phone:
Integrator: '1 19
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
F] Yes r❑.. N -o F] NA E] NE
❑ Yes
Design Current
Design Current
Design Current
❑ Yes
Swine Capacity Pop.
Wet Poultry Capacity op.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Layer
Non -La er I
-
Da'x Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Desi ­u.., n
2a Cow
Farrow to Feeder
Dry Poul: Caaci - POP.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other _
Turkey Poults
10ther
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
F] Yes r❑.. N -o F] NA E] NE
❑ Yes
❑ No
C3<A
❑ NE
❑ Yes
❑ No
[0.I?4A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 1A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facili Number: FA _73S Date of Inspection; 3 O
C3 N
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[B'I�o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P'jgo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3,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
[db
❑ 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
[]Ko
❑ 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
U�Xo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[714o
❑ 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
F-1,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2-Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ErNo ❑ 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): alk)(3
13. Soil Type(s):
r
14. Do the receiving crops differ from 4
designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C3 N
❑ NA
❑ NE
❑ Yes
[]50'No
❑ NA
❑ NE
❑ Yes
[B'I�o
❑ NA
❑ NE
❑ Yes
[!jNo
❑ NA
❑ NE
❑ Yes
[]4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [B"N o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 N ❑ 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 dNo
❑ 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 %f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes u No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: jDate of Inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ '�To ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []&?O'o' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [g -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [3'1Go ❑ NA ❑ NE
❑ Yes DoNo ❑ NA [] NE
❑ Yes [a'No ❑ NA ❑ NE
❑ Yes [-No
❑ Yes [ o
❑ Yes [}No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 3,'� ' 3 33
Date: 3o r it,
2/4/2014

$I vqs , l0' ak, 1 s
Type of Visit: tram ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ef Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Amval Time: �� Departure Time: l /n ;5 Ud I County:
Farm Name:
Ownear`EEm`ail::
Owner Name: �� fp {�� l �L�4 ✓yC5 hone:
Mailing Address:
I ,
Region f
Physical Address:
Facility Contact: Title: ' -� Phone:-
-- - _
�l
Onsite Representative: -Integrator: �
`(oc3Certified Operator: � Certification Number: l6-7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
' Design Current
Design
C•iirrent
Design Current
Swine Cap qty Pop.
�..
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I a er
Dai Cow
Wean to Feeder 1-62 r~ e7-
Non -La er
Da Calf
Feeder to Finish
eifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,onl
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other:,
Turkey Poults
Other
—Mer.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3"No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ NoA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ❑ No C3.1TA- ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) []Yes ❑ No [:3rl<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes 10 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

Ficili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F2<0
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
o
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):_
17. Does the facility lack adequate acreage for land application?
❑ Yes
[],rlo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Eg-m7'
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Ca"No
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[E no
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
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 C3 N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 0 0
_ -
13. Soil Type(s): W _('4 teZ.tAA�
14. Do the receiving crops differ from hose designated in the CAWMP?
❑ Yes
0-<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F2<0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[],rlo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R<o
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[l"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Ca"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 E2No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dT'Jo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes &No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

0q Q
[Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Dw ❑ 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
j-1 o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P " -
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Vo
❑ 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
Flo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ 1'50
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E] -K°
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to..question ft Explain any YES answers and/or any additional recommendations or any other c'om- enter
r r
Use drawings of facility to better explain situations(ase additional pages as necessary).
_
7,.:-
Po 'ivx -e
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3
Phone: 13-S ^ ��
Date:
2/4/2014

Type of Visit: of Com nee 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: /' / Departure Time: � County: Region.
Farm Name: r/J / LU AUS Owner Email:
Owner Name: y a !e( Phone:
�F )Grr�r �� Phone:
Mailing Address:
Physical Address:
/ Y�r
Facility Contact: l "s Title: bb( Phone:
Onsite Representative: _ Integrator:
Certified Operator: f Certification Number:
Back-up Operator: Certification Number:
• Location of Farm:
Latitude:
Longitude:
Dische es 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)?
[—]Yes No ❑ NA ONE
[:]Yes ❑No
❑ Yes [:]No
� ❑ NE
EJ -5A'
""' ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes ❑No I-1 l"A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes [J -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EKO`�
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
Current# , P. Design Current
Desig�Ca�rrettt Desig�iy�
Swine
Capac ty P p: '
Wet Poultry Capac, Pop Cattle Capacity Pop.
g
We to Finish
La er Da' Cow
Wean to Feeder
(�
Non -La er »'i Da' Calf
Feeder to Finish
.h Da Heifer
Farrow to Wean
- Designs Current D Cow
Farrow to Feeder
Dr, Poul Ca act *a'Po k" -Dairy
Farrow to Finish
La ers 1r ' Beef Stocker
Gilts
Non -La ers Beef Feeder
BoarsPullets
r
'� Beef Brood Cow
i
.. �
Turke
Other}
Turk5X Poults
Other
Other
Dische es 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)?
[—]Yes No ❑ NA ONE
[:]Yes ❑No
❑ Yes [:]No
� ❑ NE
EJ -5A'
""' ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes ❑No I-1 l"A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes [J -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EKO`�
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili , Number: Date of Ins ection: (4 1 L"T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EgNo-0 NAS [:]NE
a. If yes, is waste level into the structural freeboard? C-]YesE]'NA
No ®❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes E?X-6y ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
Q o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[��o
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
I, J '"o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q' oo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®'No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P-ro
Waste Application
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�-1'�`❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D ""
❑ NA
❑ NE
maintenance or improvement?
1 I - Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydrab�ic 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): Yee l
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2'Tq—o -
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[��o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a-1 0_
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]'Po
❑ 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
P-ro
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�-1'�`❑ 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 IJVP ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �lo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [d]`Evo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I_ o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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)
❑ Yes
[]<o
❑ NA
❑ NE
❑ Yes
0-N-5—
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes Ej 1VO ❑ NA ❑ NE
I
❑ Yes (21ro — ❑ NA ❑ NE
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Ej-'No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA
❑ NE
Commentsi(refer to question #):-Explain any YES answers and/or any additional recommendations or any dthe`r1'coinments:
-
Use drawings-of.facility.to:better explain situations {use additional pages as necessary).
`
SIJ F65'3 S�� ��z
�(10 ru�O, f '� l3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Date/,
Page 3 of 3 - 2/4/2011

Type of Visit: ®'Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (BrIfoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: �X }arrival Time:Cftdtl I Departure Time: I ID, County: RegionF�O
Farm Name: es Qs +W -s (F. 4ild41A t-I,V ^ Owner Email:
Owner Name: if Phone:
Mailing Address: 1
Physical Address:
Facility Contact: ,[ St 1 {tle:
Onsite Representative: 1
Certified Operator: t L
Back-up Operator:
Location of Farm:
Latitude:
Phone:
integrator: _ �— o `~
Certification Number: 167@6
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes 10 ❑ NA ❑ NE
❑ Yes
ign Current
Swine *� n� Capacity Pop.
Wean to Finish
Wct Poultry
I ILayer
Design
Capacity
I
Current
.Pop.
Design Current
Cattle° _' Capacity Pop.
Dairy Cow
[3XA
❑ NE
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
', ....,:. _. -.. d,:...
Design Current
Dr Poult . Ca aei P,o
Layers
Dairy Heifer
Dnir Cow
Non -Da'
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Othe
Other
Pullets
Turke s
trkey Poults
Other
Beef Brood Cow
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)?
[:]Yes 10 ❑ NA ❑ NE
❑ Yes
[:]No
[JI -KA
❑ NE
Yes
[:]No
[3XA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes ❑No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [GI'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesEf_No�
❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

•
Facility Number: jDate of Inspection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes ®'1 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [s o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
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?
❑ Yes 5j -Na ❑ NA ❑ NE
❑ Yes LLd'�"" ❑ 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 Q-1 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes a<01 ❑ 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 �❑ 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 W' dow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
r '
12. Crop Type(s):to L3
13. Soil Type(s): C a 6
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 C�-<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ` 5, - ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[—]Yes
[g er
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[4>o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
U]Xo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes <o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes nNo. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

racili umber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E<o❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes U6o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
Comments (refer to question ft Explain•any�YES`answers and/or
e dflawutgs"offacility to; better explatngsiftikti6m use additional. a esas`aecessa
( P g i
o0 -'C ` 0,
r
r
,4 ( V S��-k - E X�� " '7 " _� -z' - '�- � (4
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes D140 ❑ NA ❑ NE
❑ Yes [310 ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
❑ Yes [E"No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [ar] No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
Phoj1.0-qZ3_34R Y
Date:
k-5
24 L3
2/412011

. ype ul v isit: v t ompuance inspection v t.rperatton xeview v structure r vaivanon t) i ecnnecat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: E� Arrival Time: Departure Time:11: p� County:
Farm Name: � r, w ,items xTV5 Owner Email:
Owner Name: _ a,qv, P % 1 RA t�141 [l) r \ltot�s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: S Pty
Certified Operator:
Title: —()W
()W'1 r k.
Integrator: pUY)
Certification Number:
Phone:
Region: Eft
—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesegnCurrent Des�gnCurrent Design Current
..,
Swine Capacity k Pop Wet Poultry Capacty« Pop C•atlle Capacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder \a Non -La er D ' Calf
Feeder to Finish Da' Heifer
Farrow to WeanDry Cow
Farrow to Feeder Dr. Poul Ca c.Po Non -Dairy
Farrow to Finish Layers _ Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Puttets Beef Brood Cow
Turkeys ..
NEVAher Turke Poults
NJ ..r
Other Other
Dischargss and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes G No ❑ NA ❑ NE
[:]Yes YNo ❑ NA ❑ NE
[:]Yes E�fNo
[:]Yes [jtNo
[:]Yes MNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - g Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E9<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [BIKA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in): 1
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 E? o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 1"
7. Do any of the structures need maintenance or improvement? ❑ Yes [1" No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EvrNo ❑ 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 CD14o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [i] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
p PAN 0 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): C6AS�j a k V3IV R %VW r� p,
1b
13. Soil Type(s): C,rA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes &f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [ 'No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ "No ❑ NA ❑ NE
0 Yes E+ 'No ❑ NA ❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[VNo
❑ 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
2No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfal I ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:)Yes
Efo
[:]NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: %Q__ _3%V Date of Inspection: '711J �..
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes Cg'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
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
❑,<A ❑ NE
NA ❑ NE
❑ NA ❑ NE
[—]Yes CDNo ❑ NA ❑ NE
❑ Yes [EKNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [1/ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E iNo ❑ NA ❑ NE
[—]Yes 2No ❑ NA ❑ NE
[;omments (reser: to question #): Explain any YEN answers and/or any additional recommendations or any otner°comments.
Useedrawings,of facility to. better explain situations (useadMonal-pages as necessary).
%.14
V
NEED
s03\
SAMA\t
FC3R 4.01t7;L
4
V0M'VN
t_.00 <
Ste , -w
rn-k I� CfT
'OP,
Reviewer/Inspector Name:s Phone: Reviewer/Inspector Signature: Date: 1 t
Page 3 of 3 214/2011

. ype of visit: w L;ompuance inspection V uperatton xevtew v structure Evatuatton V i eenmcat P►sststance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
H-15-11
Date of Visit: � Arrival Time: : O Departure Time: ; County: SAnlpJon
Farm Name: 'JAMtS rhftty' 1jT%%Tgp5 Owner Email:
Owner Name: / imus FKiknV. L_�_.'\hMAm5 Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative.'.!. URRn K " ILT A*S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: /&7&0
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [o No ❑ NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
❑ Yes ❑ No W NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Design,- Current
Design Current
Design Current
Swine@a
Po
p
Wet Poult
Ca actty Pap.
Cattle C►apacity Pop.
-!Ci
�t,p'
rP Wean to FinishLE111-ayer
Dai Cow
Wean to Feeder
a00
Non -La er
Dai Calf
Feeder to Finish
+� � '��� tk� .=�
Dai Heifer
D Cow
Feeder
D . P,oult .
Ca ci `1'0
Non -Dairy
Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
VWeanDesigtiCurrent
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 [o No ❑ NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
❑ Yes ❑ No W NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: `a - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _A_2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
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
W No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
V] No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes{,[A
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
' ❑ NA
❑ NE
maintenance or improvement?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[In No
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes " No [DNA ❑ 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 ❑C Application Outside of Approved Area
12. Crop Type(s): COZnIkk Q P_RMQ A W&AT OEAO%6
13. Soil Type(s): C A]
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes [)n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [A No ❑ NA E] 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 (M No ❑ NA ❑ NE
❑ Yes 60 No ❑ NA ❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V] 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
[X 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
[�j No
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[In No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

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 0 No ❑ NA ❑ NE
❑ Yes 1� No [DNA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes M No "�] NA ❑ NE
[:]Yes g] No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1 \ Q cn' -
214/2011
4
Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
K] 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 0 No ❑ NA ❑ NE
❑ Yes 1� No [DNA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes M No "�] NA ❑ NE
[:]Yes g] No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1 \ Q cn' -
214/2011
4

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:�� Q�k Departure Time: Q County: Si m r�� Region: f;40
Farm Name: `T— )CLL 'S 0 ltq vi, s _ Owner Email:
Owner Name: _ j0.njj4 w `ha c Phone:
Mailing Address:
Physical Address:
Facility Contact: F�an - W C7�I Q{ s Title: Phone No:
u .
Onsite Representative: Integrator: li.
Certified Operator:k Operator Certification Number: o
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O = =ds Longitude: = ° =' 0
Design Current
Swine Capacity Population
Wean to Finish
Wean to Feeder Izoo I asa 1110
Design Current
Wet Poultry Capacity Population
❑ Laver
Non -Layer I
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
1:1 Layers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
u
❑ Pullets
❑ Beef Brood Cowl
UNo
❑ Turkeys
❑ NE
Other
❑ Other
❑ Turkey Poults
❑
Number Structures:
Other
of
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 �d No ❑ NA ❑ NE
❑ Yes
❑ No
A NA
❑ NE
❑ Yes
❑ No
FPNA
❑ NE
ffl NA
❑ NE
❑ Yes
❑ No
❑ Yes
Pbo
❑ NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

12. Crop type(s)
13. Soil type(s) a. L5 ,,
Facility Numher:3 Date of Inspection 7 O
Waste Collection & Treatment
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No RNA ❑ NE
Struc re I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
❑ Yes
No
Spillway?.
❑ NE
17. Does the facility lack adequate acreage for land application?
Designed Freeboard (in):
No
❑ NA
Observed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
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 [:1 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
Y] No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑YesNo
[:1NA [:1NE
maintenance/improvement?
ra
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
8 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) a. L5 ,,
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
IReviewer/Inspector Name ` =- Phone:
Reviewer/inspector Signature: Date: 716110
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection !fl
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 No ❑ NA ❑ NE
the appropriate box.
❑ W[JP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Y9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [)INA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 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
P4NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P 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 faii 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
[5 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12/28/04

i11A,, —ai,r -9 I I
V 11119 0 vi 113010
Q Division of Water Quality
Facility Number I� 393 Q Division of Soil and Water Conservation
:01
Type of Visit a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival TimeDDeparture Time: 'r County: Region: K
Farm Name: 12/ose( E '1k W Ir l b' "f I Owner Email:
Owner Name: y� 1I'ans Phone:
Mailing Address:
Physical Address: t,
Facility Contact: fr TI �t� Title: 0"e4 Phone No:
Onsite Representative:Fral M1 I �'� Integrator: Ow
Fft
Certified Operator: � ,f Operator Certification Number: AW 67
60
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =S = „ Longitude: 0 ° =I Q
Design Current
Design %Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacit Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
a. Was the conveyance man-made'?
❑Non -La er
❑ Dairy Calf
B Wean to Feeder Q
❑ Feeder to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
SrNo
❑Turkeys
❑ NE
Other
❑ Turkey Poults
KN
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tR'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Ycs
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
SrNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KN
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

-1 0�)_30/oq
Facility
❑ Yes
WNo
Number- —393 Date of Inspection
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Wnste Collection & Treatment
C"No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
reNO [:INA ❑ NE
a. 1f yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Stricture 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NE
IS. Is there a lack of properly operating waste application equipment?
Spillway?:
P�No
❑ NA
Designed Freeboard (in):
Ohserved Freeboard
5. Are there any immediate threats to the integrity of any of the structures observed?
D yes
tkNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Flo ❑ 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
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
t?'tvo ❑ 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
CRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Autslicalion
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
WNo ❑ 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 type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i ❑ yes
RrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NrNo
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
P�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector NameLf E Phone !
Reviewer/Inspector Signature: Date:
1212 14 V Condnued-

Facility Number: <; a —38 Gate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 52 -No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design C1 Maps ❑Other �S
21. Does record keeping need improvement? If yes, check the appropriate box below. ZgYes Wo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
N:No
❑ NA
❑ NE
❑ Yes
❑ No
&NA
❑ NE
KYes
❑ No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No (RRA ❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
bNo
❑ NA
❑ NE
❑ Yes
�jNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
NAo
❑ NA
❑ NE
Additional Comments and/or Drawings:
.sal`) Analyse, 'rvar & _ Hath awq in fvepa b.,-&slL ec I,euro..* on �
-E)-eIds , 4 ryas s�h+Jo aMrter /a -b i i� q��ie�'o�-�b01 -th d ido
Copprat t t1ne_ Gmd ys'&,r, PJeaJe. QsOm (e- s f�a% fie1c�- 1n ao�oq-A,
Cofer a -id- -;-;hc , 1dr had hi A 1� 4300? f'ati par+
h 4 o o' f�s oe) j ro,/ A, t7 a® Illd�� }
Dy .Caf, bta-,t� hra,r Jarf -dole in ao% _W4sho kt Edi 7e eV.�Y/, a ears,
Nov 'gyp b e I ssuPc� a �o�+ecQh br i�� ,n ye h�hen m�e �e��� 4 ,
L �v-Qooq-pc -4-73 J
Q"5 �d ryas t✓!t°Q�P� ou� M� 13-� y, a�,q b J -
�+ a,�,� me ► s
�s19 �s�v� a �flt bedm 1� "
9 `fix ooq � r L- ear,
Ma I 1 ,e
1;a010 ' -fpm /,s iwfw 4V RaNk'pr, -lobe M-bCkd- next- tyeek. i r
I acooed-c_mr_ 01 1d
�o, ks,
� CGS; bladed s olid S'ef Md 1 a I a 010 q� f 12/28/04

-Facility No. _Farm Name ;� P�Vl( �frf f+fOnf Date -� 13010�
Permit COC
OIC
FB Drops
NPDES (Rainbreaker PLAT Annual Cert )
lfbserved freeboard -------,
Sludge Survey Date
I.�-1
Calibration Date
Design Actual Width
«'---��-.
Soil Test Date 3 ? AQL Rg'kn Lob Crop Yield � 120 min Inspections �
pH Fields Wettable Acres Weather Codes
Lime Needed -Mi0 WUP Transfer Sheets
Lime Applied Weekly Freeboard ,�_ RAIN GAUGE
Cu Zn Jno�I Rainfall >1" Dead box or incinerator
Needs P 6 1 in Inspections -
-mac-
- s/e�g2
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
50 5a, -
10
4 -iY
Verify PHONE NUMBERS and affiliations
Date last WUP FRO D}atte,last WUP at farm Cha App. Hardware
FRO or Farm Records}�}'�,�"
Lagoon # �,,,f
Top Dike 41rr �-,94ZY1 4 cvxvl,(�9--C pw 2 1800 AAV
Stop Pump 44.
Start Pump 91,9 GIV41e vv'vhf•
t, rP

(Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:EC;
Arrival Time: ��Departure Time: County: Region: _
Farm Name: L1hno C1 �� r S [ i a wT� N "�5,. Owner Email:
Owner Name 3� 1t5�Z� ��n�ey,s Phone:
Mailing Address:
Physical Address:
Facility Contact: C'4= i,�i s c a v�- Title:
Onsite Representative: �r
L!
Certified Operator:
Back-up Operator:
Phone No:
Integrator: t.+0./ f7 ez-.'V%
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =I
=" Longitude: =0=1 0 u
Swine
Finish
Feeder
Design -.Current
Capacity Populaon
pp ']
Wet Poultry
❑ Layer
❑Non -Layer
Design Current A.
Gapacty Population.~
Design Current
Cattle Capacity Population
❑Dai Cow
❑Dai Calf
1. Is any discharge observed from any part of the operation?
❑ Yes
No
El o Finish
to Wean
o FeederNon-Dairyc Finish
rGilts
Other
❑ Other
❑ NE
Dry Poultry
La ers❑
Non -La ers ❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
- =
airyHeifer
❑ D Cow
Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Discharges & Stream facts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
flaNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes]
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,0No
[:1 NA
EINE
other than from a discharge?
``
Page I of 3
12128104
Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes &Io ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) _Uerw..,Jo, 6y -n (6U1C,, ), 5na, (ta:._ Ggt i
13.
Facility Number: — Date of Inspection
Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�&o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
RNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
No
❑ NA
❑ NE
18.
Spillway?:
❑ Yes
No
❑ NA
❑ NE
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Wo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
MNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
b No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes &Io ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) _Uerw..,Jo, 6y -n (6U1C,, ), 5na, (ta:._ Ggt i
13.
^�
Soli type(s) ;� �16
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
159 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name I �� Phone:
;4...
Reviewer/Inspector Signature: - Date: aic Q$
rage z of .3 11A/ rsssr-sac:

Facility Number -
9 Date of Inspection 1 d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes fibNo ❑ NA ❑ NE
21 .
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
JB No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ 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
,t�,r,
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ftNo
❑ NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (XNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
EINE
33. Does facility require a follow-up visit by same agency?
❑ Yes(
YM No
[:1NA
[INE
_
mihnWind/or Dr'a' ;`:
"6idn '-6o i wings
Page 3 of 3 12/28/04

ID Division of Water Quality
Facility Number 8 a .3$3 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % /v Q Arrival Time:'m
tf r .� 1►+ Departure Time: � 3 County: sgPSO`j Region: �0
Farm Name: tQw�esF f�,��tQo �uar.r Owner Email:
Owner Name: Ta i 1'1p S F; -an Lli i/ ,a fy'c- J Phone: &� to? ym
�
Mailing Address: 0`I L( Mak ; ►`� r , V+goi� _ RI �av _S
V
Physical Address:
r
Facility Contact: h"Q Q h itle:
Onsite Representative:
iC
Certified Operator: Lc
Back-up Operator:
Phone No:
Integrator: srer✓tiuw+ shit
Operator Certification Number:. i676 Q
Back-up Certification Number:
Location of Farm: Latitude: = o =I
="
Longitude: F� ° = I ❑ u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
D4 Wean to Feeder 1;200
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Nan -La ci
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge!
❑ Yes �a No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
�H NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ YesNo
P
❑ NA
❑ NE
❑ Yes
,
01FNo
❑ NA
❑ NE
12/28/04 Continued

+ Facility Number: ga; 3 3 Date of InspectionOlo'I f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E!? NA ❑ NE
S�ructure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes rM No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes f2 No ❑ NA ❑ NE
through a waste management or closure plan?
P) No
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 6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �i To ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Pallo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window
��',El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) Gas &( UPXYrtt(o Ma,, .5r►+_- 6� n cc w, Svt�,s-
13.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P) No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation desig or wettable acre determination?[:] Yes
�DNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name e Phone: NW'3.2_
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: — Date of Inspection ,
Required Records & Documents %
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
�.No
❑ NA
EINE
[_1 Yes
KINo
El NA
EINE
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 ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
[ RNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
R9 No
❑ NA
❑ NE
12128104

Type of Visit 4P Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: _C Arrival Time: �eZ�� Departure Time: �/i y� County: .SO�1 Region: t R
' O
Farm Name: _ n
Ja4ES F"k- Wi t h'o m S Ijurs e, Owner Email:
Owner Name: Frank W 1 1 'a_tvwPhone: 1/01 ` eS - V7S_1
f y l �4xw e�j ltd 1�a A/C �� J 62V -7W
Mailing Address:,
Physical Address:
Facility Contact: 3 a-yv"tS 6_10nk LL 1, 0.w1S Title:
Onsite Representative: 4i
u
Certified Operator:
Back-up Operator:
Phone No:
c
Integrator: �rt? 21444"t 5_10�
Operator Certification Number: /ow
Back-up Certification Number:
Location of Farm: Latitude: = e E=1' =1 " Longitude: = o =' = u
Design Current' Design Current Design Current
Swine GapacttyPopulaho Whet Poultry Capacity Populahan 3 Cgt�h Capacity Population
❑ Wean to Finish ❑ Layer D Dairy Cow
Wean to Feeder 1,2CO 873 1 1 ❑ Non -Layer ❑ Dairy Calf
❑ Feeder to Finish ❑ Dai Heifer
❑ Farrow to Wean`110UN17
❑ D Caw
: _ -h
❑ Farrow to Feeders
❑ Layers
❑Non -Dai
❑ Farrow to Finish ❑ Beef Stocker
Non -Layers ,
El Gilts ��;El Beef Feeder
❑ Boars ❑ Pullets ❑ Beef Brood Cowl
s ❑ Turkeys
Other.x .,.,❑ `. Turkey Poults H
r
❑Other _ El other
of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
rO NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
❑ Yes
❑ No
[ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
[29 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PgNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

12. Crop type(s) WM04U 4 j U 6y%j I
Facility'Number: 9383 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 1P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ Yes
[� No ❑ NA
❑ NE
Spillway?:
❑ Yes
1� No
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A No
Observed Freeboard (in): �✓� `�
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q9 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
P9 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
[� No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No ❑ NA
❑ NE
maintenance or improvement?
iJ
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1P No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] O 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) WM04U 4 j U 6y%j I
13. Soil type(s) �13
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M�No
Ir
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[� No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Now
Reviewer/Inspector Name I per- It I Phone: (7/0) Jji S,SOG
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: oZ —3 Date of Inspection 8-D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pn No ❑ NA ❑ NE
the appropriate box_
❑ WUP El Checklists El Design E] Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �§ 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
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[INA
ElNE
Other Issues
11
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q§ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[§No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1p No
❑ NA
❑ NE
Additional Comments and/or Drawings.:
A,
Page 3 of 3 12/28/04

Type of Visit t® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: //%:3 p Departure Time: County: a Region: F -
Farm Name: al�r.+e-�.. r,r&-%L W : 14.a --a Nt".-NV Owner Email:
14 F3 - q 73 q'.^
Owner Name: rll�lk {1y 11; t+,.r Phone: 910� G au - 7 9G/-
Mailing Address: _ ���/ y %�"7a �[ wr_1( 2aQ_ . � _ei(C .2 9y 7S
Physical Address: 74 5 4 A-vcrc_ ��. _/ ,,cam, -,_5, ; / lc. /(!C -2-" for
Facility Contact:
Title:
Phone No:
Onsite Representative: 1414,k Integrator: _ aZM'urn
Certified Operator: ,j_-� ll_ik04 s _ Operator Certification Number: /G 7 a
Back-up Operator:
Location of Farm:
;inn • Cu,
rreal
.. _.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Back-up Certification Number:
Latitude: =0
=1
=11 Longitude: = o E--] , 0
ign
E"tC�FNVE
Current , , .Poultrcity
Population Cattle
❑ NE
❑ Dai Cow
�La et
;;+' ❑ Dairy Calf
G..
= ❑ Dairy Heifei
aoultry
❑ D Cow
'" ❑ N D
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- airy
❑ Beef Stocker
❑ Beef Feeder
F' ❑ Beef Brood Co
jumber of Structures:
4`yx
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volwne 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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: �,� — 3�3 Date of Inspection C?T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes [V No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® 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 [M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
k] 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
f@ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
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 Drifl ❑ Application Outside of Area
12. Croptype(s) L c ern+ 3 I �o ,r�, A ',—I #j
13. Soil type(s) (21,13 JF
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable acre determination, E] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[2 No
❑ NA ❑ NE
Reviewer/inspector Name Qrr ``fjQ /�' '7 __ Phone.t7to� qx /.S'iF/ G jr>< 7l
Reviewer/Inspector Signature: ,� Date:
12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
M( NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
[I NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
k] 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
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[j] 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
0 No
❑ NA
❑ NE
A*diunal Comments and/or`Drswings
12128/04

Facilitv lumber
Uate of Visit: i; S Time: L[
10 lot Operational 0 Below Threshold
ermitted M Certified O Conditionally Certified 13Registered Date Last Operated or above Threshold:
Farm lame: = S County: 4J. a.
Owner -Name: �a¢¢r-.rs fit x h�; jai GbvD.t ff ` Phone No:
Mailing Address: p 0 _ wtl� �� At ;-.,A/ C .0 9 3 gs
F2cilith' Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
POW Riw,- R4
Title:
Phone No:
Integrator: _ 51!2::"
Operator Certification Dumber:
rt61e
21�w_ine ❑ Poultry ❑ cattle ❑ Horse Latitude ' 4 0` Longitude ' I
Design Current
Swine C annritr Pnnntntinn
etimtoFeeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Ca acity Population Cattle Ca acitti Population
❑ Laver I❑ Dairy
❑ Non -Laver 1 10 Non -Dain,
❑ Other
Total Design Capacity
Total SSLW
Present IILJ Lagoon Area IEJ Snra;• Field
Discharges & Stream Impacts
1. Is any discharge observed from any, part of the operation?
Discharge orininated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there an-,- adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Strucntre 3 Structure 4 Structure 5
Identifitr:
Freeboard (inches):
03/03/01
❑ Yes Oho
El Yes El No
❑ Yes ❑ No
❑ Yes
0 No
❑ Yes
El Yes
L_�, Iv<o
L11vo
❑ Yes
O'No
Structure 6
Continued

Facility Number: — 3g3
Date of Inspection ata
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, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level .
elevation markings?
Waste APPfication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ /PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type 5+'+1 r►fht[ ��r� Sc�[r.s �S'fa� -
TT " T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
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 attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
I9. 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.
❑ Yes Ly'No
❑ Yes IldNo
r-
❑ Yeso
L��f Ng
ElYes
❑ Yes Flo
❑ Yes L4'No
❑ Yes 9io
❑ Yes [}vo—
❑ Yes B No
❑ Yes E114o
❑ Yes BNo
❑ Yes fallo
❑ Yes QN16'
❑ Yes 2'No
❑ Yes 04ro
❑ Yes [moo'
❑ Yes UNo
.—«
�Com'mcnts (refer to giresttoni i#) F,xpiam a ry I'F5 a mv� and/or arty i�amaieadatiaas or ay atl>e dents. ;� s .� ' ;�
rise diawrngs of l'sc�ty to better exgla�a srtnatEoas. {wise addihotna! pages as necry) � ; - � e d Co Frnal Notes `, °�
' /Ins for Name _ r t
Reveewer -
_ a
Reviewer/Inspector Signature: ' -P--JDate: 0a7 O
12112103 Continued

Facility Number: T�P _ 3J3 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[4hlo
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
0<0
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[moo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�To
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
B416-
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
O -Ko
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
iii
28. Does facility require a follow-up visit by same agency?
❑ Yes
leo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
GNO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es No
31. I€ selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditronal Camment5 and/nd'Dra:'vtrtgs t �- °= ti-
�1 1
A. tuidi&. `{nr,„ S&—s `b (ic ;in �1>J 5V'4(t All 4y'-% of �r►,. a.ct [`oa"i o -J wt l%
L
7
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up O Emergency Notification 0 Other ❑ Denied Access
Qatc of l"icit:� X03 Timc:
Facility Number
Not O erational 0 Below Threshold
Q Permitted M Certified r©Co�nditionally Certified 13 Registered Date Last Operatedor Above Threshold:
E
Farm Name: J lone anltj, 1 bI A lhS _ Cou ntv: /a,"7 el
Owner Name: agg k 62 r � -41" S �`Phone No: I/O —783 -
Mailing Address: 1 � LAde �yr" � W39S
Facility Contact:
Title:
Phone No:
Onsite Representative:rr__ rf�htl tj�77iI!GMS Integrator: /P rim+ STG/r[lGr4
Certified Operator: Lr_A -i k W 1 Elft 2'" l - Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �` Longitude �' �• C��
Design Current
Swine f a-aAft• Pnn��lofinn
® Wean to Feeder 1.1,90
❑ Feeder to Finish
❑ Farrow to wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Roars
Design Current Design Current
Poultry Ca acW Population Cattle Capacity Population
❑ Laver ❑ DairyI I ::::d
❑ Non -Laver ❑ Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JJQLagoonAre2 JEJ Spray Field Area`
Bolding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
Discharges 8- Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori=inated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notif}. DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there e-6dence of past discharge from any part of the operation.'
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection S- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Strucrure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
30''
05/03/07
❑ Yes [&No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
®No
❑ Yes
Pa No
Structure 6
Condaned

Facilih' Number: �, --,383
Date of Inspection
5. Are there anv 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 ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
S. Does any part of the waste management system, other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? V
❑ Yes ® No
❑ Yes 4 No
❑ Yes (J No
❑ Yes ® No
❑ Yes ® No
Waste AnDdication
10_ Are there any buffers that need maintenancehmprovement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12_ Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes m No
b) Does the facility need a wettable acre determination? ❑ Yes V No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes EQ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes W No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design_ maps. etc.) ❑ Yes QO 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 DNVQ of emergency situations as required by General Permit?
(ie? discharge, freeboard problems, over application) ❑ Yes 5Z No
23. Did Iteviewer,'Inspecror fail to discuss reviewiinspection with on-site representative? ❑ Yes E 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 RNo
W leo violations or deficiencies .were noted during this visit. You will receive no further correspondence about this visit.
Cotn�entsrefer" to' nestJon - a
{ q �j. 'Eipiamaag YL5 soswers sndfor any rrtotnmendsttons or aav�a�ter hommeats ;- ,: � �--�- -:. '-
w�a .s
Use dr�+sz,
bxinittio«ns.stonl
drawings of facili to better eplasituations. (use additional pages as r�ecessarv) ' *' <
Field ell Conv ❑Final, Notes s �;
_ _ � ,_.... , 1 � -
'.. :t__.a,:.. wxr. r:a.•.i-+s...'«: `_....1`; - f 'r a:'%' .iE:2 'c,' '^[`�. + rYae-�,'C#s+ri` a:�
r c
=_g �T�c'�"S;. uq�,..�.. �s�.+'aa'M'. •�7q"`z. -"- r�°a',z.
Reviewer/Ins ector Dame -
P1� f,.Q
Reviewer/Inspector Signature:' Date: /D '.2j - 0 3
05103101 v Coni hued

Type of Visit 4P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
_j
Facility Number L Date of Visit: l7 !/ dz Time:rO
Not Operational 0 Below Threshold
■ Permitted e Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: I 1 County:
Owner Name: ��i-its /.�1 Phone No: ��7'z
S—o-r
Mailing Address:
r
Facility Contact: 1�i.�.✓�dr�i�i�+c�litle Phone No:
Onsite Representative: ✓ai zz 11%iA,�� Integrator:
Certified Operator: /tom'/ �'l�.a� Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Oe 0° �" Longitude Q' 4
Design-Cterrent
Design Current _' Design Carrent
Swine Ca ace ", _Po gtilahon' I;oultry :..
Cact Pa' ulatitin3e ,Cattle Ca aci P,o ulativn
can to Feeder /Z Dd FO—Layer
�'j❑ Dairy I
(] Feeder to Finish 10 Non -Layer
JEI Non -Dairy I
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
El Farrow to Finish
T()4814 e. Capacity
❑ Gilts
SSLW
ElBoars
_Total
-
Areao
Number of Lagoons ��, ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field
Holding Ponds /Solid Preps ❑ N
Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05/03/01
❑ Yes 'K No
❑ Yes 0 No
❑ Yes 15 No
❑ Yes P No
❑ Yes KNo
❑ Yes eKNo
❑ Yes RNo
Structure fi
Continued

Facility Number: 82 — Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ict trees, severe erosion,
❑ Yes
�fNo
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
❑ Yes
PNo
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
IR -No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
DUNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
(KNo
11, is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
12. Crop type
/WNo
--
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
PNo
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
JkNo
R aired Regords & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18. Does the facility faileall components of the Certified Animal Waste Management Plan readily available?
(ie/ ecklists, 'aps, )
IT "I
❑Yes
No
19. Does record keeping need improvement? (iel imgation, 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
t9No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22 Fail to notify regional DWQ of emergency situations asre uired b General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes "PNo
23. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑ Yes F No
24. Does facility require a follow-up visit by same agency? ❑ Yes JZ3 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes fQ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
i( `}q �:) zp S aosrtie d/or any m A&SOem n ahons o%any.other'comments. y
Cotnthents; refer to` uestson=#i E lain any YE
x
❑ Field Couv ❑ Final Notes
/ll� •� c�or s i��.sx j�v�.v c3%s��•�- �o-��-r�'7'�°',� /�''eC�%',� .�ss,�-� .
'9
Reviewer/inspector Name j .
Reviewer/Inspector Signature:
Date: '71111e-
05103101 Continued

Cl
Facility Number: OVZ —3 Date of Inspection % O
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes El No
❑ Yes 'PJ No
❑ Yes 29 No
❑ Yes IRNo
❑ Yes CgNo
❑ Yes KNo
❑ Yes f@ No
Additional Comments.and/or,Drawings:..
O5103101
O5103101

Date of Visit: Tune:
Facility Number 3
O Not O erational Q Below Threshold
*Permitted 0 Certified p Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _ ....�...-
J wteqrm County:..........1,,�. �!t� I-10. ..
Farm Name: .............. ........�.......&n�........1�'r.�...��i.�...... ........... / .............. .....
OwnerName:...... GS........ ......................... Phone No: ... .. �....1...7�...f....__ .......... _.
Facility Contact: ........._. �!t P!i ..__.. .__%W Title : .................. .....................
........ ..r............. fP,,hrone No: ....' _ ._ ...
Avel
Mailing Address:.......... & I....-•-•-/1-•�Lf�e �/ ........ ................... .... (/�- �' d � 1l �.�-�...................... � 3....���
T
Onsite Representative: .< o/ . Integrator:.....- T r%? i U�tit „�...f........d...4..r.....a.....
�`�, J1/r r'
Certified Operator:......,,r �t�x �,�, til .. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 4 Du
Design Current gn Current _ Desiga Current :N
Desi
Swtrte : C= 'Po' ulaadn:...' Poultiry Ca - ci Po. ulation _ Cattle Po lation.
Wean to Feeder ZO 10 Layer I❑Dairy
Feeder to Finish ❑Non -Layer - ❑ Non -Dairy
Farrow to Wean _
Farrow to Feeder
.. Other
❑ Farrow to Finish Total Dt'S: Capacity 1Z
Gilts
da
..
Boars ^^ ' :.:..:' TotaISSLW
_ _� Nnfnher o! Lagoons rT 1 ISubsurface Drains Present Lagoon Area ©5prey Field Area
Holding Ponds
Z. Sated Traps, No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ YesNo
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes A No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 4No
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 ❑ YeskNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structu b
Identifier: .............................................................................................................................. ......................................... ..........
.... ............
......................
Freeboard (inches): 3
5/00 Continued on back

Facility Number: Z — Date of Inspection
" rtiries ' dente about this :visit . . ' ' ' ' • . ' . • ' '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
�ileeo�e7/a�
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
��Twt
closure plan?
❑Yes
#9D_
(If any of questions 4-6 was answered yes, and the situation poses an
I
immediate public health or environmental threat, notify DWQ)
Reviewer/Inspector Signature: Date: 5/00
7. Do any of the structures need maintenance/improvement?
❑ YesNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[io
Waste Application
10. Are there any buffers that need maintenanceliitnprovement?
❑ Yes
o
❑ E��xrrcessive Ponding ❑ PAN ❑ HydrauIic Overload
11. Is there evidence of over ap lication?Aj;
❑ Yes
gNo
12. Crop type 6 ? e ,L5. re(_ A140 J A-
13. Do the receiving crops differ with tffose designated in the Certified Ani al Waste Management Plan (C P)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
0
FR
C) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15. Does the receiving crop need improvement?
❑ Yes
toNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
dNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes�J
No
`
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0" No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ANo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
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 o
.: � •Yi�:a��l1s eF i��f epen��e� wire noteddt»g {��s:v��� • Yoo w��->�ee�iye t�ti f�gr
" rtiries ' dente about this :visit . . ' ' ' ' • . ' . • ' '
Coiiu aftits (reser to gnestron #) Explatri any YES a eis and/or any recom e�udation4 ar,a ya otl ed Co� _
- _ -
:-
Use:drawingg of facilitp to better a pilin sitaatto additional pages a neecessary)� —� , -
..... . .. �. _
4_C/ -5-yam /1J�C S-
�ileeo�e7/a�
��Twt
�c�:ztar�
-arm /S GUS/
Reviewer/Inspector Name <a 3.�.x._
Reviewer/Inspector Signature: Date: 5/00

Facility Number -- I Date of Inspection —D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
yyyy���
\\
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes E2'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes ANO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes k No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes grNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ONCr-
do omments an or.: raovmgs: r -u
5100

e • ..
Type of VisitCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit {$Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: -%r?I1 Time: Printed on: 7/21/2000
S3
=Not Operational Q Below Threshold
Permitted 0 Certified [3 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: County: .......... .......................
.................
Owner Name: ,.... .1. '1r►!tL' .... ........ {.`- ................................... Phone No s�v ?.. Z-5-0
......................................................................
Facility Contact: ............. GJn 0:4 . . ......................................... Title:.......................................................... Phone leo
Mailing Address: ....� i...i..�....R (� f.�... IN. f�J CSC ..................... ...........
................................................... z�l
Onsite Representative:.......�L�f11-�� ! Integrator: 34 �.........................................
r,
Certified Operator: . .. ......C,�(fr fl ......... Operator Certification Number: ...............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �s �6 66 Longitude • 4 "
Design Current Design Current
Ca a
city Population Poultry capacity Population Cattle J_ .:. aci Po elation.
rFarrow
Feeder ❑ Layer ❑ Dairy
F`.
o Finish ❑ Non -Layer ❑ Non -Dairy
o Wean
o Feeder ❑ Othero Finish Total Design Capacity ' z6o
Gilts
-"" Boars Total SSW
�„x Ntixtbe of lagoons Subsurface Drains Present ❑ Lag^n Area JOSprayneld Area
Ponds/ So6d`Traps ❑ No Liquid Waste Management System
DischaMM & Stream Im acts
I. Is any discharge observed from any part of the operation? ❑ Yes PfNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes XNo
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) [] yesNo
c. II'dischargc is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ YesNo
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):
5/00 Continued on back

Facility Number: - Date of Inspection K/= Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
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
(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 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes i�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level .
elevation markings? ❑ Yes )No
Waste Aanlication SCC
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over
//ap-plicatio0 [—]Excessive Pondinng 9PAN ❑ Hydraulic
Overload ❑ Yes No
12. Crop type .J^ iJ�tyi2s 114114�er A"Lka1571XerP"Qja l a"
13. Do the receiving crops differ witlithose designated in the Certifid Animal Waste Managemdnt Plan (CAWMP)? ❑ Yes 0
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O� No
b) Does the facility need a wettable acre determination? ❑ YesVNO
o
C) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes WNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checkiists, 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 J 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 MfNo
yioiattgnis :oi• deficiencies -were noted• dr< fthi this:visit: Yoo will •;eeeiye iiti flut tli .
icorires deike: about: this visit ' ::::: :
Comments{rater to question #}:-: Edi plain any -YES answers and/or any= secoa�tendations or any other cotnmeats
Use draw>ngs of faeiltty tci better explain situations (use addJ tio6al_ pages as necessary) ..
r `jf.%raS /S %� / �t r�C�SS rh f I���k Sel��S�/ �'
5 /r�� y ,� ,.� aP� t
i
�1 rrvv /LLSh 5 J��N >.t /✓e �/ �N���°C� %k E�
1A
Reviewer/Inspector Name - -'
Reviewer/Inspector Signature: Date: —6v 5/00
IV I

Facility Number: 52- —3W Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Wes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JK No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Mlo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes A�o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes bNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
5100

Q Division of Soil and; Water�Conservation Operation Renew -.F,- .
W;
t
Division of Soil and Water Coaservattoti -_Compliance inspection �.. `
Division of Water Quality _Compliance Inspection _ r r
s - t
Other Agency Operation Revtew::..w .-
14D Routine ,Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection f
Time of Inspection ; pO 24 hr. (hh:mm}
M Permitted y Certified (] Conditionally Certified% Q Registered Not O erational Date Last Operated:
Farm Name: ��.....-.Fe7c.t_+.1:�_._.....1�J�._._I.... .?�-
a�.......--.---.
..................... `` , .1........ q y
Owner Name: �R�!'r-'� ..... .f r' k....... �1 t.. �r Phone No q10--..J5..b..I.......:a505.......................
1 .�
FacilityContact: ......... ............ ......... Title. ........................... . Phone No: ...................................................
191
Mailing Address: 'l.f.S.... + �Q �� ` `� f . / ...................... ...4A!V5
^� .. ... j.............................................I..........
Onsite Representative:...... r,t �!'t� LV - { l tAw✓lS .... Integrator:.... �Q'. ....._ .....
rt J
...................................... ..... ............................ ...... .
Certified Operator: ,. C�!v►'.&5. F. ..... l Operator Certification Number: ..........................................
Location of Farm:
r................ ..... ..........................................................................................................................................
Latitude
Longitude
...........................................................................................................r
�• �' �'�
.
__ ... - Design Current
- _ _Design. Current.
Design- Current
Swi#te Capacity Po ulatiori
.. Poultry
Ca 'aciity._ Population_:..Cattle
Capacity Po ulahon
Wean to Feeder
Layer
❑Dairy
Feeder to Finish
; "'
❑ Non -Layer I
❑ Non -Dairy
-
❑ Farrow to Wean
ElFarrow to Feeder
-❑ Other
❑ Farrow to Finish
Total Design Capacity
% -axD
❑.
Gilts
❑ Boars
•Total: SLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes VNo
c. If discharge is observed. what is the estimated flow in gaUmin'? A�lof
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ) ❑ Yes K No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 4No
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 K
4. Is storage capacity (freeboard plus storm storage) less than adequate? [ISpillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): ....... ........................................................................................
..................................................... .."-.......................-----... -
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes] No
seepage, etc.)
3/23/99 Continued on back

Facility Number: a — Date of Inspection
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, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenaricelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of over application? . ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designaYed in the Certified Animal Waste Management Plan (CAWMP)?
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?
❑ Yes k No
El Yes .No
❑ Yes [QY%io
❑ Yes R'No
❑ Yes IgNo
❑ Yes 0 No
❑ Yeso
El Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes EYNo
Regu-ired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Al%A❑ Yes ❑ No
18. Does thejaeility f�ailw have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, check/ tib s, design, mps, etc.) ❑ Yes OKNO
19. Does record keeping need improvement? (ie/ irri tion, freeboard, waste analy sts & soil sam a reports) ❑ Yes YNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ YesNo
21. Did the facility fail to have a actively certified operator in charge? E]Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) 0141
❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes K. No
24. Does facility require a follow-up visit by same agency? E] Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
No viola(icjt... ilel ... . i.. were noted'. &.i. . this:visit. • Y©i* wi�i•reeeiye iio Futt
corres oiidenke: about this visit: - :: :::: :
Comments:(refer to-clueshon #} YES answers and/or any recommendations or any other corn ents
_Explain'_any - - _ -
Use drawings of facility to;hetter explain situations {use add>itionallpages as necessary) - - -
+ r
AL
01 lk
Mi -6-- wl✓a
tM 5� v quill
U
Reviewer/Inspector Name ... c:
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: — g Date of Inspection 1-Q�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation., asphalt, ❑ YesNo
roads, building structure, and/or public property) IV
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? I}/4 ❑ Yes ❑ No
110II pI1�II1eI1 aII Otis r awmgs
3123199
3123199

❑ Division of Soil and Water Conservation 0 Other Agency
0 Division of Water Quality
LO -Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of InspectionI lo
Facility Number oz
Time of Inspection LC En 24 hr. (hh:mm)
© Registered NCertified [3 Applied for Permit 0 Permitted 113 Not O eraEi[►nal Date Last Operated:..
Farm Name:.. 2!.r.G..s ..... rm.. k.......11v(.&r.............................
Owner Name:...- t n!1 .`r........1 ........ ................
Facility Contact: ..............�r5
ontact:..............�(1!► sorrt ! . Title:
Mailing Address:........... ...... .......�oX............................................
Onsite Representative:.......... ........... W, � 1^'?.'5 ....................
Certified Operator:...... 3 ......... F. ............1: [.1.! :..............
Location of Farm:
County: ............. !r► ................................
Phone No: ...................... ..-..�.A a .......... .
PhoneNo: ...............................................
"-...X.c ........................... . ....... .......
Integrator:........ ..................
5..
Operator Certification Number;..........
Latitude • 06 « Longitude ' �� 0°°
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. is any discharge observed from any part of the operation? ❑ Yes 'O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes to No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes I( No
c. If discharge is observed, what is the estimated flow in gal/min? LVIA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes IM No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
main ten ance/improvcment?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7125197

Facility Number: —3
8- Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes No
Structures (Lagoons,Holding Ponds, Plush Pits, etc.) "
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft) : ................................................
10. is seepage observed from any of the structures? Yes (( No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes � No
12..
Do any of the structures need maintenance/improvement'?
❑ Yes
{ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level marker~?
❑ Yes
No
Waste ARplicatioll
14.
Is there physical evidence of over application'?
❑ Yes
'No
'15.
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
Crop type ...........�1'1 +_I-/ --04d---- f!''r�,r....................
l
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
O No
18.
Does the receiving crop need improvement?
OWN/
❑ No
19.
,Is there a lack of available waste application equipment?
❑ Yes
06No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
OdNo
21,
Did Reviewer/inspector fail to discuss review/inspection with on-site representative`!
❑ Yes
0 N
22.
Does record keeping need improvement? `
❑ Yes
RrNo
For Certified or PermittedFacilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available? ❑ Yes (� No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ( No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes ❑ No
0 No.violations or deficiencies were'note'd during this visit.,You.will receive no further
correspondence about this: visit'. -
11
Coiutonents ('refer to question#):.Explain any VTS answers and/or any reconimendatians or any'other comtnents.�!
necessary):. x '
Vse,,drawings of facility to bettcr'explain situations. (use additional pagcs:asAL
Lj- w,ll,Com -
U
Reviewer/Inspector Namef
Reviewer/Inspector Signature: Date: _ /0_ .zt! 91 _
v-t —

Facifity Number
L
Farm Status: Pea; c+erxzj
,j
Date of Inspectiou
Time of Inspection 3A Use 24 br. time
Total Time (in hours) Spent onRevitw
or Inspection (Indudes travel and processing)
FarmName: Ene--p-1 County:15d; u1i I a< -an.
OwnName: Max- w.a:% CxM q Phone NO: ("
40 2 -
Mailing Address: a.% wale, Nc-
Ousite Representative: - -rax wt&T e-) L �wd-nj ar-MS
Certified Operator. I 1 r Operator Certification Number. &a 2
Location of Farm:
V�7 Naw'.RM M-MMM.Rllff r M -M.
Latitude Longitude
13 Not Operational Date Last Operated:
Type of Operation and Design Capacity
.. .. . .....
umber
M-uzEbw
4S Numbers: .`
W= to Feeder
Dairy
Feeder to Finish Non- tzyer Bed
ixlS'w
to
Farrow to WeanW Feeder
EPA,,
13
Farrow to Finish 1 ;99 Other Type of Livestock
7-F7'�� i., - � OMU; ^":v.+ - "I
er,of.Lagoo -ni" 61din'g-Ponds Subsurface Drains Present
RI
tO Lagoon A 93 Spray Fi
-5
Ma
Tw i
MJA Area
J
I. An there my buffers that need mamtenan E3 Yes No
2- Is any discharge observed from any part of the operation? E3 Yes PNo
a. If discharge is observed, was the conveyance . man-made? 13 Yes )E(No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) 13 Yes Id No
c. If discharge is observed, what is the estimated flaw in gaLk3in? A(1z+
I
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) E3 Yes R(No
3. Is there evidence of past discharge from any put of the operation? 13 Yes *0
4. Was there any adverse unpacts to the waters of the SUft other than from a discharge? 13 Yes ANo
S. Does any Part of the waste management system (Other than lagoonwbolding ponds) require ..Oyes ONo
Tmin AM4. vvemient?
condnmed on back

6. Is 5o0ity not in coinpliance with any applicable setback arteria?
7. Did the facility fail to have a certified operaw in responsible charge (if inspection after 1!1197)?
S. Are thele lagoons or storage ponds on site which need to be properly closed?
J�ctures [Lagoons and/or Holding Ponds!
9. Is strtxturrai fiedmrd lea: than ado uate?
Fntx*awd (R): .12900111 Lagoon 2 Lagoon 3
b N
10. Is seepage observed from any of the anus?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the struetures need
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
.13. Do any of the str uctum lack adquate markers to identify start and stop pumping levels?
Waste AMML", ion
14. Is then physical evidence of over application?
_(If in excess of WMP, or runoff entering waters of the Static, notify
15. Crop type W ►� e A...�5 _ ..�..c�I.t'' �.� c�
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for lead application?
18. Does the cover crop need improvement?
19. Is then a lack of available irrigation equipment?
Lor Certified FacUitiet Q21Y
20. Does the factlity fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Anima! Waste Management Plaa in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/inspectorfgil to discuss nview/tioa with owner or opesamr in charge?
D Yes 7,�No
❑ Yes 99<NN o
❑ Yes $�No
,aYes JKNo
Lagoon 4
13 Yes 0,No
❑ Yes P(No
❑ Yes gNo
0,Yes 10 No
❑ Yes ❑ No -
E3 Yes �No
E3 Yes R(No
E3 Yes P�No
© Yes UNo
I] Yes © No
❑ Yes E3 No
E3 Yes ❑ No
E3 Yes ❑ No
❑ Yes ❑ No
ir4IIlrIIchts-(refer t0 g11C5IrDa r plalfl eery L� 8aS4VQ3 gran rtco mmdBtlOa$ or $rYjt Other C0IIIII1eni5.� t
Us��drit vmgs of facaitty ro btrtttr atplarn sutuattgas Anse additiortalPgeas
1. F�eeboaJ is Aiq� — Mr-, i5 Oark•,•9 w*_ AlkOS 4-o uP9 e
4
Ats IMjaor- 1:50, +,;S- 514r.
it/3 5414-5;�f Pc—P MGrker 4, be i,s4lled a,+ Co,,?ir4rttr..4 ,fy-.Je.
11
Reviewer/lnspecror Namt
Reviwerfinspector Signature:
late: 5-2--,77
CG Division of Mater Quality, Water Quality Section, Fadlhy Assessment Unit 1 I/14/96

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. James F. Williams
Rt. 1, Box 166-D
Wade, NC 28395
Dear Mr. Williams:
[DEHNR
DIVISION OF WATER QUALITY
May 5, 1997
SUBJECT: Annual Compliance Inspection
James F. Williams Farm
Registration No. 82-383
Sampson County
On May 2, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facility. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facility was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and
Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call John Hasty at (910) 486-
1541.
Sincerely,
ohn C. Hasty, Jr.
Environmental Specialist
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Wilson Spencer - Sampson Co. NRCS
Wachovia Building, Suite 714, Fayetteville N�`� FAX [phone]
North Carolina 28301-5043 C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 SIMM 50% recycled/ 10% post -consumer paper

I
1
,
. I
I
O
A I A . 'A
© 171713 o Qap
Qf
r r
•
it ,yid
•
f
1•a'�!��1�[ ih•
I
O
A I A . 'A
© 171713 o Qap

CL b Sdtity rot in oa oe wig asy se n& efta&? . _ 13 Ya No '
7. Did tie bulky 60 to bw e a rued oprsator irs:apooailrle CMV Of knew a alter IMM my= i10
8 Ane dwe Iagoons or storage panda an site whM need to be popatly closed? fl Ya JP(No
t�t+rtrctar R.astoerns REWM H 210 lsfnelsl
p. b mssctMw irrePI r w has tbaa Odkgjaw �Ya
Fwd (!tX I Lagoon 2 Lagoon 3 Lspv m 4
I4. Is seepage obasaved $aRm =7 ofthe Ibuctow 13 Yea
11. Is army other thxraati m dw integrity of airy of the 10 memo C"Or"O my=
P(No
12. Do any of the a need mainhwasmi 13 Ya PCNo
(if any of questions A-12 was answ+erwd M rad the dtwdon pries an
tsamedlate public be" or env hmmental threat, sci► DWQ)
13. Do ray of the structw= lack aelgrraoe mak= to idea* alert and stop pappmg hwels? 0Ya Na
Waste Aoolic_atisa
14. Is theme physical evidence of over appUation? Q Ya 13 No -
.(Iiia autos of WMP, or tnaoff entering waters of the State;, soft DWQ)
I& Crop type 'jke as — C,)cs4,aJ &-rrt t&Ja_
16. Do the active crops differ with those "paced m de A=md waste MansgemeM hon? D Yrs PLNo
17. Does the heilisy have si lack of as sc re gv for led T D Yes P(No
18. Doo the cover crop Dead iarpra ? Q Yes P+To
19 Is th= a lack ofaviflable irrigation egWpmmtT fl Yes MNa
Fac Certified Far ifi n Osie
20 Does the fseMW M to have: a copy of the Animal waste Management Plan readily available? tl Yes D No
21. D= tau hciliry fail to comply wig fes Mmol waste Mit Plan in my way? D Yens D No
22. Doo retard ke qkg aced ' 13 Yes 13146
21 Does fw&ty nqui ,e a follow-tp visit by sacoe apnry? 13 Yes E3 No
24. Did It M;ewer or Srl to disc s reviewfinpxtios with owner or operator in © Yes O Wa
Ust
"-^k. ii ._�
Dttlt�t'LOC:ltti't�Cit�lC�$,C�iS.'aw _...-r
q� Fffre beg t� is k jg Mr, Willi ap s is "r k;,, J w 4lL A1105 4v 4Pg e
At$ ln,oar. an '}'h%s 514r.
10-13 5fq4` 5�v rupf tuarker -* be i-Y4114ss% ca4Irfrm,,C uto -e-je.
RevkwexRnspectpr Nasse
RwtwerAaspeetor Signature:
C= Df lou of Water Quaffry, (WaW Qaafiry Sedkm, Jr&dUW Carew Pair
Daft S -z —4 l

Site Requires Immediate Attention: O
Facility No. -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE YISITA77ON RECORD
DATE: 2A ° ` , 1995
Time: I ca --
Farm NameJOwner:,��
Mailing Address: 2,DZta I $,, X
County: 3S QOM _
Integrator. LUVA� _ _ _ Phone:
On Site Representative: 'P -C a t1'hkb Phone: S61- ZSos 4?'5 - L7 5]
Physical Address/Location:
Type of Operation: Swine PoultryCattle
Design Capacity: _ % _ m_ iJ _ Number of Animals on Site: 15 a o
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: •
Circle Yes or No
Does the Animal Waste Lagoon hfvc, sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) a or No Actual Freeboard: Z Ft. winches
Was any seepage observed from the la oon(s)? Yes or &gT Was any erasion ob rved 7 Yes or No
Is adequate land available fornA
y? Ye or No Is the cover crop adequate? es or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin or No
100 Feet from Wells? e oNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Nr
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes OTS)
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<Nq If 'Yes, Please Explain.
Does the facility maintain adequate waste management records (vol mes of manure, land applied,
spray irrigated on specific acreage with Dover crop)? Yes or o
Additional Comments:_fl e ��s_��vi 4r-�01�.,\A .,r,
Inspector Nam
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: D
Facility No. gZ-3% !Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
AN DAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm NamrJOwner:
Mailing Address:
county: SAkoso
Integrator. l,uND,
On Site Representati.
Physical Address/Lo
Type of Operation:
Design Capacity: —
DEM Certification
Latitude: ° —
DATE: 2A D ` , 1995
Time: 144
W, W, 4,0ks
,e: IF2,4u1, 431U,.A+A% Phone: 7.Su 41 3 — 41�;
ation. S �, lcS 'N%. Zlk o vk_V-4 V71 At �o%t J 147-4 a
Swine
1500
Number:
_+ w
Poultry Cattle
Number of Animals on Site: 3b SSS
ACE— DEM Certification Number: ACNEW
Longitude: w
Circle Yes or No
Docs the Animal Waste Lagoon huz sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)mor No Actual Freeboard: 3 Ft. —2 --_Inches
Was any seepage observed from the la n(s)? Yes or(go o Was any erosion obed? Yes or
Is adequate land available for spray? fvk or No Is the cover crop adequate? ;7rs or No
Crop(s) being utilized: Cokr-kk
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin l or No
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orw9l
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or&l
Is animal waste discharged into water ostate by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain. .
Does the facility maintain adequate waste management records(vo es of manure, land applied,
spray irrigated on specific acreage with cover crop ? Yes 1 _
Additional Comments: mµu' VOwI% o '(A4\.5 0 �'
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.