310856_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

(Type of Visit: (rj Compl* a Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: C outine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I
Arrival Time: Q® Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 6Title:
Onsite Representative: r Y_n ' k k L `(
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number: / Agoe-S-ST
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
jDairyCow
Design Current
Capacity Pap.
Wean to Feeder I
Non -La er
Dairy Calf
Feeder to Finish 20
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder D , P,oul C►_a act P,o ,
Farrow to Finish Layers
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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?
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility dumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .12-14—o—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 ZNo ❑ 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 rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 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 D NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
VNo
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[ to ❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
KJrNo
❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo
o❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ,Number: Date of Inspection: 3 /
14. 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 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 ❑ No E]"NBA ❑ 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 � o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNc, ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 7 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes O'I10 ❑ NA ❑ NE
Comments (refer to,questiona#) Explain any-YES"answers: and/or anyaadditional recommendations or any other comments:
Use .drawing- s of facilityto.:better explainAtuations".(use additional pages as necessary"): .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
&-(e VO-A
Phone: l�`J 7 6 7
Date:
21412015

jType of Visit: l3'CorlrpHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1
Date of Visit:
Farm Name:
Arrival Time: Departure Time: /Oa.0 County: �(� Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: '&_LL Ili otlnK,r Integrator:
Certified Operator:
Phone:
Certification Number: `19 -7;0�)
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
pacity
Current
Pop.
Wet Poultry
Design Current Design Current
CCattle C►apacity Poto
7r
Finish
rt
La er
Dai Cowo
Feeder
Non -La er
Dai Calf
DairyHeifer
to Finish ZO
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oultr,
Layers
Design Current
Ca acit Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 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 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [ 0 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: -Y5
I Date of Inspection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UkGCR�J
Spillway?:
Designed Freeboard (in): II
Observed Freeboard (in): Wtl
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 E!(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Zyes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
dNo
❑ 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
[3No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo [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 ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Vlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
5No
❑ 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
[lo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[� No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Zj
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of Ins ection:
;4. 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 5/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 V 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?
24. 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 <o
❑ Yes o
❑ Yes Po
❑ Yes E No
❑ Yes o
❑ Yesi',�o
Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #) Explain any YES answers and/or any additional.recommendations or any other. comments I
Use drawings of facilityao better explain situations;;(use additional.pages as necessary.). .
Ca JT,— .l VC jb G E i G C'C-C-2 G rLASS couau o ►J OgG9 xsi J CUIC.E L„ /p k ,
F&O G EC5 f WAS eC-SO PA A bE
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
aho PAf4ktL,
Phone: ( U) 996 "13 a 8
Date: S 3
214/20l

Type of Visit: IrCorpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance V
Reason for Visit: l&Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Timer Departure Time: County: Lu��T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: '
Onsite Representative: DA=- S!n s __ Integrator:
Certified Operator:
Back-up Operator:
Phone:
4
Certification Number: C? q c q r ?j'
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
DairyCow
,Design _C•urrent
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�j,0
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D�P,ou1t ,
Layers
are
Design
Ca aci.
Ca a�i.
C*ucrent
P,o,
P,o
D Cow
Non -Doi
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other Other
Discharges and Stream Impacts
Stream Impacts
jNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
�dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: I Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ixo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAcrmo7J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): leij�j
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 0 Yes [Z/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 U40 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ 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 Coverage & Permit
�No
NA
NE
of readily available?
s
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Vyes
❑ No
❑ NA
❑ NE
the appropriate ox.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
�'No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 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 � ❑ 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 L.:"'o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes AIo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes C9 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [2e< ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes zo ❑ 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 asMecessary).
PA5
'f>COJ
W60, D od Q�i ;� .L a•Xcos
(JUP
To
9 E Wt-! 1 C- C.6e_,_ps ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonk l_1J 1 �� 13
Date: 6 g
214,12015

Type of Visit: GFgRoutine
pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: - County: ;DUP i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: DAvmiD5 Integrator:
Certified Operator: Certification Number: q % -p 11-7 5
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
C•at#le Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
I SZ•O
Design Current
I) . P,oul C•_a aci P,o ..
La ers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
I
I—M
Discharges and Stream Impacts
I . 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 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
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
g�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - —(7 �ateof ection: J` 2Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Li (� r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 7
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 VNo ❑ 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
D Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
U/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[f _ . _
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[- ,+ ?o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E i<
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ es
N
❑ .NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
eNo
❑ NA
❑ NE
the appropriate b
WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2' o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? [:]Yes rNo
. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes�Noo NA El NE
the appropriate box(es) below.
Failure to complete annual sludge survey D 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 N NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes VNo DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
Yes
❑ Yes 21/No
❑ Yes ZNo
❑ Yes ZNo
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? D Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
DNA ❑ NE
❑ NA NE
[:]NA ONE
0 NA ❑ NE
NA NE
D NA D NE
No [ ] NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..,.
Use"drawings of facility to better explain situations (use additional pages as necessary).
Owoca_ �gsSco, 06a> Tu UPDATc OuP mip ortW=rL ?A9C- _woe_ .
W�E
Reviewer/inspector Name: I;flA[�akseLl.
Reviewer/Inspector Signature;
Page 3 of 3
Phon —1la Q -�
Date: j aZ
2/4MI ]

Type of Visit: q 7Routine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: y Arrival Time: Departure Time: County: b(R Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� ��- Integrator: _ _ _
Certified Operator: Certification Number: �Cj (s1CI Sj
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
C►urrent
Pop.
I ILayer
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I
jNon-Layer
Dairy Calf
XL
Feeder to Finish
Design Current
1) , $Dolt . C*_a aci P,o
Layers
DLt Heifer
DIX Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
I
113eef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
Yes
❑ No
FdNj
❑ NA
NA
❑ NE
NE
❑
❑
❑
❑ Yes
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2(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: LAC ao�
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes EyNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
U Yes
U NA
U NE
15. Does the receiving crop and/or land application site need improvement?
Yes
iA
LAS !� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E*No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ IVo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1' "o
❑ NA
❑ NE
the appropriate box.
❑WIJP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes i
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facilityfail to calibrate waste application equipment as re required b the e it? Yes NA NE
PPq Y P ❑ � ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �7No ❑ 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? ElYes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes VNo ❑ 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
12 No
❑ NA
❑ NE
[:]Yes
ZNo
❑ NA
❑ NE
❑ Yes
ZI/No
❑ NA
❑ NE
/No
❑ Yes
(2
❑ NA
❑ NE
[:]Yes No
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer,to question:#): Explain.any YES answers and/or,any additional recommendations or-'any;other comeuents: -
Use drawings of facility to better explain'situations (use'' additional pages as necessary).
wo cjwv_*, aO l eay AvA IFz_6JS,
Reviewer/Inspector Name: L �� �L� �� Phone:
Reviewer/Inspector Signature: kM, Date: `f / 30
Page 3 of 3 j - 2/4,M]

r - Division of Water Quality
Facility Number 31 - © ®Division of Soil and Water Conservation
OO Other Agency
Type of Visit: 6Tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: hRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
rill
Date of Visit: �T J7� Arrival Time: Departure Time: IvOS' County: Due LZIJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
3XLL-I? 01 o 1/M&-
Title:
Latitude:
Phone:
Integrator:
Certification Number: i t 7 Z
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle
Da' Cow
Design Current
Capacity Pop.
Finish
La er
Feeder
o Finish
o Wean
o Feeder
EFao Finish
f ZD
d5 0
Non -La er
Da' Calf
Design Current
D , P,oult , Ca aci P,o
La ers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Non -Layers
I
jBeef Feeder
Boars
Other
Other
Pullets
F
Beef Brood Cow
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
mo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
LJ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: g
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes YNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes N ❑ NA ❑ NE
maintenance or improvement? 4
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 [�J'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
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 Ej� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6/N o
❑ NA
❑ NE
Required Records & Documents
�/xo
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 No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes j�/Vb ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacilityNumber: �j - Date of Inspection: '1 Z_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Wo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �'No
❑ Yes No
❑ Yes [ 1] o
[:]Yes [/] No
[:]Yes ]nNNo
[:]Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
E,—�J,,N/o
ld'"o
F3/No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/IOl

(Type of Visit: (D Compliance I2p7omplaint
ection O Operation Review Q Structure Evaluation O Technical Assistance
RoutineReason for Visit: O O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L , Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �usu_.`I' i L7CJ).1(-r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
C**apacity Pop.
Wet Poultrypacity
Layer
Non -La er
gn
MC-La!
Current
Pop.
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
%40
Farrow to Wean
Farrow to Feeder
Farrow to Finish
DIlt .
Layers_
Non -Layers
Pullets
Design
C►a aci_
Current
P,o ,
Dry Cow
Non -Da
Beef Stocker
113cef Feeder
I Beef Brood Cow
Gilts
13oars
Qther
Other
TurPr
Turoults
Oth
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes E N
[:]Yes F�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: (,11
1 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: of
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "7 -3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes [2(No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 12/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 [:?�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes ZNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
dyes
�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? .� �a, Ch
Yes
n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
1
17. Does the facility lack adequate acreage for land application?
❑ Yes
E J o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes d o
[3 NA
❑ NE
20. Does the facility f 'l to have all components of the CAWMP readily available? If yes, check
dyes go
❑ NA
❑ NE
the appropriate x.
WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes CZNo
❑ 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 dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes FZ/No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: 5 I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
25. Is file facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CjNo ❑ 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 ❑'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes UNo [DNA ❑ 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 [2rNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [—]Yes [/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes eNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [E]/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FJ/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). -
y ftg3al f8p 36) -fit 37, rqP 3� � �� � 3� ARE
?t-A 9T ►� �.+� 1 EA PJ UT S. LJ L} P HAS 'Fzc t-OS =4 ( Gz M uD A j S G a
20) 9OTATZ0n! , >s 0_ P � D2.A N 1 s -Co `TN E T-Wo rXEt0S, w UP NEE D5 Vj
SAC of DATc0 ALa0C-r- WM`t�4 VrE L_.D r✓1A
Do wqr
` lsc.
r ELp .
GE-#- A, OMC
`?EAR A IMM u9M 6
4s AR,
PExrt
S?OzZ4G
SPRIG
_6AQk_ INrb
6EKMUJ)A UNL_E55
(jUp
CH AnIC-.S.
�i ov To �Z ut_o', J.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
V dq&) 1FAd { l� Phone: Q b
'4Z AAwSe Date:
2/4/20 I

V Division of Water Quality
FaClllty�°Nuitib�er E`" �S(p 0;Div�sron of Soil and Water,Conservan
Ot r A
0� he gency
Type of Visit 9Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: bdb Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: (� Title: Phone No:
Onsite Representative: 1.31 Z-Z- ` Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = i =61 Longitude:
;�
Design Current Design CurrentZgnCurrent
"ouaoCWt Pulta acty 'a ulatton
;Capacity Popu�i"ation
Wean
to Finish
Wean to Feeder
Feeder to Finish jl S I t s Do
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other __
�
i :::::d
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes UrNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑NA
El NE
El Yes
[I Yes
VN9❑NA
[I NE
El Yes❑
NA
❑ NE
12128104 Continued

Facility Number: 31 — g, Date of inspection 2
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Oo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
EO No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envirZyes
7. Do any of the structures need maintenance or improvement?
❑ o ❑ 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
2No ❑ 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?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
VNo ❑ 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
E o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ Vo ❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
WNo ❑ NA
❑ NE
64
Comments refer to ' uestion # . Ex lain an YES:answex n or -,r n tin r n to r c mments
, (. � ) P y rs a dl any ecomme da o s o a y o e, � o
Use�drawings, of facility to,betierexplain.situatrons (useaddttronal pages as necessary):,��
Reviewer/Inspector Name f d E(;au `"' "`M x £gI Phone: O — t ,�
. �,�
Reviewer/Inspector Signature: ��,,w,( Date: Z.
Page 2 of 3
I
Continued

Facility Number: 7J — Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
❑ Yes Zo
o ❑NA ❑NE
ElYes ❑ NA ❑ NE
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
V N
❑ NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
l No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
[I NE
29.
Did the facility fail to property 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
��o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
& Nc
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or. Drawings:
Page 3 of 3 12128104

a
Dtvtston of Water Qua it
Fac�llty Number j � S(� 0, Div► ion of Soil and�Water Conservation,,
� �
Type of Visit
Cotnpiiance Inspection
0 Operation Review Q Structure Evaluation
0Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: j 313�/Q I Arrival Time: Departure Time: County: bUPL21i Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: &4-i y 'tlbo0r, I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = ![ Longitude: = o =' E__1 "
-r Design Cu"rreni b
me,,�y ., Capacity Population Wet'Poultry`
Wean to Finish`
❑ Layer
Wean to Feeder
]❑ Non -Layer
Feeder to Finish
i I S 7r0
k_; ;:xe,`
Farrow to Wean
Dr�`y�Poultryr
Farrow to Feeder
R
Farrow to Finish
Boars
:. Z
ter 4
Other
S77
t�7 Current
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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?
U Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
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 dNo '❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
El NE
❑ Yes
El Yes
❑ NA
❑ NE
❑ Yes
Ko ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

l
Facility Number: — S6 Date of Inspection 3d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes dNo
❑ 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: CA(,=/J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2�No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
_,(
El Yes V 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 tt reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
12No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
J: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)
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
e o ❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
WNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I(J No ❑ NA
❑ NE
Comments (refer to question #): -.Explain any YES answers and/or a©yrecommendations-or any other comments
Use &awings'of, facility !o better explain situations (use additional pages as necessarv): =
b) J P ()Ai (r- WUP rDO-- 5 4 hA AtJVPk AL
Reviewer/inspector Name D �� �, P, _ ;I Phone: Ib - A9
Reviewer/Inspector Signature: Date: 311 b
/10
Page 2 of J ,­­-.... I.-

Facility Number: 3 — Date of Inspection 3 v
L Re uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20.
Does the facility fail to have ll components of the CAWMP readily available? If yes, check
E(Yes
El No
❑ NA
[I NE
the appropriate box. �WUP
❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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
[Alo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Xo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Zo
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Vpq o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[(No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
26No
❑ 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
El Yes
,7No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
/No
❑ NA
❑ NE
Additional=Comments and/or
Page 3 of 3 12128104

Type of Visit Qr7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: O Arrival Time: 3 U Departure Time: County: DUPC rJ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: `) y Title:
Onsite Representative: i�rJ_ (_-
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 d = Longitude: ❑ ° ❑ 1 ❑ «
Design
Current
Design Current
Design C►urrent
Swine
Capacity
Population
Wet Pouitr�y Capacity Populatian
❑ Layer
❑ Non -Layer
Cattle Capacity Population
ElDai Cow
❑ Dai Calf
❑ DairyHeifer
Dry Poultry
❑ Layers
El Dry Cow
ElNon-Dai
El Beef Stocker
❑
❑ Pullets
El Turkeys
❑ Beef Feeder
El Beef Brood Co
Other
El Turkey Poults
❑ Other
❑ Other
Number of Structures:
❑ Wean to Finish
El Wean to Feeder
® Feeder to Finish
El Farrow to Wean
� � $ Z6
�l70Q
[I Farrow to Feeder
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
�No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El 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
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[I Yes
�o
o
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Date of Inspection
Facility Number: —8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
Cl NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: U4G-vi-J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3r7
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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E(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 0/1, o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7No
❑ NA
❑ NE
1, ) ALE C- Q , u 0 V-IC.,= u Cs OJO wn<.e w ALL CYL0 91 o N .
Reviewer/Inspector Name c �} (G -� Phone: f } -71 C -239 9
Reviewer/Inspector Signature: Date: Lf. o

Facility Number: ( — S(o Date of Inspection t. a
Remuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�'No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
�(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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?
ElIJ Yes
_,(
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,��
ICJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
io
❑ NA
❑ NE
Additional Comments and/or Drawings: ...
Page 3 of 3 12128104

Facility Number 31
$0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit QS Cpmpliance Inspection Q Operation Review 0 Structure Evaluation 0 Technicaf Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I--1 Departure Time: County: - jK�� / Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 81LA i JJ Uri [,. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =]' 0 Longitude: = ° =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 115 7A 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: El
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 ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Ye
N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

A
Facility Number: 31 —$ Date of Inspection i
Waste Collection &Treatment ,_.,/
4. Is storage capacity (structural plus storm.storage plus heavy rainfall) less than adequate? ❑ Yes LS! No El 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: U4C-yG)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) , �/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes l.d 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 Zo
ElNA ElNE
8. Do any of the stuctures 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 E3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement? ,.,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LYNo ❑ 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 EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o ❑ NA ❑ NE
fN
ElNA ❑ NE
❑ 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):
2J,) UPOATe Moo '3rt--uD rop.tM..
2k) 5v(34il-T NAt�GE Or OZC
Reviewer/Inspector Name d N I Phone:.(916) Wo —TM
Reviewer/Inspector Signature: Date: aha
r 711sin,r r .,..;.....a

Facility Number: '31 Date of Inspection c 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
21. Does record keeping need improvement? If yes, check the appropriate box below. L'J Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee ly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El 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? El No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L!fNo ❑ NA ❑ NE
❑Yes CJ� ❑NA ❑NE
ElYes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L"J No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
O"Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2'No
❑ NA
❑ NE
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
3l. 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
EJAo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
[r No
❑ NA
❑ NE
❑ Yes ,[Jo ❑ NA ❑ NE
❑ Yes 21 o ❑ NA ❑ NE
❑ Yes P4. ❑ NA ❑ NE
Page 3 of 3 12128104

Facility Number. g
Division of Water Quality
0 Division of Soil and Water- Conservation
O Other Agency
®tea
Type of Visit to 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
i
Date of Visit: td Arrival Time: Departure Time: ounty: ? GZ,,./ Region: O
Farm Name: l+G AG/n9 2 27— LGC Owner Email:
Owner Name:l=/n�%� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �f�l�`���>2 Integrator: ��,D3,c3�OlZO
Certified Operator: Ali�f 1�����—� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E__1 0 E--] ' = Longitude: = ° = I =
11
Swine
�' ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Design Current' Design Current Design Current
Capacity Population Wet Poultry Capacity "Population Cattle Capacity Populatio
Farrow to Feeder
Farrow to Finish
Gilts
J
U Boars.
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
❑ Dairy Cow
Numb
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
�
❑ Beef Feeder
❑ Beef Brood Co
er'of_Structures:"
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No
[3 NA [I NE
❑ Yes No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5
❑ NA VNE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA �NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ;2TNE
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 7NE
S. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes ❑ No ❑ NA 7NE
(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 XNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes ;YNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window /7❑ Evidence of Wind Drift ❑ Application Outside71,1,
ea12. Crop type(s) �FI �(t�(JG G�+�%!7C/�4
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ElNo
ElNA
ElNE
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
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. l
Use drawings of facility to better explain situations. (use additional pages as. necessary): 1[
N7
Na cQiP r�rc j�J'1f�C G C.-�i¢-zi✓ J'—� �s �. iJi
A000e
Reviewer/Inspector Name 72,o '1,3 1 Phone 0 l��p 1c3z
Reviewer/Inspector Signature: Date:
Page l of 3 12 8/04 Continued
'k/o-'Z-

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes []No ❑ NA J[J NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA NE
the appropriate box.
❑ WUP El Checklists [I Design [I Maps ❑Other
/16
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA /0NE
❑ 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 XENE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ElNA �N
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA XNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NANE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA ZrNNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA JQ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Xyes
ElNo
/
ElNA
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA [;INE
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 PINE
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
gNo
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
���,,,///
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
LG No
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yess
XNo
❑ NA ❑ NE
Addition al.Comments and/or Drawings:
��ti �GZF
Pit ri .� ��- 3s .��f Jo / 7, lj-r✓t
S.
L"Afr-
Page 3 of 3 12,,2&04

Facility Number: Date of Inspection ?J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA yJ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA /1NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
P! Yes ❑ No
/❑ Yes ❑ No
❑ NA XENE
ElNA �N
❑ NA XNE
❑ NA 4E
❑ NA ONE
❑NA NE
❑ NA
❑ NA PINE
❑ Yes ❑ No ❑ NA /�NE
❑ Yes gNo El NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yess 0 No ❑ NA ❑ NE
lA�
Jo v� �ypR���s, ���o T B�
7 4 1/ 14 V 4OC
Page 3 of 3 12128104

ArDivision of Water Quality
Facility Number O Division of Soil and Water Conservation
- — — — - Q Other Agency ii// .
Type of Visit 0Compliance 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: D Arrival Time: O Departure Time: 'pQ ounty: Region:
Farm Name: Owner Email:
Owner Name:/Y1 ��C Phone:
Mailing Address:
Physical Address:
Facility Contact: Q �,�% Title:
Onsite Representative: /1 QCE2- � `�/��i�
Certified Operator: 40 A/ —_Z %
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = I[ Longitude: = o = 1 0
di
Design Current Design Current, Design Current
Swine Capacity. Population Wet,Poultry Capacity Population Cat[le Capacity Population' e
Wean to Finish
❑ Layer
Wean to Feeder
i ❑ Non -Layer
Feeder to Finish
AIQ, 00Y'
Farrow to Wean
D Point ry
ry
Farrow to Feeder
i
El
Gilts
Boars
Other_
❑ Other
La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [IApplication Field ❑ Other
a. Was the conveyance man-made?
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
Number .of..,St
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
tares
❑ Yes WrNo ❑ NA ❑ NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [IApplication Field ❑ Other
a. Was the conveyance man-made?
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
Number .of..,St
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
tares
❑ Yes WrNo ❑ NA ❑ NE
❑ Yes
Number .of..,St
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
tares
❑ Yes WrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes VNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: `j5 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 ❑ NA ❑ NE
S ructure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?: D
Designed Freeboard (in): 2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;I No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No ❑ NA ❑ NE
0
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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA ZNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) G C� s� ��r �vf�SG�� 11&/211't
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[I Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
OYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9f No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
>iA 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):
,rf 5 F�+O Al} Ss LC��X"C AL0 �PyS S dC�/%./ 7s G�I�RD✓
�
l",2f 54AJ r19
&4—
Reviewer/inspector Name ,
l Phone: G%/1%
Reviewer/Inspector Signature:
Date:
Page 2 of 3
12128104 Continued

Facility Number: Date of Inspection.
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 )ZNo El NA El NE
the appropriate box. ElW-up El Checklists [IDesig
n El maps El Other C,l�v_
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes 0No ❑ 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 PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ZNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IVNo
PrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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
1P
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
No
X
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P(No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A�
2 r �i.Ff; Lt/ EF_�l��r� ©f✓ '`yPl,�° ✓�� Q�''� ` 7V O� v d �
���" / `��5' ✓/7i/tP% �" fr / ����i(7�G' 1 ��//�/�' �` �� � cG'r� T'!T"�f1DD�jiP'
Page 3 of 3 12128104

r
tiodwed' FOR IR 2
Lagoon I_kIt M Inigat Record
One Farm for Each Fte.- Ow Cmp Cyde
ill
Trac
Field Stae fwe%o saes)
Farts Orr
Owners AWN
I. ,1. -.l
Fadity tNr tw
From YVeete tltirlseOM Plan
Gap Type r� ,y Reoam�ended PAN
AS
:] - loadYg ltblaae) = {17i
rn M rat Ilit rat rn M% rat flat till
MIMI
in , MIx
F - M. -, M
-----------
-
--------------
Craop Cycle Totals Tow PM I . -J
Owner'srteture Operator`s Sipnatura ilk
CertlSed Operat t pN) _ Operator CWdSCatlon #
Weather {'.odes: Cam, PC -Partly Cloudy, 043audy. R4ia1n, SAS wwSleek WWktdy
Persons eompletlrq the trr4atiM kmpedkxm must Initial to sOft that klspactlons Wee oomph tad at leas! every 12o minutes.

modaw TOR , R-2
One o Form fear E M Per CroP CYcle
Trac
Field Size (wafted aaes)
Faun owe
Owners Addre
Owners Phan
Fad► Number -
From t+iraw ullummlon Plan
Crop Type RecommmJod sm. L'RA;AJ =�1 �
r.► n► n► rn rs► ra► nt rnl 1101 rtns rtt►
Crop CW* Totals - - Total PAN
Owner a Slpwum Operators Sipnaturs
Certified Operator (Print) - -- Oparatar Caffka ton
' Weather Codas: C-Gear, PC-Podyr Cloudy, CI- Nm*, R-Rain, S-SnwdShmt, W-wb*
" Persons oDmpleflflQ the hykp lan hrapactlans must trtift to slanlfy that inapacWm were completed at least avary 120 minutes.

&WOMW r%P-W IKK-!
• i
i WM i KAW iaw � R QW
Or+a Fo�etM !or EacA 1 ,�er Gop GycJe
Trion
AW She t&Ws i +cam} •
Farman OW
ownw% Addm
Fmdk rwrM«rr � � - ��
l
wpow
W loop o wom
%ft tfl
ova DOWN a 3 — D
*weid PAN
) -
a a m 0%
� � f
Mkaw Cody: C-aw, • `^" (U* O cb*, ii 4*4 &&M6 nb* W40*
"ftM nol- I at hrf QWV 120

� YY :"A�YYcrr
K7 lM-2
lapoon L.qud 1" } Fula' Racwd
One Form tw EvO 1 pw Cmp Cycle
fH
Teat
SW Sim bv@dW smo a
fans ow
OWrwe Adds
Fdti low -60
r+b.uon QOMMor R H ge ICA
A�Iera�
gwwoft FN N P vej
Flmw YMasm udbow "m
toov womo - ml=
!11 Isil tat m an rn an a% Hst fill
CRUMB
m-mmulm
mmmmmm
Em
m
L
�mmm
m
cmPOMds roar. f TOW PAN
omwa s+pn.rN. Llparelors slp""
Crflad up in ( OpwoW CwUecnWn 0
• wedh.r Coaet c. w. PC4%ft Cb*. .I 4Wk l ammol sK way v*
"POW er WIN oft I ped P m W bW b dw* f1Al kII11A4M amnr plebd al hm! s" 12011111M 1

■rues rf�lUlf eht�c-i
4
One Fom for Ent bid pw crop ode
(1)
TM
Few S s r■s.e ROM} _
Fsm om
owrr«t Adism
FNWN.► _ b
Fran Maaesr tlr3 dbm p n
Crop T)" cSM tr Los"r N a7-r
Q} (3) M) ray fm m m 0 Out (111
" Pwom mpols lip ft mutl Md to so* tm kwoodom npl Im 1 M bm &my 120 wkwwk

a9K-z
lapoon Liquid by �Fl� RKo(d
Ons f onn for � ro psi Crop C.yde
�y
ttn
Tree
hN Uo hws1.d MC M!
Faml om
fw tmwdw P .[:==
r
FMM Mob t1oftom Pka
_ L sir). GSA;I.1 'AAVM pq r
US m (41 an 0 m r101 V t!
" P�p I'm 0101r 0 h N tOm I'MclinM MOWN b ab* Mt kw*w*o wp rim Mew" t20 m u l

Modified FOR. )R-2
Lagoon Llqukl Inigat. ,fields Record
One Farm for Each Flew Per Crap Cycle
a4�
U11
Trac
F*W Sho (wetted acres) ■
Faun Owr
FacOy N rrim
Y, VIP 3 F 2 MM,
�From V hwM Ut andon PlanCrop
Rawn PAN
Type -S'" �'-�Ar'�i i tag {Id'aae) - (B) _
Hl rw� M MI rill 171 rAl All r1Ql till
Owrlees Signature,
Certified operator (PrtM) _ _ _
Crop Cycle Totats I
Total PAN I
operator's Sipna4ure
operator cerMcatlon #
• Weattler Codes: C-Clear, PC.parlll► Cloudy, q-f b►*, R-iW, S-SnoWSlaet, w-Windy
`l » Persons compietlng the kr%p lon Inspecllons must Fni W to soft tlrst hapeetlona were conipieted at bast every 120 mEnWaL

rA
Ie
Facility Number �5(a
(6'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
L
fVisit QfCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 a$ o(o Arrival Time: o7-s Departure Time: County: Z)OQL?_-►✓ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ZA 6 C a- (J Ntrc 1 F .k Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o [= ` " Longitude: = o "
Design Current yDesign Currentol Capacity :Population Wet Poultry Capacity Population Cattle C pacityK Pop lu atmn
U Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 111,32,0O
❑ Farrow to Wean I
9 ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars I
Other,
❑ Other
Non -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
[a Beef Brood Co
Number of Structures:,...'; C
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes 'K. ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — 5 Cv
Date of Inspection 1 3 v
Waste Collection & Treatment
f
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
[JJ 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: r! abnj
Spillway?:
Designed Freeboard (in): a -1
Observed Freeboard (in): L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E✓J 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
[a No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2No ❑ 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
WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IJ� No ❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
n 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 ElApplication Outside of Area
12. Crop type(s) C4-js 13 (14 -� ra Gy t/iq
13. Soil type(s) fJ o rt 6 1, K f tJL6 q J.LI.t"4 _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0"/NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,,0-*No
tSNo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
L 4
❑ 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):
A rLh"_ Ntj o CrGolrl A S (_. ) 01 C1 G b-0 0
Reviewer/Inspector Name I -J ,s 1413 f q a-t/ L U,� Phone: 1 /b 7 ri � - ?a
Reviewer/Inspector Signature: Date: 3aejo

'Facility Number: Date of Inspection 3 a (O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �A ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes LI Co ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �jN�o ❑ NA ❑ NE
25. Did the facility fait to conduct a sludge survey as required by the permit? ❑ Yes ❑ N ❑ NA IQ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�,!
L/Zo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i'' 1 1r
Type of Visit O Compliance Inspection Q 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: S g5 Arrival Time: Departure Time: I &s� County: 0&10P Region: "Ie
Farm Name: A, --A Al 1 Owner Lmail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:�l�����T J����%��L Integrator: �����a-
Certified Operator: _9D/'.1L.- Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = 0 = A Longitude: = ° = I I=] "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
_ I 1i 10 Non -La et
Other
❑ Other _ -- -- - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ UTkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: 0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes m No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

a . .
Facility Number: 31 Date of Inspection �' O
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: ;V/
Spillway?:
Designed freeboard (in): 2
Observed Freeboard (in): 90
❑ Yes '0 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.)
10
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
/2fNo
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 A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )No
❑ NA ❑ NE
. maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /ZNo
El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground [I 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 Drifi ❑ 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'0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ZYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;
❑ Yes
A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U�No
❑ NA
❑ NE
�jrOU240 GZ*w- tile 1�asc�5 8
0
to
Reviewer/Inspector Name ��� R ' �° Phone:
Reviewer/Inspector Signature: Date: p
12128104 Continued

. .
Facility Number• -4f,jrp Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VrNo
❑ 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
to
[A 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'0 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over. application)
IV
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EZNo
❑ NA
❑ NE
Additional _Comments,aud/o°r Drawings
l� �pirr�- �<-� .log,► ��DG ��� �� ud,4 %Ds,
o �ocv C��s
to �av� AV4r
12128104

Type of Visit J3 Compliance 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: 5- % 4 Time:
3 S
O Not Operational O Below Threshold
Permitted © Ce�fifiedl 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: ��% G�/� �[� a.... ...... ............. -.... -........ ..... .............. Coanty:...L.l2......................................,
Owner Name:..1 � .fr�..ike _...__. ...........� - Phone No: ............w
Mailing Address:
FacilityContact: ...... ..... ..._................ ..... ........................ ......... W_ Title:................................................................
Phone No:
Onsite Representative:
ir
llIntegrator:
�.....'Q�1
Certified Operator:
Location of Farm:
Operator Certification Number:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • ' «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.___. .. __.... .. _.... _.__ .... _....... .
Freeboard (inches):
12112103 Continued

Facility Number: -- �' Date of Inspection
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 Application
10. Are there any buffers that need maintenance/fnuprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessh
12. Crop type
13. Do the receiving crops differ with those desigfiated in the Certi
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?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the,facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
B� LF4 Ky R fr)r o I?- 2c6D,
J W�rz* Oaer 7;P/-=•
❑ Yes VfNo
❑ Yes VNo
❑ Yes RfNo
XYesJXNo
❑ Yes JA No
❑ Yes ZNo
❑ Yes XNo
❑ Yes J2] No
❑ Yes EfNo
❑ Yes [!I No
❑ Yes EfNo
XYes ❑ No
❑ Yes 21 No
❑ Yes XNo
❑ Yes to No
❑ Yes ?No
❑ Yes INO
boas -o F any other commence.
wry) ! 1 I Field Coov C7 Final NotesT
157o'- 84
IV2
23 -MEeo -ro /iexpop-7- &.o -_Al OF/
-71
Reviewer/Inspector Name
Reviewer/Inspector Signature:
�t71 SIG
12112103 Continued

r Facility Number: : S6 Date of Inspection S 4
Required Records & Document;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 8'No
22. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie! WUP, checklists, design, maps, etc.) ❑
Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No
❑ 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
P'fio
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ffNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
9TNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E'f10
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ef No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ONO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ONO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Cj No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

t)_
Type of Visit T Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit/ Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Time:
10'Not O erational Q Below Threshold
ermitted O Certified 0 Coonndditionally Certified] 0 Registered Date Last OperateAor Above Threshold:
Farm Dame: I �i!�L�12/Yl , vp. l/ County:
Owner Name: ,v Phone No:
Mailing Address:
Facility Contact: /�/Tjitle: /f�FiSZirie i�o
Onsite Representative: &z� � �/�] omma. `' ` �Zrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Hors, Latitude �• �� Longitude �• � ��
Design �, Current Design Curretst Design C©rrent
SWtne�
Ca acity Po nation ;_ Poiiltn_V_Ca aciri . Pu iilatiori Cattle .. ?Cs achyPo ulstion
❑ Wean to Feeder < ❑ Layer I Dairy
M
Feeder to Finish I [] Non -Layer er Non-DaiEX
Farrow to Wean
�,a ❑Other y � � �"
❑ Farrow to Feeder
❑ Farrow to Finish. _ Tnral.t�rciam t'ssari ;. �e
❑ Boars
Total SSLW
I
r0Number of Lagoons ❑ Subsurface Drains Present 11[lLagoonArea
5 rav Field Area
"Hording Ponds`! Solid Traps �� ❑ No Liquid Waste Management System
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 ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, 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?
/Z
❑ Yes
Waste C9llection & Treatment
'VNo
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier:
Freeboard (inches): 17-07
05103101
Continued

Facility Number: — Date of Inspection
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? El 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 PNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes to No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 517"f No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application! �❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overloa4 ❑ Yes No
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes A No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
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?
XYes
AO
16.
Is there a lack of adequate waste application equipment?
/❑ Yes
0N
Reauired
Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
/No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
ONo
23.
Did Reviewerfinspector 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
VNO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commentvoefer to�quespon #) ExpWn aay YES:�at�ers anwor any recommendations,br anv other comments:
Use drawings of fad*, to better explain situations: (nse addttionsl pages as necessary) 1 ❑Field Co pv El Notes
2�C19fJ RA SS CO F_/t 9N 6Nary fiRGq5, o5,cobi
Cu-r5 �AP PJ E F O FzuL.F-+O !SF-
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: (%
05103101 vi - w I Continued

Facility lumber: Date of Inspection
dor 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 property 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?
Additional Comments. and/or_Drawiags:,
. x
Ovizv&aa o 'R ANi= r� ,
-v
rO 6E-
14PP
v ccrvrF,.,.o / 0 wARpS
fJF60 7002 Soz[_ �� 5 c f\�QDR i -C%Zh� ��GO►2 A s.
7��m` 1 ' If -3 6- - / -3 �'�f
05103101
❑ Yes ❑ No
❑ Yes XNo
❑ Yes x No
❑ Yes t /I No
❑ Yes [ No
❑ Yes X-No
❑ Yes ❑ No

I7ype of Visit A Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: /' /`7— D/ Time: %D �
Not Operational Q Below Threshold
APermitted © rtified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold-
Farm Name:...... .. Q................................................................................... .......... County Jp ..
........... . .
OwnerNamc:....� ]A 1 Y. ...................... .......... .�7 �.!�! .. ................. Phone No:................•...................................................._...............
Facility Contact:
Title:
Phone No:
MailingAddress: ................ evl�......._...................._..................................... ��......................................
.........`.....................
Onsite Representative: ,'"I(11Y �e ...... I+c..i ..... lntegrator:,,,,,,,,i, dYPt
Certified Operator—
„ ,,,,, .... Operator Certification Number: ~]
r{h 44- t�'F
Location of Farm:
KSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` �4 '4 Longitude ' 4 .6
Design . Curfent
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
l 15Za
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagobps i ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System j
Discharges & Stream Imp
I. 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?
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
AA-
[] Yes ❑ No
❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ((No
01/01/01 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes (XNo
Struct e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
. Aft�.............................................................................................................................................................I........................
Freeboard(inches): ........... 00..lg 6......................... _..................................... .................................... ................. ................... ..... I ............................
..
..... ....7
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
XNo
8. Does any part of the waste management system other than waste structures require rnaintenance/improvement?
❑ Yes
9'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ 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 (CAWMP)?
❑ Yes
J2(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
EXNo
17. Are rock outcrops present?
❑ Yes
XNo
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
No
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KNo
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
gNo
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5&
23. Did the facility fail to have a actively certified operator in charge?
❑ Yes
5No
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes $,No
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
26. Does facility require a follow-up visit by same agency? ❑ Yes No
27. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes NrNo
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes A
No
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P!kNO
01/01/01 Continued

Facility Number: '�� _ . Date of Inspection ) 7 Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PkNo
roads, building structure, and/or public property) 4NO
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
32. 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 XNo
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes x No
113 No violations or deficiencies were noted during this visit. You wiil receive no further correspondence about this visit.
Reviewer/Inspector Name 5
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
Date:
01/01/01

Facility Number Lagoon Number Lagoon Identifier1ib
J6 Active O Inactive Latitude & ©� Longitude
By GPS or Map? GPS ❑Map GPS file number: I Wp 11 -7 /,6—
35. Surface Area (acres):
36. Embankment Height (feet):
37. Distance to Stream:
38. Water supply well within 250 ft of the lagoon?
*On -site ❑ Off -site
39. Distance to WS or HOW (miles):
40. Overtopping from Outside Waters?
41. Constructed before 1993 NRCS Standards?
42. No verification of adherence to 1993 or subsequent
NRCS Standards?
43. Was groundwater encountered during construction?
44. Depth to Groundwater:
45. Spillway?
46. Adequate Marker?
47. Immediate threat to the integrity of the structure?
48. Freeboard & Storm Storage Requirement (inches):
O less than 300 ft O 300 ft - 1000 ft X19reater than 1000 ft
0,Yes O No
k5
05710 0>10
O Yes
XNo O Unknown
O Yes
XNo O Unknown
O Yes
%No O Unknown
O Yes O No #Unknown
J�Unknown
O Yes x No
Yes O No
O Yes jg No

'WDivision of Water Quality
_ Q 'vision of Soil and: Water Conservation* -
0 Other Agency,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit* �'1-imI—LZZ+�J
e: Printed on: 7/21/2000
Facility Number
�- -OC7 0 Not O erational 0 Below Threshold
Permitted [3C rtified 13 Conditionaly Certified 13 Registered Date Last Operated or Above Threshold
Farm Name : ........ ................ .. 1 ...:.................................................... County:........---.h..f<t.V
�, .1t! ..... .......
Owner Name: Lt �iL�-�.. ....... ...l.i!✓LQ Phone No: 71 a9..r.cZ tl
Facility Contact: Clgay-.L_.......... :�11 ........Title:.....OX 111.E .. ........ Phone No: ..................................................
MailingAddress:..........................................................:.:............. ..---...................-........................................ .
Onsite Representative:....!'s!_.-t........5�'L�Integrator:......./:.f�Vp.....f�.....
Certified Operator: _.! [.rvf......... M.-I... ................ Operator lll
Certification Number:.................
Location of Farm:
❑ Swine ❑ Poultry []Cattle ❑ Horse Latitude ' 4 •4 Longitude ' 6 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer L 10 Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag^-n Area ❑.Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste :Management System
Discharges & Stream Impactti
1. Is any discharge observed from any part of the operation? ❑ Yes <No
Discharge originated at: El Lagoon El 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)
c, If discharge is observed, what is the estimated flow in gal/min?
d, Does discharge by pass 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: ..........4 .L&.......................................
Freeboard finches):
5100
❑ Yes
❑ No
❑ No
❑ Yes
❑ Yes
W40
❑ Yes
KNo
❑ Yes VNo
Structure 6
Continued on back

Facility Number: Date of lnspection Printed on: 7/21/200
5. Are there any immediate threats to the integrity of any of the structures ob erveP(w/rees, severe erosion, es
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 Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of -design?
21. Did the facility fail -to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. Nd-iliolations:ot- deficiencies were noted•diWitig this:v AL- Yoik will -receive fio further: -:
correspondence.ahout:this visit.-.-. .•.•.-.•.-.•.•.-.•.•.•.•.•.•.•.•.•. -.•.•.•.•.•.•.•.•.-.•....
...
31
Yes ❑ No
Yes ❑ No
Yes ❑ No
❑ Yes �11No
❑ Yes 1qNo
❑ Yes 1(�No
❑ Yes JdNo
❑ Yes �No
❑ Yes -05No
[]Yes <o
❑ Yes )�No
❑ Yes IxNo
❑ Yes 'Pio
❑ Yes YNO
❑ Yes
YesjNo
No
❑ Yes Nk".1No
❑ Yes No
❑ Yes No
❑ Yes `' 0
❑ Yes FJAo
-
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):
r
/Jir��sT.�.f�a -- s 'w`�t,� i� S°'°� • �`�C 11., 1lJ !2r A
iReviewer/Inspector Name
Reviewerlinspector Signature: Date: - / 5/00

Facility Number: bjZ . 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 Wor 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 KNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property) \\
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes El�o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes fl�No
Additional Comments and/orDrawings:
7, S) OLtIvre-PI;+44v aMoJtVL�- /J/j-�-0567r
Y
6-A
rvYL
sk
4�A
�P�f S S Vyv"- s V
AS
U-r
5'� 'thlwuo�-1 .
.(.� V v�evt�' Sy Ca v�
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Lk CY -94U!SS JV--F--
V V, i U11VV4, S-ta
PWIS� .
szv
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O' S
5100

7/25/97

Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 9kGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number
Date of Visit: — fit) 'firne: � `. S Printed on: 7/21/2000
/
,,........ O Not Operational Q Below Threshold
Permitted [3 Cert' ted E3 Conditionally Certified 1 Registered Date Last Operated or Above Threshold: .........................
TV Farm Name: Q I..(e./I,� Z County: Lt{I1 ..............................� .........
.........................................z
......................................................
OwnerName :...... ho.a.K............... .... :+....✓.................................... Phone No:......................................................................................
Facility Contact: .............................................................................. Title:................................. Phone.No:
............................... .......................
MailingAddress:................................................................"..........--".".."..............,............1.............../........................................."..(.f.�../..............................
�.0 l �rzq f- j%1 T["Ad Integrator: :.............".l %l ei // ;1/1..............
Onsite Representative:...........<}...Y..w�(.� r .........."..............1... ...: f�U , rj't�................................................................. ......
Certified Operator :.....
&JY!(/Gi......................... Operator Certification Number:._".
Location of Farm: /71,m mj leA l
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �• Longitude �• C�` �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
❑ Feeder to Finish JEI Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish L I Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagllon Area JEI Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Pq No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes rvfNo
Waste Collection &'l'reatment
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 b
Identifier:.................................... .................................... ...................................
Freeboard (inches): + ��
5100 Continued on back

Facility Number: Date of Inspection I_I_=.�_L: V� 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 maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes ❑ No
11. Is there evidence of over application'? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑ Yes No
12. Crop type S
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 ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
jgNo
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
R(No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0; NoM61atiotis'ot- deficiencies •were noted cutting 4his:visit.'- Yoit will -receive do further -
corres oridenC, e: aboutt: this :visit ..... ::::::::::::::::::::::::::::: :
[Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Udrawings of facility to better explain situations. (use additional pages as necessary):
C u fL fZErt-v -,CxC e- -r D
r/+r,Lu(L� e� II�fc�UPr7"tc S�/s`��M . ?QvPos>� f(,q5 c"3 Ery sS�(Sr-firi�D
f-b,t: CanL57`2ueTt Dr,(
v-f- A Co N [jCN'r'0i r ere— L /-6 i90N -i— S P4iYy s y s Irc- ',
Reviewer/Inspector Name
Reviewer/Inspector Signature: d�_ 1� �� �'/ Date: / --2--'7 -peg 5100

•Facility Number: 2J — �� Date of inspection ]% -Ov 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) ❑ 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 ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
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? ❑ Yes ❑ No
Additional omments and/orDrawings:
1 His W its ' +2Ie-F- r` ECC7_ 10%,( TO
ox-L�E2�S �3aLc- i�.PRRyiN j aTt
5(Q to W- W Tf-{ ST-s z H UJ /JTG2
PO W D -Oue�-
/Z c..c r- S
LJ 6-2U2at16 i"Kp-T T�i(✓`�[�
R
5100

Q'Division of Soil and Wate-r'Conserrahon,=:Operati©n°Review
-- A
5' - "� Dmseon of Soil and Water Conservation = Complrance Inspeetion,�� ��` �- �. `� '' �-�-� �_
10 Routine O Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review JO Other �
Facility Number Date of Inspection
Time of inspection j 24 hr. (hh:mm)
*C—rmitted {'] Certified 0 Conditionally Certified [3 Registered JEJ Not O erational Date Last Operated: ..........................
Farm Name: .........ap1! . ! ............... ..... .5.. .... .� . County:..""..... �r�., . 1.�f1............. ... .._.....
. I G
Owner Name: ��eL.4............. ..................��Pl��!�r Phone No: ........!.�..:�.3..". �P....... "........ ..... .................. .... ..". ....
Facility Contact: V1� l' ► Ll� :!LL.....7�� Y nr� icy. Phone No: _.. �..��.5"7,1� r i
itle:................................."........................ rJ
MailingAddress: ..................... ..................................."....".............."........................................................................."......".........."................................. ..........................
Onsite Representative :......... �......."..V �n�ir { �r Integrator:........O.O.-I&ASker,0..... 1h�
......... "......-"".- ".."..."
Certified Operator:................"......................................."....."..."..".......................................... Operator Certification Number:
Location of Farm:
...."..........."...............".........."...."........."...................."." "........ "..."..........".........."."".".. .
Latitude 0 t iA Longitude 0 ° 44
.Swine
Design Current'
- -Canaeity Population
❑ We to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Cterrent m = Design ° " Current'. .
Poultry Capacity _Population -Cattle Capaci Po`uiatioII
❑D ❑ Layer airy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design, Capacity,:.=
Tow SSUW , s
- Number of Lagoons _ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
'Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharaes & 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)
c" If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (II" 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): .......... oo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
tructure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
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?
&. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
.:Y Z)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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 ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rettuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �'Vo yiglatigris:or deficiencies were ngtea during �his:visit; You :wi�i rein ... . further. .
correspondence: aboek this .visit:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer b guesaon`#): Explain any'YES answers and/or_any recommendations or any other comments
Use drawings of faculty to better;explain situations (use addthonal -pages-assnecessary)
�+�rtlry ci drirti-5� 6�I 4D ►4- k)giS 045erV-( . 4kU_t 51rA/ atr:aftli&K tt/ivt4 AL
4k-jac 4etI. �. T1aC - - �t> -{;okS aW-k ,.Z+ Saad .Fa.- S�v-&yr' 1 . edS ^rf- -et -.�f4—t
S-L4-,,4ci� CLAM Arb Cam+'&^_A CAu440(-e#11 tt"S. Fj>.%W iS O J50 c cpccJ-'d Avot _ (V ti,
Tom t a La v - {
5 k�•5t S w + �t,� � a� �1i r��., � c to roc rtt-l� . f;'--
11��.Q�-r' d`� it��� �� at. -ecru �-f ice$ 1�•atti;rs
wit\ ^_A_eLAv 41— V'A YY_+ tag -pit- 04-0-61y S kka,-k- WV4A P AA a
Z -to 3 " I &t lL. s i h kO 14,r-no , Ao nd , 41-,&r< ; s +11"14 r OS a 1, -rd , - sa f'AWi ru +dA ►. • •
Reviewer/Inspector Name
Reviewer/Inspector Signature: „ „ '� A_" A N Date: 7 1L 7jn£

Facility Number:` j — Elate of Inspection 1 7 2
44- -,M.� o-F .17 WQ r4p re ,fir,.. 40
QlAC,tj-r- 40 ip'C--F l Wtw.td \44 l
�� -{� n,o � - sa.�,ti�Fab�,e. �•( �-fi �s �r: kt ? t r d�oi S�-�-
~�
Eft►n+ Gbtpts 6aro YVU, IV 40 �rY��to� }\��ry►� �1-� CL.�r,r•C4
C �.c Vwv . : c�Y� Gu m IWO Q,
Co-y-bQ; 4,�m5 w� - �,r,..! s ►�-t ,
/(a 5ffiytv� of vtks4,c—
are cL+ t !�Ly b es+ i
•Olavr Ac,V,",ClC-ff — -�) J Wp
3qo0 -ea aa-S
Olt
6 V,5 -e (2— C)I,-L s j
re
4tit, Y- %cavv-e.
7/25/97

Facility Number 3 S Date of Inspection i OCJ
Time of Inspection l i S 24 hr. (hh:mm)
© Permitted [3 Certified 13 Conditionally Certified © Registered 113 Not Opera Date Last Operated:
•"�
Farm Name: ............ County:......UA9.1.?..... .........................................................
..............................................................................................................
OwnerName: G i c� , r ......................... . a Phone No:.............................. ......................................................................
Facility Contact:
........................................ Title:
MailingAddress; .....................................................................................................................
Onsite Representative: e �%� k r �G�e� WA ee 1 e. f
............ .. ........................... /..............................................
Certified Operator:,,,,,,,
Location of Farm:
....... Phone No:
Integrator: ..... G 5 b.o' c ................ ...............
Operator Certification Number:
Latitude ' & 46 Longitude • 6 46
- Design Current-
_ -:Swine-, Canaci6, Population
❑ Wean to Feeder
Feeder to Finish
1 d
2 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current, = %Destgii:,:. _ current, .
Poultry Capacity :population, Cattle Capacrty `l'o ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Degign. Capacity=
':Total `SSLW�".
V.. Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ElSpray Field ElOther
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 systern? (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: I
Freeboard (inches): 27.5
`. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
\'23/99 seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back

Facility. Number: 3 1 —B$ 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 maintenancelimprovement?
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?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
�z�aa
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Vo yiolaiions;oir• deficiencies mere nUe#.OWirig this'visit:- Yoe wiil•feeeiye Alt? #'urtlter ; "
;correspondence. aboett this visit. .. • . ........................
... . . .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes S No
❑ Yes ❑ No
❑ Yes ❑ No
Comments referto uestion'# : Ex lain an YES answers and/or any recommendations or, any -other comments:
•Use drawings of facilty to better explain situations '(usi ;"dihooal pages as necessa r
r3
7�tspe�� d� Cov�clv0a.� 4o Obsev le- h,41A "--t :) Pa-,ei1 s;40et l0-, ,
NOTE S-lo��"� 'rha i/( 6e t't-La+.rOeGi -�o co��re� Lvecds'�o
!/lid ;r� 1r�s�OcC ion . Tyt;! w.11 al[at„�T-�- eatSlc� p�e-��a-� iati L
1A 41,c y Qe,: re .
,J, TE: All Gl eavto(,4 fiOC.s .0,1 44 c, %V PlotX
sh ,Lt 1A 6e ex-�&nAeo( sL,cC-rGoan+ Vse all a� , ?Vtd I-,) care i-1 pr,,, �a q"
ot/cr Flom. �iU�1i1 T_fle glees ct-� Sli,u_l � of C'Coc_k occur. �
Reviewer/Ins '-` `T l C3` 3
Reviewer/Inspector NameS ¢ t.� Gi ✓12a=7i=s - �' 3�1 S- �46"`eke{ 2p
Reviewer/InspectorSignature: Date: -7-17OCR

:LJ
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 85
Date of Inspection S 1 Oo
Time of Inspection I t Q p p 24 hr. (hh:mm)
Permitted © Certified [j Conditionally Certified (] Registered 113 Not Operational] Date Last Operated:
Farm Name: Ca h e I `Ax .'-�L .... -County:..............................................................r.�N............................... Owner Name: C f a, r e h Q e� Phone No:
Facility Contact: .... Title ........................................... Phone No:
.................................................. .......... ......................
Mailing Address:
Onsite Representative: GeO fj e -Pe Vs� �,^c ri ~} G� e r �......... Integrator:... Q u z-6, ro 9,7"- 5
..... ... ........ J....................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
L...: _.................................................................................................................................................................................................................................................................�
Latitude = • Longitude =-, =, j 11
Design , Current Design Current ,� Design Current
wine _ '� Ca'aci ..°:Po" ulatson
: "Poultry ' ' Ca` `ci :Poulation� Cattle ��'aci =Po iula4on=
❑ Layer ❑Dairy '.
❑ Non -Layer ' ❑ Non -Dairy
❑ Other <.
Total Desigln Capac>Ity
.:Total SSLW= -
Nuinber of Lagoons"
Subsurface Drains Present ❑ La oon Area . Spray Field Area
❑ g ❑ P Y
Holding Ponds/ Saitd Traps
❑ No Liquid Waste Management System
❑ Wean to Feeder
Feeder to Finish
1 , `f00
1 � Ste©
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
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: I
Freeboard (inches): ......... .......................
.......Es .............................................................................................................................................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23199 Continued on back
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 10 No
Structure b

Facility Number: Y J -8s� 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
� oD
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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) "Phis 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19- Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
P' N . iolatioris;or. difflciepcie5 •were noted dirriri� fbis'visit; • Ypik will•reoeiye riti furthirr
correspondence. about. this visit: . . ..
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes g No
❑ Yes ❑ No
❑ Yes ❑ No
Comments(refer to 4u9ti #):.,Explain, any'YES answers and/or any.recommendations or: any other comments
a
Use deawings of facility:.to better explain -situations (use additional pages as necessary) _ ; ' -
_ on Gonot iJG4ea! qS Gt �o((n`,)"UP -{-u 513oloo DWQ ;r'lsPpG
15T E-ncure � �^��+ o�-e bEG]O�3/ps L1JEji( eS'lci�7��S� fC.on'jr'O� LJeF�'i Gs`rOIJ�
�G ,�7rOyytp� f I��O!'} �S�A C�I'-tD�Y✓L['i`T ,J
n/0T45: Cam+;°heat s►-�c Ves i`?af �o ��r�t� i,a c,,;•,dt�
Gandl�ioh s.
VW
Reviewer/Inspector Name f4oAec.Jq, i,l ( �. t.9 L2� ,S. ` �'lo . S 3� d cx 7173k
Reviewer/Inspector Signature: ,t, Al ._ T Date:

'w Division of Soil and Water 'Conservation Operation Review
10 Division of Soil and Water:Conservation'-.Compliance liispectiun -
ivision of Water ali Com fiance Ins ectioii
i W .i � ty P P
:.13 Other Agency Operation Review -
O Routine Complaint O Follow-up of DWQ inspection O Follow -tip of DSWC review Q Other
Facility Number 3 I �, Date of Inspection L7
J4:3t
i7 ae
Time of inspection 24 hr. (hh:mm)
01 Permitted 0 Certified [] Conditionally Certified Q Registered 113 Not O erational I Date Last Operated: ........................
Farm Name: .-..�Gt'N�1�i.°4...........1. r?..rat.--...A.V�-.-....z...._���L, County: ....._.....t�ll..rl.......................... �:.............
.
Owner Name:.... ............... ......-............ Phone No:.............. .
Facility Contact: .. rKq:....... _4ik d)................ Title ............ 1./... . .. Phone No:.................
Mailing Address:
Onsite Representative:.........1...'........./....V..l!l?F-i<.rA4...r.. Integrator:............��vS.........!.l..i.l..l.t.......
.--.. .-........................
Certified Operator:--..................................................................................-........................... Operator Certification Number:
Location of Farm:
A
................................................. ....................................................... ..... ............ ......................................................................... ..............:......................................••---.---........_. �
Latitude Longitude • ��=
.Design Current - esign; urgent
Swine. - Ca acity Population Poultry Capacity Population Cattle
❑ Wean to Feeder
Weeder to Finish
J4.a t}
t t _t y D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer Dairy
[] Non -Layer I 1E] Non -Dairy
❑ Other LL -
TotA1 Design Capacity
;Total SSLW
Design Current
;apacity Population.—
-Number Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
.Holding PondsI Solid Traps w ❑ No Liquid Waste Management System
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'? El Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dees 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? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �fvo
Structure 1 Structure 2 Structure 3 Structure 4 Stricture; 5 Structure 6
Identifier: ll�
Freeboard(inches): ....... 1J....................-..................................................................... ................................... ...................................
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:3 Date of Inspection I C /.z�r/7�#00
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 maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type 4 rv`"" R , C4_A- � r 3
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. i�To viol'.. ..s . def cienfies •wire pOte ....ing this'visit; ... .. i•e. . . do #�t>t ... . .
rtirresporic�eR�e: about this visit: ... ... . • . .. • .. •
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes b4o
V-Yes ❑ No
❑ Yes ❑ No
Use drawings of facility to"better: explain sttuations (use additionalTages as necessary) ' r f a
JY,5f(1JH,,, Cc-VJtxL�CA iV\ Vat,, &A v4-
fvw/}-�,/k & 1- ,J- A �}iCs•�nN­
GLA^+` b''�-�dl/[_or.gii �,�o�,S. �iia( S-14C2ys�_-
,� �,�»,,�„r-1•t,�.,'k -Wti � �a .�s�-.�.b�-, s�►� o. �Jw b�1�v a� visa O'er 'M J�, h�
rt LA4 . �Y,-c )Ov&�• -- �-�-,--�aC .[ S�- . ��.�:
.>� INA r�
� � �.c,1d�-Sb--
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� _ ( Date: % i7)

[3 Division of Soil and Water Conservation Operationevi
Rew
13 Division of Sail and Water Conservation Comphahce Inspection_
d ,� � Division of Water Quality Compliance Inspechon�
* ` ` 0 Other Agency - Operation
JoRoutine Q Complaint %Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last O erated:
Farm Name: County. 1� p........................................
OwnerName T,.-L��.���................................................................................. Phone No:......................................-................................................
Facility Contact:
Title:
.... Phone No:
MailingAddress:.............................�......,.�................................................................................. ....................-....... ..........................
Onsite Representative:.. �. �..... V�...................[....... Inter;rator...............................................
6 ` �.......-�--� 1 ...... 4 .. ..... ......
Certified Operator:....���....................................................... Operator Certification �Number:
-�,•.......{{................. 1
Location of Farm:
►\
.................................................. .......... ....................................................................... ................................................ 7
Latitude • Longitude 0
Design Current Design Current Design Current
...Sne Capacity Population Poultry Capacity Population Cattle
wiCapacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Weeder to Finish agog JEI Non -Layer I I JEI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish _-r -. = Total Design Capacity
❑ Gilts;
❑ soars Total SSLW
=`s ilreimber of Lagoons =` ::,i ❑Subsurface Drains Present ❑ Lagoou Area ❑ Spray Field Area
.;Holding Ponds /.Solid Traps 0 - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischargc 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 die estimated flow in gal/tnin?
d. Docs discharge bypass a lagoon system'? (If yes, notiiv 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 ) Structure 2 Structure 3 Structure 4 Structurc 5
Identifier: n
Freeboard (inches): ............. f ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (iec/ trees, severe erosion
seepage. etc.)
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
qNo
❑ Yes ❑ No
Structure 6
❑ Yes %No
Continued on back
3/23/99

Facility, Number: — Data of Inspection
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 maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type W
L-10—A
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 ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required. Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
l8.
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
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0: Rio •yiolationS or• difflcieneies •were noted• during this:visit: • Y:ou *H1.teeeiW d futther
icorres orideirce' abauf this :visit.:
Comments (refer to -question #): Explan,any YES answers and/or any recomruendations orany other comments:
Use -drawings of facility to. better*explain.sttuatroias (use additional pages, as necessary} -j (1 �
WA
�S- AV Liz- eft - c Aid
c� '4l�S' 'k Q 'tl `--� t S ti Cc � Yeb42 '
Reviewer/Inspector Name's
Reviewer/Inspector Signature:
Date:
3/23/99

Facilit}C Number: 3 — 95� Date of Inspection �-i-
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
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
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`?
❑ Yes
❑ No
'Additional omments and/or-, raWings '_ ,d
ems,
117
[��C- "�-�'- � ��.� cam`, �S � or c�l� • k2�
(ICJL—
Cl)
,
r
A.0 L
Q L'Q V'—' r
'Q
3/23/99

I
10Rou�Complaint 0 Follow -pp of DWQ inspection 0 Follow-up of DSWC review Q Other J
Inspection
Io Date na 1-13-2000
Facility Number 31 856 Dap
Time of Inspection 1100 24 hr. (hh:mm)
® Permitted 0 Certified [3 Conditionally Certified © Registered 0 Not O erational Date Last Operated:
Farm Name: CAwcHjaYaMZi%.2.................................................................................. County: D.uplk........... .................................... W.. RO.........
Owner Name: Claim .............................. _...... Kninin ....................................................... . Phone No: 410-22�95Qb.(hoLme).910:_29.3-3222.---------
Facility Contact: .............................................................................. Title:................. ................I. Phone No.
MailingAddress: .02-Cale.]?&C...................................................................................... Hawfilcad.NC .................................................... 2$4.43.............
Onsite Representative: .)jXe,y. l mt.l cbtell..?Yxmei...................................... Integrator: GsQldshoxu.Hog.Fama.......................................
Certified Operator: Rmn1L3&c1L................................................................................ Operator Certification Number: .16561 .................. ...........
Location of Farm:
Latitude 3S • 04 �� Longitude 78 ' 1)3 1 ®K
❑ Wean to Feeder
® Feeder to Finish
14400
12000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
t d.
❑ Dairy
❑Non -Layer
. ; _
'.
❑Non -Dairy
- - - - - - - - - - -
ther
❑ O-1-M, f--MM-M-'.--M.MM-'MM'-M.:�M =MMMM'MMf-M.M`M
Dischar¢es & 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.SWe? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flowi m 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 1 Structure 2 Structure 3 e Structure.4 . Structure 5
Identifier: ................................... ................... ...
Freeboard(inches): ...............22 ............... ..................................... ................................... .................. ................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed?. (iel.trees,`severe erosion,
3/23/99 seepage, etc.)
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes . ❑ No
Yes
❑ No
❑ Yes
No
❑ Yes
❑ No
Structure 6
...............................
❑ Yes
❑ No
Continued on back

Facility Number. 31-856 Date of Inspection 1-13-2000
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 mamtenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes []No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type Wheat
13. Do the receiving crops differ with those designated in the Certified Anirnal' Waste Management Plan (CAWMP)? ❑ 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 ❑ 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 ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ 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 0 No
24. Does facility require a follow-up visit by same agency? ' , Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
N i�ioig1hons: o,r:di tkiericies-ivece1.:rioied:during i iii•vfiii:: Viii ivafreceivt no fii e:r:
d'E3M1'PGtOp(��ItCP fIh(ll�i'tliii:•vacii.•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This inspection report has been changed slightly from original left on -site. A copy of this report will be mailed to Owner and
)oro Hog Farms.
is follow-up inspection was conducted to access the ability of the facility to remain in operation while options are investigated and
proved for re -designing the waste treatment system. Current inovative waste treatment system is completely inoperable. Farm is
eating like a traditional swine operation utilizing its undersized lagoon -- this will require a high level of management to maintain
-quate freeboard. A bio-agent has been added to lagoon to reduce nutrient content of wastewater -- it appears to be working with a
)p of PAN from 5.3 to 2.3. (Cont. on Page 3)
tir
Re •ew ecto vt erllns r Name
:.......: ..................... .
It=fit.,
Reviewer/Inspector Signature: " Date:

1/2412000
•I Facility Number. 31-856 1 Date of Inspection 1-11-2000. :,.,—
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or;lagoon fail to discharge attor 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 ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
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 Q 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? ❑ Yes ❑ No
o date the facility has installed underground irrigation to directly access approx. 50 acres of wheat that has been planted. Approx. 40
,res of additional spray field can be accessed via aluminum pipe from the installed system. This acreage has yet to be planted in wheat,
Lit is expected to be done as weather permits. No more waste is to applied to original spray field without prior DWQ approval.
Old waste still ponded in back right comer and ditch of original sprayfield.-;-T1ds.is the area that resulted in a discharge from the site
is the field ditches on 10-18-99. This waste should be pumped back onto dry.area of field or returned to lagoon prior to unblocking
itches that were blocked to cease off -site discharge.
Original spray field and main facility site remain fairly saturated. Suggest releasing water trapped in ditches by unblocking ditches
r old ponded waste is handled properly.:as discussed in Number 2 above. Ditches should be unblocked gradually to prevent large
)unt of water being released at one time.' Adjacent landowner should be advised of this activity prior to beginning this process. In
ition, facility should seek permission from adjacent landowner to allow access to his ditch line if necessary. Opening up these ditches
uld allow site to begin to dry out so that future improvements to waste treatment system can begin ASAP.
;gest berming or grading area around ditch adjacent to pump location to prevent potential. discharge should a problem develop.
Equalization Basin that collapsed during Hurricane Floyd needs to be closed out ASAP following normal lagoon closure procedures.
ility received rainfall earlier in the week and it appears that level dropped in the basin 3-4 inches since. This structure poses a threat
groundwater and overtopping the longer it remains.
e joints in the non-functional, fiberglass aeration basin/tank are showing r j gl g signs Area adjacent to one such joint is very
t and spongy in an area approx. 4' x 8' with evidence of dark liquid sinular,to waste in tank seeping to surface. This tank poses a
=tial threat of overtopping and to groundwater the longer it contains waste as the joints continue to degrade. Liquid waste needs to
drained and placed into holding pond/lagoon. If possible, it should be cleaned out as well. Consult with new engineers about potentia
this structure to collapse should it be drained. Freshwater could be added to prevent this if system is to be retroitted or parts are to be
vaged. Liquid level should be dropped well below areas of joint separation regardlcss.