310022_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Eti
Division of Water Resources
Facility Number 70 '� � I .0 vision of Soil and Water Conservation �§
�§ ? OtherAgency' , i;
Type of Visit: t9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: } , Departure Time: County:
(`
Region: 01
Farm Name: �-Q�r�
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Oosite Representative: j(/�(1 l]1 V/y1"' 1 Integrator:
Phone:
Certified Operator: Certification Number: [q 3 1 2-
Back-up Operator:
Location of Farm:
c 1, Design
Current..
Swine
Capacity
Pop.
Wet Pi
§
Wean to Finish
4£
"
" La er
Wean to Feeder
Non L
Feeder to Finish_
Farrow to Wean
Farrow to Feeder
l
© Pi
Layers
Non-L.
Pullets
Farrow to Finish
Gilts
Boars
©them
Turke
Other
Other
Certification Number:
Latitude: Longitude:
Design,11. Current}
tryf, Capacity Pop
Poults
Design Current"
Cattle Capacty .pope'
Dairy
Caw
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
ri
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JVNo
❑ 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
EI(No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
k
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fadili Number: jDate of Inspection:
Waste Collection & Treatment VNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — 6 C, 'J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ 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 Do 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 [XNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [UhNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ANo
❑ 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
0n
12. Crop Type(s):. , wk-tall ;
13. Soil Type(s):
l4. 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? 0 Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ak No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [—]Yes 0No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes V No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'IN] 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �[,d] No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa�'ili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charged
❑ Yes D�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
�NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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?
a
C,- "v� an
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ip No ❑ NA ❑ NE
❑ Yes ONO [:]NA ❑ NE
❑ Yes lij No ❑ NA ❑ NE
❑ Yes No
❑ Yes l No
[] Yes. No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
ise ad'tletional pages as�necessarw'. '
Phone: 1 r o —7 ,1 &— "-7 39- 7
Date: I2 Zo j
214,12015

UDivision of Water Resources
VaciEity Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: 30— Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: JJ Title: Phone:
Onsite Representative: r �+�4 C �9� ,f� w4— Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Laver
Non -Layer
Wean to Finish
W to Feeder
eeder to Finish
Itfloo
X]br
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Other
Pouets
Design Current
Dis_charp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes No ❑ NA [] NE
❑ Yes ❑ No
[-]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes LrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

FaciW N tuber: - 2 V Date of Inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes go 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier; _ _ 0 G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;2-3
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
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 ]fNo - ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes _ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes [—]No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ 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
© No
❑ NA
❑ 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
VrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
19 -
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes �� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes u No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

jFacHUy Number: 3 - Date of Inspection: /
f 2� Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑'1Qo ❑ 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 levelsE
on-compliant sludge levels in any lagoon ` Z c
List structure(s) and date of first survey indicating non-compliance: [�� 04 `�'
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
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
[3 '`'o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
idthe facility fail to notify the Regional Office of emergency situations as required by the
D0.e
❑Yes
No
❑NA
❑ NE
rmit. (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ef�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WNo
❑ NA
❑ NE
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Reviewer/Inspector Name: QR 1 ['_ a t Phone: O 7� f0 73a y
Reviewer/Inspector Signature: Date: 1 Ti ' Z
Page 3 of 3 21412015

V70
" "

V Division of Water Resources J
Facility Number"° - ZL 0 Division of Soil and Water Conservation _ W _ J
0 Other Agency
Type of Visit: Co lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ( Arrival Time: Departure Time: 4 D County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ( Title:
Onsite Representative: ! L C, e_ 1 6 " t b Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Certification Number: _ 12 :3 '1 Z
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
to Feeder
Fn
er to Finish
Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W R)
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Becf Feeder
Beef Brood Cow
❑ Yes ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑NA
❑ NE
❑ Yes
rq
❑ NA
❑ NE
Page I of 3 - 21412015 Continued

Fac'li 1"! mber: -
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 I Structure 2 Structure 3
Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): g S7
Observed Freeboard (in): rl-1` �` 2
3 Z
❑ Yes No
❑ Yes ❑ No
❑NA ❑NE
❑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
(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
ONo ❑ 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
[ ' oNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F'<oC]
❑ 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
ONo ❑ 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
D N ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
��No❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
To ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E�Xo ❑ 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?
[—]Inspections
N ❑ 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

4
Fac3li Nrtmber: - VL— jDate of Inspection: I Z— `I �
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues +
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Flo ❑ 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 6 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Tom❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES:answers and/or any additional recommendations or any other comments.
Use drawingslof facility.to`.better explain situations (use additional pages as necessary). .:
-.[ 5 (&, (9 r 0 k'5
sr���� s��� It ��s
L/�'3�n
w
f 1� ��.1d.�
(A n 5
f id r(ij
Reviewer/Inspector Name: OI/- Q �Q `__C y
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (P ? 4 b 7X `
Date: [ 'k �1�
2/4h015

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 310022 Facility Status: Active Permit: AWS310022
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Duplin Region:
Data of Visit: 12=12015 Entry Time: 08:45 am Exit Time: 9:00 am Incident #
Farm Name: Dexter Jackson Farm Owner Emall:
Owner. William L Jackson Phone:
Mailing Address: 122 Cox Pond Rd Mount Olive NC 28365
Physical Address: 586 Emmitt Jackson Rd Faison NC 28341
Facility Status: ❑ Compliant ❑ Not Compliant Integrator: Prestage Farms Inc
Location of Farm: Latitude: 35' 08' Longitude: 78' or 48"
North of Faison. Take Hwy 403 exit from 1-40. Turn left (North) at flashing intersection onto SR 1302. Farm is 2 miles on the right.
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
OnSne Representative(s): Name TIHe Phone
On -site representative Michael Gilbert Phone :
Primary Inspector.
Inspector Signature:
Secondary Inspector(s):
David Powell
Inspection Summary:
Lagoon B and C need sludge POA s. (12130114 Sludge Survey)
*Sludge Survey on all 4 lagoons due 2015
-Lagoon William Jackson #2 (Lag B) Structural FB 1.5 ft. 25124 7.5 inches, Total FB of 25.5
Have Soil and Water look at lagoon design and email results to [e-mail]
-FamVrecords look good.
Phone:
Date:
❑ Denied Access
Wilmington
019-658-6717
page: 1

ki. Pertnit: AWS310022 Owner - Facility : William L Jackson Facility Humber: 310022
Inspection Date: 12/09/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity
Current promotions
Swine
SvAne - Feeder to Finish 14,700 14,823
Total Design Capacity: 14,700
- ToldSSLW: 1,984,500
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1-5(A)
19.50
21.00
Lagoon
11-15 (C)
19.50
21.00
Lagoon
16-20 (D)
26.20
32.00
Lagoon
6-10 (B)
19.50
21.00
page: 2

Permit: AWS310022 Owner - Facility : William i-Jackson Facility Number: 310022
Inspection Date: 12/09/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0110
State other than from a discharge?
Waste Collection, Storage & Treatment
Yea
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
01111
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ■ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310022 Owner- Facility: William L Jackson Facility Number.
310022
Inspection Date: 12/09/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yas No Na me
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
■ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
01111
Records and Doornents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
01111
20. Does the facility fail to have all components of the CAWMP readily available?
❑
NoD
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

.
Permt: AWS310022 Owner- Facility: William L Jackson Facility Number. 310022
Inspection Date: 12/09/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility tail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
-❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
M
11110
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
0
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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
0000
Other Issues
Yes No Na He
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed nominal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface We drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32, Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33, Did the Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
D
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
1101111
page: 6

(Type of Visit: Qf 7Routine
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 O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (Y1Zk�C- C-y_�R:T Integrator:
Phone:
Certified Operator: Certification Number: 1 !9 aq a
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Certification Number:
Latitude: Longitude:
Non-L.
Pullets
]Turkey Poults
Other
Cow
ow
Cy alf
y Heifer
Cow
Stocker
Brood Cow
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 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
❑ 7
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

,
lFacitity Number: - Date of Inspection: it
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 �� Structure,4 Structure 5 Structure 6
Identifier; —LjqCZ6jU IS 71J1 l/ n�[�cx�"°ty�1JJ�
Spillway?:
Designed Freeboard (in): 119 19
Observed Freeboard (in): '.1 22
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 MNo ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F?(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 O No. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes L_'J No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E3 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 of Coverage & Permit readily available?
20. Does facility fail have the CAWMP If
❑ Y No
Yes
❑ NA
NA
❑ NE
NE
the to all components of readily available? yes, check
[:]No
❑
❑
h
t e appropriate
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesgNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

f
FacibV Number: 3- Date of Iqs ection: 11 1191H
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 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑NA ❑NE
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C2440 ❑ NA ONE
and report mortality rates that were higher than normal?
❑ Yes E3"No
❑ Yes �No
❑ Yes 0 No
29. At the time of the inspection did the facility pose an odor or air quality concem?
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 CAWW?
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?
,) WDATC WUP WT-74 NEW OtNpErZ .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J_08rrJ i'iaR►��c,�.
❑ Yes
❑ Yes
❑ Yes
InfNo
FfiI0
No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone l b ! q b
Date:
2/ 014

�07ffivision,of Water Quality
` Facility Number - .0 Division of Soil and Water Conservation
0 Other Agency s
type of Visit: lEFCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: P Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: " Departure Timer County: lh Region:/; R
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: / • t , _ . ��� 1 _ Certification Number: , 4
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
Other
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
La er
Non -Layer
.Design
Current .
Dry Poultry
CaDBCity
Pon.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design. Current'.,
Cattle Capacity_: .Pop.,
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Co
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [—]No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

1Facili umber: S l - ? Date of Inspection: — ")
Waste collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PTNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Struc e l Structure 2 Structure 3 Stru re 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
RjNo
❑ 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
4No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0], No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
rr
9. Does any part of the waste management system other than the waste structures require
❑ Yes
VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑: Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
PNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes INo
❑ Yes �No
0 Yes P No
❑ Yes KNo
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VfNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: - t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes 01"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
❑ Yes9No
❑ Yes [�No
❑ Yes No
[—]Yes VfNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
[] Yes ZfNo ❑ NA ❑ NE
❑ Yes 0No
❑ Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: �i�,�- D �llia Phone:
Reviewer/Inspector Signature: Date: 1�
Page 3 of 3 d 21412011

Division of Water Quality
E_acii€ty NuEnber: r Division ofSoil andrtWaterConservat�on'
OtherAgency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: f a county:�Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: _� ict4ae _ (�, i c6ei?_ 1 Integrator:
Certified Operator: 1 �� C_ C . CAL ge6Z j CeF�tificcation Number: q S9 of
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Design Current 'Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
has
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
_Z Farrow to Finish
Gilts
Boars "
,Other '
Other
Layer
Non -La er
Design Current
Dry Poultry Cap aci .Top.,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design
Cattle Capacity
Pop::.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes�*No
nw
=�3 w
w
y -4. F_€
DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[FacHity Number: - Date of Inspection:
Este 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 Structure4
f
Structure 5 Structure 6
Identifier:
Spillway):
Designed Freeboard (in): _ 1
Observed Freeboard (in): '5D I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ VNo [3 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?
T�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry;stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ISA No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. 0 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes No
❑ Yes o
❑ YeskNo
No
❑ Yes
OWUP QChecklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1A No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste Transfers
❑e Rainfall ❑i Stocking Q Crop Yield E] 120 Minute Inspections [] Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
o
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: _ I Date of Inspection:
A. J)id t-he-facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility oui 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 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)
3 1. 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 No
❑ Yes No
❑ Yes No
❑ Yes 'qNo
I
❑ Yes No
❑ Yes 10 No
❑ Yes No
❑ Yes rNo
❑ Yes
❑ 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). '
Dal D 'e�o IL �Z�T Sbofq& 8U �( ;�> )INC.
-4- To RA u C Cki�_ �LGSLM_-rS tNLLkX-DJ&T�1 � THE
Se To
ATrN : 4rnANDA Q44/Ve5 910-
C�� 1/� c flAu�`3 Orr TWS SIT& V I S 171—
-i- Co©Ic^E� {� i,AS T L3�A(Z �SAmP`e-C�uLTS Gt� c-�u taS a
P,c(9 a mA"-M-
c�
gF-A )) oNa l
Reviewer/Inspector Name: tQM'q 4 JOA7- C"A/ /V6- S
Reviewer/Inspector Signature: k, n .
Page 3 of 3
Phone:
Date:
21412011

ivision of Water Quality j
Facility Number 3 ( - ® O Division of Soil and Water Conservation
O Other Agency`_.'
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: J�-Routine 0 Complaint 0 Follow-up O Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: t P M , A C J c S aX/ Owner Email:
Owner Name: I�E_X T [ (1Z A aC ic-ov Phone: 419 - b s- S — 03 3 3
Mailing Address: V/ L( CaL-14T (Lti � t �C ftC.c (f 0 (J U E , // c 0 6 3 6 s
Physical Address:
Facility Contact:
Title:
Onsite Representative: _M ingige-L- Ct L earj
Certified Operator: _ffl f C.YL4t . C . 61 C._ Q�_g- 1
Phone:
Integrator:
pI\
ertification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Poults
Design Current
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?
Longitude:
t939QL
Design Current "
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes '.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

{
Facili NQmber: jDate of Inspection:
Waste Collection & Treatment
4As 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:_ u G
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 XNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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 Cro Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CZ�-�.(,i�I COigW WHE-Al- 5'�>
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW10fP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes jSrNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
QWUP ❑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 El Weekly Freeboard 0 Waste Analysis ❑` Soil Analysis ❑ Waste Tr ns ers [] Weather Code
Q Rainfall Q Stocking Q Crop Yield [] 120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9
No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fadli Nt;mber: jDate of Inspection:
24. pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
(�] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facHity to better explain situations use additional pages as necessary).
W.A. A G In �nr
FTd lY dill-L46'00A1
_�f NIII P. I �,3 �•� �� S 'buslaNs
I
Reviewer/InspectorName: AM14,qC)A 61q/,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 f G- 1_&-1 3 M
Date:
21412011

d Division of Water,Quahty � R
!+
Faculty Number 3 4 DtV1SIOn of Sol and'Water�.Conservahon
Q.Ot ler Agency
a k ,A .lz
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: (—i Region:
Farm Name:lExioz r . \ _] A msconl f r o e m Owner Email:
Owner Name: w1L1Am Ex l Eiz �PC4SCA/ Phone:
Mailing Address: SM WU-N—faLl,
Physical Address:
Facility Contact: , Title: Phone No:
�1�1
OnsiteRepresentative: I2 2Ie11AF-L- 63) iIntegrator:
Certified Operator: Ace qeL_ C. a lo_ e 1 OperaTor(:ertification Number:
Back-up Operator:
Location of Farm:
Latitude: E__1 o
Back-up Certification Number:
Design ' ` Current S Design , C,urrent�:z-
Swine Capacity„ Population Wet, Poultry ;Capacity Population
- ,a . w¢e ,
❑ Wean to Finish
i1: ❑ Layer
❑ Wean to Feeder
❑ Non -La er
El Feeder to Finish
• .
.""
❑ Farrow to Wean
" Dry Poultry q
❑ Farrow to Feeder
La ers
❑ Farrow to Finish
rEj ers
GiltsNon-La
Pullets
❑ Boars
—
�
y ❑ Turkeys
Other
❑ Turkey Poults
❑ Other
" ❑ Other
"
Longitude: =o =, =
tittle n:Ca
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

Facility Number: Da Date of Inspection %(_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Strur�ture 4
�1
Structure 5 Structure 6
Identifier: C�
Spillway?:
11
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
9
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ElNA ElNE
X
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
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 *o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any 6tnor comments , � ' x
Use-drawmgs;of:facrhty.to better explain situations (use additional pages as necessary} :
)6�Z_-31CA( a L&S(2� 5 L-M
coccv`�'GS 3e�" FQ�G��� ox� GRLcc�c.P� s-' (9.9"F1Zcr, BaAV- i'1'xai�lG�(Zr�/
LAGWt4 b 1 S NOT CL&A4Z Tee'-C At, . )\f fC-_D f 0 RSrz '&A > .tAl S,cw oR P4LE's-7-pG&
ICa Slur CC -GOAT ►oNON 61f9zr`-EI_-ro HAG go p(Z �XF)CENEW M19JGCCT, jqCSp
W 4VE -p6ok Lcov %�� p�S1Get P�7EewtUccr (�f41U+ 5tksAAAa� I S ACCc.�fWV'--. C.E I Nb`'' 1..
1
Reviewer/Inspector Name A NDPhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

F . Oty Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
the appropriate box. !!!! ���`
0 WUP [] Checklists 0 Design 0 Maps El Other'
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo []NA [3 NE
El Waste Application 0 Weekly Freeboard El Waste Analysis 0 Soil Analysis 0 Waste Transfersv✓ ❑tWeatherCode
ual Certification
0 Rainfall 0 Stocking E]Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
X.-o
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�40
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
''
❑ NA
El NE
Other Issues
11
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
AddiitionatComments amuor Drawings.: "
W+A AA G w �
qpq/)o 0?. to CD, C9. 9 a. 0
91crfiflog 1.,L9 C� Q
To A0Uf- �►p�N Sa, L6 wo�c-qv flEs 'CAI
_o
C.y co
+4�-S �E� QAlMr-14 -� rAc.ToR- JrtzEs1CH— OAS
511� I� S-AR-7 1C,L-pINGi L44G00PV AT
�-� NCEms!
Page 3 of 3 12128104

DiVISIUn of Water Quality
Facility Number, O Divisionc of Soil and Water Conservat<on
k k. Q Other ,_gency
(Type of Visit KCompflance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit SN.Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �� Departure Time: County: Region:
Farm Name: _ Ei�l E�L -�490c5cw ii Owner Email:
Owner Name: t l�l Am Ex Pacsc�y Phone:
Mailing Address: u T�L! UE / Y C ZLa ,3L9S
Physical Address:
Facility Contact: %i Title:
(�(�
Onsite Representative: 1 � +IG0�}( 1'L1aEy-T
Certified Operator: M %"Q L- C.
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 1 9 3M
Back-up Certification Number:
Latitude: [� o [� [ Longitude: = o = , =
Design Current Design' Current �r"�Desigr
Swine . Capacity Population Wet Poultry"Capacity Population Cattle Capaci
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 06
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Fa er
on -Layer
Dry Poultr}„
❑ Layers
ElNon-Layers
El Pullets,
ElTurkeys
❑ Turkey Poults
❑ Other
Other°
❑ Other I I J�]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Co
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 V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes YNo ❑ 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: C_ 2_
Spillway?: Q
Designed Freeboard (in): rrj �9. t)
Observed Freeboard (in): T 3C>
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 14 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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R! No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'ANo ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DR No
\No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of(Acceptable
`LCrop Window ❑` Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) '171 i 3') c4w _lJ� r'1q- S1[_�!'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments refer to question # . Ex � Ia n ""
{. q ) p in any YES answers and/or any recommendations or any;other comments. >
Use drawings of facility to better explain situations. (use additional pages as necessary]:`,_ _ _^-`
2_
Reviewer/Inspector Name AIPI Phone:
Reviewer/Inspector Signature: Date:
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 No ❑ NA ❑ NE
the appropriate box. 0 wup ❑ Checklists ❑ Desig
n ❑ maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ )(nnual Certification
❑ Rainfall ❑ Stocking [7 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes J0 No ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
vl No
❑ NA
❑ NE
❑ Yes
j$LNo
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
AN No
❑ NA
❑ NE
El Yes
�No
❑NA
[I NE
❑ Yes
00 No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
KO No
❑ NA
❑ NE
❑ Yes
to No
❑ NA
❑ NE
12128104

s
a ."ivision of W
Facility Number, 0 -Division Of
Q Other A' :_i j
Ater Qaabty ,11b
(Type of Visit 0Tompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Vis�t—Al,oDutine Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: G� �Departure Time: County:
r,.C.f&oAi Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No•
Integrator•
Operator Certification Number:
Back-up Certification Number:
=�Cc�
Latitude: 0 0= S 0 Longitude: = 0 0 1 a
Design -' Current: 7 Design Current ; + Desi ._'CH
urrent
,�� H
Swine»
Capacity-'Populatioin WetPoultry
CapacitVe Populahoitro�attle�yzMy� h Populao
_ n r+Capactty,
'..
❑Wean
to Finish
;- ❑ Layer
_
❑ Dai Cow
❑
Wean to Feeder I
I
LIE] Non -Laver
❑ Dairy Calf
El
Feeder to Finish
n a°"
':�
El Dairy Heifer
El
Farrow to Wean
I=.
Dry Poultry
-
❑ D Cow
❑
Farrow to Feeder❑Non-Dai
ry
ElFarrow
to Finish
���
El Layers
El Beef Stocker
❑
Gilts
Non -Layers
: Beef Feeder
El❑
❑
Boars
❑Pullets
Beef Brood Co
T
,Other
e.
❑ Turkeys
❑ Turke Poul ts
„� Y
w
❑ Others
❑ OtherFlumter
ofStructures.
_.
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ETNo
❑ Yes ON
❑ NA
❑ NE
❑ Yes;zo
[DNA
❑ NE
12128104 Continued

G,
acility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'p4i/o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes io ❑ NA ❑ NE
StruZtul Structur 2 Structure 3 Stru re 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
(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 ,gNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 2 ' V U
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ado
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes _�Ko
❑ 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 ,3'lRo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes � No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2fNo
❑ NA
❑ NE
.�:: _.. fir:
Comments (refer tognesttan #} Ezplarn any YES answei s andlorxanyrecommendatian�'s oryany other5com�neats $`
Es'iUse drawings ;of facility to better explain situations. (use additional pages as neeessary)�-m ,�
rotlUrec d a ,- `
�.-z//o ��`e�,� �,/ �1 Gay � �px'e!i �' cJ/ •t�,/c /�',>ry r7 T—� �' •''� „
W O e'o'r �2
h�q c-,/ cz Jle - C/ iff— ,( ce,.�. "91"cc✓ el
�/ Gc /►T®c
reels' w cro_ �. �'�du l a-. 1:5 L.,,-&-le 1� �� 1W
I ReviewerlInspector Name I
Phone:
ReviewerlInspector Signature: Date:
r

10 Division of Water Quality ✓
Facility Number 0 Division of Soil and Water Conservation
- — 0 Other Agency
IType of Visit %Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit �K Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: ! Ll_\ A Ian ,� E X 'Fef Phone:
Mailing Address:
Physical Address:
Facility Contact: (� /i Title:
Onsite Representative::O � I yGHAE _ C-,1 C aefL7_,
Certified Operator: ti t I l G�1(} F L C• r g �C2 I
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: 19 s_
Back-up Certification Number:
Latitude: = o = 6 0 « Longitude: = ° = C
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
44 00
31096
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey 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:
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 [X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No El NA El NE
❑ YeskNo❑ NA ❑ NE
12128104 Continued

L
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: G
Spillway?:
Designed Freeboard (in): } 19.5
Observed Freeboard (in): �-{ 3 S 3 C 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1A 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 El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes <No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes A No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
CoA/T(AlC4.E woR!XIAlC\ ©A/ F_f0S[on/ 0A/ N3 wACk-
qV
Reviewer/inspector Name Af QA l N E S Phone: q�a ` ��4 —
Reviewer/Inspector Signature: Date: �g
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [I Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �rNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes A No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
A� No
❑ NA
❑ NE
❑ Yes
,KNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
PUNo
❑ NA
❑ NE
❑ Yes
["No
❑ NA
El NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes k No ❑ NA ❑ NE
❑ Yes ,jNo ❑ NA ❑ NE
❑ Yes ,K No ❑ NA ❑ NE
[Additional Comments and/or Drawings: I 1
Page 3 of 3 12128104

[] Division of Soil and Water Conservation 0 Other Agency
. RDivision of Water Quality
Routine Q Comm laint 0 Follow-up of DWQ inspection O Follow-up of IISWC review O Other
Date of Inspection 0 a
Facility Number `��
Time of Inspection ® 24 hr. (hh:mm)
© Registered U Certified © Applied for Permit O Permitted 10 Not Operational Date Last Operated:
FarmName:.... 3 ................................................. County:.... .......................................................
Owner Name: ...... .`1. .... .................. Phone No:........1.� fe 7'a- 3. ........................
Facility Contact: ................................................... ... Title: ...... Phone No:
Mailing Address: CL—` �h C `7...1. A, ...................! `�'C; Oki VIA�.......KL.....�8 .� ��.... ..........................
............ ..........* ................. I
Onsite Representative:.L!l`�. S=.a ........./&-4.. i�t�Q. `Integrator:....s.!' �'��' .............................
Certified Operator; ............. :.................................... ............................................................. Operator Certification Number,........----........
Locati of Fa
'
......................�.....
x"1 .......................` '......:........ i'!'..........~`.... k.........�^?�'a...
......
!
� -,.... .........s�...��a:........r - .,.5....a_ .. ....... ..--.........
.................
... ar ...
, .;._.................
Latitude ' ' "
,�
❑ Wean to Feeder
LT9
Feeder to Finish
i Gb
❑ Farrow to Wean.
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Longitude �• r�' �"
Designurrent,
" Foultfy Capacity Population Cattle
❑ Layer JEI Dairy
❑ Non -Layer I0 Non-Dair
❑ Other
_.,
Total Des' 'gn Capacity:
AM Total SSLW
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes KNo
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
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 Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes 0 No
❑ Yes j] No
1 Ar
❑ Yes M No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes 14 No
❑ Yes ((No

Facility Nurrtber:
4t 8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Yes ONo
❑ Yes P(No
Structure 1
Structure 2
Structure 3
Structure 4 Structure 5 Structure 6
Identi f er:
.................................................................
....... .............................. .............................
Freeboard (tt). ......... ��•,; !...........................�•
................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environtnental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of W�_MP,%o, r�runoff
]entering waters of the State, notify DWQ)
15. Crop type d"..` I..`''". I<5�....�.. U..��..��..................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18, Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. 'Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3, No.violations or' d6ideneies.were noted -during this'.visit. You:r'illi receive•Ra•furth:er
c6rr0p6nden0 d out -this: visit:-
l t P,
IZ
'—
ucr`_5,
❑ Yes U No
❑ Yes XNo
ZYes ❑ No
❑ Yes "No
❑ Yes KNo
❑ Yes EfNo
❑ Yes 0 No
tK Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes allo
aYes ❑ No
❑ Yes ti�No
❑ Yes PtNo
❑ Yes ,mot No
r.
t
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: X 111_t Date:

jVacility Number: ,., Date of Inspection: g
.I
Adi3ittanal,,Coitients
alp
& �4 '� --, Ar
4/30/97

x "
Division of Soil and Water. Conservation :Operation Review
_.e
z
t13.Division
_ e
of Soil�and Watet'Conseivabon =_Compliance Inspection r
�g
Division of Water. Qiialrty -Compliance Inspection
x
E Other Agency ©peritron-Revrew
-
Routine
nt O Follow-uu of
Facility Number 3/ 2
xtion Q Follow-up of DSWC review Q Other
Date of Inspection 1011141
Time of Inspection =24 hr. (hh:mm)
18 Permitted 0 Certified 0 Conditionally Certified E3 Registered 0 Not O erational Date Last Operated:
Farm Name: ........ t tr (�GCK SOn.....��'.�............................... County:.. D�,p!.;,I..---......---......................................
�.L1 LL ......-.. --}�--
Owner Name:..... .�x�f{ I ...J/ c A54t)............. .. ! 3i 7� ��%% 8
Phone No:
/+ f ....... ................................. .
Facility Contact: I'V1 1 C �0. ... c 7 t bCi/ Title :............................. . Phone No:
................................. .. ................-- .............
Mailing Address: .....................
..................................................................................................................................................................................... ..........................
Onsite Representative: 1 G % (�.�..........1.7. �. .> �'—. r....................... ...... .....• Integrator: ..r'G`�`5 � �e.............................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
............................................................................................................................................................................................................................ ............................. I•r
Latitude a ° Longitude ' 6 46
`ADesign' CurrenE
ty pulaionacDesign Current,' Design Curi•erit
Ca acity Population Cattle _ Capacity Population _
❑ Wean to Feeder
® Feeder to Finish
f
J g
❑ 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 than -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/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes jg No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes tff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes tZ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Z No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A Q C /IV
Freeboard (inches): S 2 29 T3.*.
......... .......... .................... ...................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;9 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3I —Z'2— 1 Date of Inspection
6.Ir re thi ore 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
12. Crop type C t , _�'e 1 6 + I '<'in
T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ PAN
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 6f the Certified AWMP?
0; N,6-yio1atidris:oi•• &flcieengpN •were noted• d. &. jrtg this:visit: Yoe �vii1 reeeiye Rio futthet
corres�6ridence. about this visit.
❑ Yes IM No
CK Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ZNo
❑ Yes -Z No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
M Yes ❑ No
❑ Yes W No
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes No
[]Yes g] No
❑ Yes 9 No
❑ Yes INNo
❑ Yes 2rNo
❑ Yes bWo
;otttments (refer to question #): Explain any YES answers and/or any recommendations of any other comments
Jse drawings of facility'to better,ekplain situations (use additional pages as necessaiy} -
�. Alow weed,< wee,17 L'ey e�4�1"m . 44Ool1 D
bg re Sjo 4S . '0r1 o r�t-rs t'�Je r..-Iq 1 � .
P14 S W re syo�t o h -t'D Df d► k� , `�r � n j►'1 �a Joi1 QY1 eS�Ci b� iS�
rA,•,74jS GaVc.- Or? -AtSe� &Ar-e A> e,^od; a[/.e4 r Keejo ah
A,14¢.✓ d , ✓ e rf j / y1 - ►•- j7 c q r Dd Y) � 't
.✓ qerO S i c?Y)
Reviewer/Inspector Name I e L zoi E sn = 4 t k=
Reviewer/Inspector Signature. "_'d Date: f/ 9�
3/23/99

Facility Number: ,? 22 Z� Date of I nspection
Odor Is�tes
r
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M 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 M 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 XJ 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 jX No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E.No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 24 Yes ❑ No
-Ndditional , omments`an or rawrngs
- LA9varl LaJ4Ok? 1s eW VC.�e�'q�1Qh !S gr'D(Nfll�j G� J✓liitf
- ,9 11 t) Ee- 1oy14 -14;� 44,e re,
e i I nhe j r.Jct sl,ef e �► � r
i -f e 1K / I't Dan
o� � �� `vim �' to ���poYl R�c �oo S �a � A �l6� 5
WAN i is be I'ny SGyL{`�l gyred c�. �jr-��M'4 sdl r�( �p�
,rf venl ,�' lker ervs►eh. -DroQ 40n `
SLr�aGe �o �P o ,%
f'ep^)'r 4-klese eee,4e.ot a/'eus. iqOsVC
Qv�-riff�s sig�r if o� fepa,rs.
15 ' 1W 11roe --o-,-elW.S /Ie9 v-'rin or ,1,o/t 4dns/aeone
7
0 cel o ( d )'KJ �,O // .
' Guy and /OG14e
j Cori } ; Au e e y- o e* -�D re ►ni oV c w ee;,4s �'�ori1 oas��r l �i s 1ds.
3/23/99

Drvrsron of.Soil.and Water`Conservation-`Operatioh.Review
13:1) gion of Soil and Water Conservation - Compliance Inspection
Division of Water Quality.,- Comp
fiance Inspection
Other"Ag enc- O eration Review- w
Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of lnspection / �d
Time of Inspection 24 hr. (hh:mm)
XPermitted © Certified © Conditionally Certified 0 Registered 10 Not O erational Date Last Operated:
�j
Farm Name: .............D............................ v-,JAL,, S�!r!.... ���' !'� .-.............. County....................' .... J�................. ....a...........
OwnerName:..........�L�c>!X`,Y........................<iLCs ...-......-:..-................. PhoneiNo:.......................................................................................
Facility Contact: ......_1.... J.. 1 Y%---..-..... l�G.�y Title:................................................................ Phone Na:....-......................----..---.......-----.•.
MailingAddress:...........�......................................................................................................................................................................................... ..........................
Onsite Representative: .......1....: i.. ...... ...a ....L!1.1...(..7............................... Integrator:................................................................................Certified Operator:........ ............%...................................... Operator Certification Number:....... r ..;�z
...I--...........
y
Location of Farm:
Latitude Longitude �•°°
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
/!( 7o0
1 Ha IJ
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area 1E1Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h- If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischan, is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WNo
❑ Yes RNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
!t Identifier: B � D
Freeboard (inches): .........�.............. `T v Je...
. ..................
1/5/99 Continued on back

Facilit Number: Date of Inspection , (T( T�- 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 [2q 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?
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 Ievel
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of,over application? ❑ Excelive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type l , I A 1-D . 44,1-l. t_) M
®`Yes ❑ No
Yes ❑ No
❑ Yes 5f No
❑ Yes q No
❑ Yes eNo
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
4 No
b) Does the facility need a wettable acre determination?
❑ Yes
P 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
NfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
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
XfNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[YNo
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[LNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[2LNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
M No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
29 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
RINo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
ii4 MOlations:or- di f ciencies •mere noted during Ns"Asit; - Y:ou +dij •Teeeive di0 fui th+gr ,
correspondence. about this visit: • : - :::::::::::.....:::::::::.::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name E e `f 110 355--
Reviewer/Inspector Signature: �� - 1 ) F Date: % ,

FaciW Number: — 7, Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below ❑ Yes'KNo
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?
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?
❑ Yes
[-]Yes ;;�No
❑ Yes KNo
❑ Yes 4NO
Additional Comments and/or Drawl9s:-
C� 1 �'
3/23/99

r ; a .w� - � �Dtvtstan of;,Water Qutaltty -� , -
�__ _.� i . O;Di'visiuri of.Soil anti Water Conservation _ ''
Type of Visit Wcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 01Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility ?Number Z
Date of Visit- � �] Time: I '3 Printed on: 7/21/2000
3 Z
Q Not O erational O Below Threshold
© Permitted [3 Certified © Conditionally Certified ©Registered Date Last Operated or Above Threshold: .........................
Farm Name: q+'L �2�C ef' ��Gks oc� f;� .�, County. P t"� .................................................
....................................................... ............................. .. ..
Owner Name:' t q wt �GjC'� G ?aG�'' Soh Phone No:
Facility Contact:
Title:..........
Phone No:
MailingAddress:........................................................... ............................................................................................................................................... ..........................
f/
Onsite Representative:.�LZM !:...�6tG�.fOnJ.. l e� b!l�e�4 Integrator:.P7 �, ........... .....................................................
Certified Operator ............. Operator Certification Number:
Location of Farm:
r�
v Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a �� ��� Longitude
- = Design Current
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
R7` - $oars
Design Current
Poultry Capacity Population Cattle
❑ Layer I I Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Current
Subsurface Drains Present ❑ Lagomm Area ❑ Spray Field Area
No Liquid Waste Management System
Discharees & 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/inin?
d. Does discharge bypass a lagoon systent? (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
Strtt,�ture l
Identifier-. ............./.�I..................
Structure 2
........... L...............
SLr cture 3
....................
Structure 4 Structure 5
...................................
Freeboard (inches): 5;—
�r
so
5100
❑ Yes )2fNo
❑ Yes IVNo
❑ Yes fgNo
it A
❑ Yes XNo
❑ Yes gNo
❑ Yes 'PINo
❑ Yes EINo
Structure 6
Continued on back

Facility Number: 3 1 — Date of Inspection ( d .Printed on: 7/21/2000
5. Arp there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes,,E!rNo
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?
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? j ❑ Exc
essive PondingXPAN ❑ Hydraulic Overload
3
12. Crop type e�"''tUd`i lc4, J'�lf C€"44"�, �orM-,Ll%"E"I sDybG�r�s
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?
(iel 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?
4yiolati&js:0. defeiencies #v re noted during fbis:visit; • Y:o>�r %rdl•reeeiye fio further . .
corres ridence. aN ' f this visit. :.. .
❑ Yes _i No
❑ Yes _Pflo
❑ Yes ,�J'No
❑ Yes 2rNo
'Yes ❑ No
Yes ❑ No
❑ Yes _O'No
❑ Yes ;!rNo
❑ Yes 10<0
❑ Yes O'No
❑ YesfTNo
❑ Yes�No
❑ Yes"EM
Yes ❑ No
❑ Yes -0
❑ Yesfo
❑ Yes, ,Z<o
❑ Yes o
❑ Yes l0
❑ Yeses ❑�i�o
Comments (refer to:quesdon'o : Explain any YES answers and/or any recorn-mendations or:any other com nenfs � r
Use:drawinigs of:^facility to -better explain situations. (use�additional pages as necessary) r
i ( a fe Was" Sovv-Le O ve n,4 ro;ceh a k Ae 7p00 GQt'r1 A'
C��• Sea Ga�xw,ow�S vn.d®� )� .
IS. So.-ne &-P 1, ec ezev-w,4g 4,eld -its �la►ti- eo( ih Go✓t�'L- m,,.
ky PIRV7 ) 'j W 0r4-ad Oh +& S1ipt„/ L1t1 Chr`t�
—rL'e OVG<'aP 1►'G��cr� " Gjb,,vea wets due Mani `�-to no Us+IA5
-f l,e vim, J t�( �i/7fe a hR.Z� is le �1t1�- Lts�; Ike sv r� -�6 vse �} l�q ST a a
11te TO- 2'S; Cc, 0n
=
Reviewer/Inspector Name U%
Reviewer/Inspector Signature: Date: 57 t f7l 01S/pQ

Facility Number: Date of Inspection l S�(( o1 1 Printed on: 10/26/2000
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,,E]"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-,�ETNo
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"PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -J;JNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or rawtn _
� 9 .�co �-� � � co �. �•,e �t.d -J'o �cl �e l-tcz.�'�� scc��' fes � v� � �D
Also, Mee,4 - c t'l vc 2ODO Sail --1eq
�o� ait -(ields 1,4t r�ca�ds�. ��tVe sail -�es� -far aJ1
once )gel'
are yell ky+l
5100

r' , T
Type of Visit �11 Compliance Inspection
O Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2/ Time:
riot O erational Below Threshold
O Permitted ©C((ertified 0 Conditionally Certified [3Registered Date Last Operated,�r Above Threshold:
Farm Name:
,i rt�J XT Z C K 50 d Counts:
Owner Name: W-r" ZAa,_FX-fe_2 ZPCK ate) Phone No -
Mailing Address:
Facility Contact: j� �'! Title: Phone No: F
Onsite Representative: ``'C� � _ i�rLa:Rr Integrator: ' S f� 7 won5
Certified Operator:
Location of Farm:
Operator Certification Number:
[ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0 ` O K Longitude 0 a
Di n nCarrent:- - Desi n Current
.. 13esEgn v WCrriut .
CCacioelaoapartPopuaton attie apacty' YopulatianSvine G
❑ Wean to Feeder
Feeder to Finish
Itf • 00
IS t)0
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number -of Lagoons
-Holding Pands / S61id,Traps A
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Subsurface Drains Present
❑ No Liquid Waste Manaaen
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 ves, 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 Structure 4 Structure 5
Identifier: ^�1 r _ 13 e_
Freeboard (inches): I tD 41
05103101
❑ Yes
ONo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
VNo
❑ Yes
WfNo
Structure 6
Continued

e, ' kk
Facility Number: 3j — Z 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/improvement?
11. Is there evidence of over application? ❑ Excessive.Poonding ElPAN Hydraulic Overload
12. Crop type 0-0 M ��aj J E& -' W HE:A-r F�rf1u_R [ l4Aq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA".
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 or other 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?
❑ Yes 0 No
❑ Yes VfNo
0 Yes ❑ No
❑ Yes ONo
❑ Yes Vf No
❑ Yes ( No
❑ Yes
No
❑ Yes
Z No
❑ Yes
it No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
9fNo
❑ Yes
i] No
❑ Yes XNo
FrYes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
No
No
No
�] No
No
No
VNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coinotents.{rrfer;to question #j:=Explain any,YES ans�rers and/or any recummetidatioas or snv other coiinments:` w
=Use drawings o , c. ity to better-explajn situations {nse agditton#pages as necessary) Field Corw -
. - ❑Field Gotty ❑ Finest Note
��R�� Erb you U'1U-AD[J 5 Roo C r €o 7b�{ R ues-r�
f
G-R RS $, � is D � P� c C'�t! Ti+ E �ooA� � FG-F-7Ii-%�►J C� vt�"�i��
1
F 14C P� Wrn Pr W:rL-L rU
vC1+,EcKI-z517 (� �r� OZtjFR-#-Tare,
Reviewer/Inspector Name 4 r
Reviewer/Inspector Signature: Date: Q
0510310I Continued
M

Facility Number: 5— 2 Date of Inspection �D—'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
ElYes 0No
❑ Yes No
❑ Yes A No
❑ Yes VfNo
❑ Yes ❑ No
.Additiohal Comments;andlor drawings:; _.
WO Vu o T 6F- RcOesrzp
DUE IO Cotrz'C-r J9,R-2 a kl,001�3 tRyou7
Ck rgC`r 8(0 CROP C &-1JaE lroR `4)Llls \62 %' 0 Of/Wp E
�JC"Tw
FRo„� v�5 CR1 �No �Q�fnDv�
©v 4, 00 PUIVNP-Z/\ G OCC.UPW DN, a 7�t,!�sE )crcZ�
1q -RF,06 1-141, rouu s 0 �Ll U
l�i 7;• �5zn7� ��-�-� �ol A-zF
Soot- f e 5T n)C�u DF_5 L� v Ls
�A- i ,,S WF-11,
�C-Z Epp 7-,
� �f��L�' �D �►� ��?O o2.
F
R'Opt GA,
rK,4 F-pre
�UO7C� �F_r-zG�r,Jc2,�i
O5103101

Type of Visit d pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Co7outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: $ d Time:
O Not Operational O Below Threshold
Permitted CIrCertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ..W .. _Q E?C (LA Gt01!) _ F/� �! County: _ fl UP ..... __ ___ » _ ........ .
Owner Name:
Mailing Address: ___
Facility Contact: __ W ... ___ Title: .
Onsite Representative: trI� I�± L LL� w,
Certified Operator:
Location of Farm:
Phone No:
,,,, Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 49 Longitude + 4 «
Design
Curren - Dcagri
Curren Design
Swine InPo" bon Poultry': j Po 'otu:.:y,Caifie Ca
bon
Wean to Feeder
-. Layer
_ Day "
_f
eerier to Finish IL'700
tSo5,3 E ❑Non -Layer
= Nan -Dairy
Farrow to Wean
-
Farrow to Feeder
-
Farrow to Finish
tx
TOI Des>Egn tY
Gilts
El Boars
- Total SSLW.'
d.
Discharges 8 Stleam 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) 0 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' N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes is
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....._—A ................. _ .. Q _ _ . _ . C _ 1) _ .. W .W _ ............ _. _
Freeboard (inches): 141 4 3 3 $ t)
12112103 Contb=d

Facility Number:
Date of inspection a
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 maintenancerimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Paading ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type CIS W 13ee MUDA t u
❑ Copper and/or Zinc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
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.
❑ Yes Q4qo
❑ Yes P10
&Yes ❑ No
❑ Yes Odlo
❑ Yes O No
❑ Yes Q Rio
❑ Yes l7 rt0
❑Yes �,No
❑ Yes
❑ Yes N0
❑ Yes IdNo
❑ Yes 01<o
❑ Yes 140
❑ Yes 10
❑ Yes Rio
❑ Yes I. - o
❑ Yes U-140
^[3se di��wmgs of thc:Lty to better � � � (tic �nal pages as ai]' 3�❑Fteld Copy ❑Final Notes �
///��� 1f��. ,y�l � A' �Vf
��e— O� LA&� `+.Y� ��`�S ���! 1'RJ� �VI-r• AiJ�/C .�yL'- •i
y
Reviewer/Inspector Names',, L ¢'
ti .
mob. _.� _
Reviewerllnspector Signature: Date: a
12112103 Continued

Facility Number: Date of Inspection o
ReOuired Records & DocumenN
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss r9eviewimspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keepingrcropYieIdForm
DES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes L/V0
❑ Yes No
❑ Yes C(Nq
❑ Yes �Nq
N
❑ Yes
❑ Yes
❑ Yes
❑ Yes No
['yes ❑ N
El Yes
❑ Yes �Z
❑ Yes 7No
Wes
�N0
❑No
12112103

Type of Visit )b Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: I
J0 Permitted 0 Certified © Conditionally Certified © Registered
Farm Name: _ .. .c-. X �. 6.....nee-\
Owner Name: ___ ASK .`T ..- L-.5o'd-
Madmig Address:
Tune: LLLSL7
Inerational O Below
Date -Last Opera or Above Threshold:
County: 2s
Phone No:
Facility Contact: Title:._ . Phone No:
Onsite Representative: 621A A)&' Integrator:
Certified Operator:
Location of Farm:
Operator Certitlication Number:
a
JZSwine ❑ Poultry ❑ Cattle ❑ Norse Latitude =• 4 " Longitude • 64
�Desiga
Clrxreut - Deszgn Current,: Deslgfl wCmr�t
S_
Po da#iom Ps�u>ttzy ti =Po 'oi� ` - ; =Po hon
, .:
..Cattle
Wean to Feeder
er to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges A& Stream Impacts
L Is any discharge observed from any part of the operation? OYes [I No
Discharge originated at: [I Lagoon Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RrNo
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes VfNo
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 El No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J6 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structtue 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued
Discharges A& Stream Impacts
L Is any discharge observed from any part of the operation? OYes [I No
Discharge originated at: [I Lagoon Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RrNo
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes VfNo
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 El No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J6 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structtue 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

-1 f I.
cdity „umber: f — 22 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 maintenancehimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Anima] Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor tissues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
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.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
OYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
:Cow {r..ef queshonA) F.p3am nay Y185 answers atrdlor arty ar aaYsaiher
,1CTse drs'faair#y to beereaGglam sitat�oas. {a�dtiro Pam') Feld Copy ❑ Final Notes -
x.
td4�� 1 ca /Jo FF I&I- c CN
A.
t4JR yDy
D"L�5O � �2 ✓,�� �c_ o .�� �.�FG/J y.��OrrE, �j�} `.��� /��C�
D
.�
,CDR .o Gnu-o,�5 p U)A srX-
1,F
/ 74 iLO
Reviewer/Inspector Name FEW
Reviewer/Inspector Signature: Date: Iva
Vd
I2/IV03
Continued

rlFaciI4Number: Date of Inspection
Reanir_ed Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WLFP, checklists, design, maps, etc.) n Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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 ❑ No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes QfNo
28. Does facility require a follow-up visit by same agency? XYes ❑ No
29. Were any additional problems noted which cause noncompliance of the -Certified AWMP? ❑ Yes ❑ No
NIPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? - ❑ Yes ❑ No
32_ Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
2�IFOOR-4 75 '4
r
Cie
Tor,
_714OP"ofC
r�c7 u �-•- � � do K MOA)-f Ea��o Go�oe�e
� ��As�� Fromm ��zbr� SPRAy&t-c7,
ST-Or
12/I2M3

IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint $6 Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: 2/ O Tune:
O Not Operational C Below Threshold
13 Permitted [3 Certified ❑ Conditionally Certified 13 Registered
Farm Name: _ -4c.
Owner Name:
Mailing Address:
Date Last Operated or Above Threshold:
County: „ �G;7 » . »...»..� ..».� ........
Phone No:
Facil-tv Contact: one No:
i.......................»._......... f............. —Title:
Onsite Representative: D�,r2 ��C, 4e c, Integrator:
Certified Operator:.
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry © Cattle ❑ Horse Latitude ' Du Longitude • < Du
Discharees & Stream Im acts
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 yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? 0Yes ❑ 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 0No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ---A— _...-....6... ..... _ - _& W.._._.-.. __ ..i2.--......___ ..
Freeboard (inches): 5/ 369 _ 3
12112103 Continued

Facility -Number: — 2 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 maintenancerimprovement?
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 maintenancerunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ 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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
IS. 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.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
-ar"`^ �sSwnt
Comments {reitr�to�gon) Ecplam aay answers or say _ or aety�o#er oom_
=Use dritwmgs of tQ better sima�. {pxe acldstmnal pages as neces�xy) '° ❑Feld COPY ❑Final Notes=�
z
Y
.--......--._ _,.� .,.�_ „._.. �: .�.: _.-.-..o.- _, _. ,'�-:_<»--e....»—,-,....,� ...,._.._ ,:... s:. m..:.'»�...rx.�,-,>.:+a._•ww:.•�W-•..—_.�.�,;�.�s.^�,:1-�:.-,,.sue«�: - :*:`�#
�-ouow t-\P No t T
�STtRbR�{ 5 C,om@���
i1
U�SiT. YiSiT �n�r Reoreo �ZeL(J ROAD �L'TC� AND
RC^^CORDS. � /
�—t� �oRQ
�« l� �s F �Afl
S-rfy-r6 . OF -64F, Tom Quin
��lmp�cJG CJi;X0e-C-"Re,E,D ©rJ f"t�(,L5 An1P �-Y�"uLL
r� G47 01- WA For-F- Oo AoADS� DF-Oy TC 1+
r - Cit
PuL-".s Q A jo o R� e)f_7E4_)APP A Alb T*f
Fm
Reviewerllnspector Name = _-: WE n z ��
Reviewer/Inspector Signature: Date:
12112103 Continued

Facili g+ Number: Date of Inspection
Required Records & Document.-,
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NI MES Permitted Facilities
30. Is -the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record steeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 090
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
1 ❑ No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit I
-r-RECDP-a5 SAdLPR [QMPZW,J-000T5 ©iF 1
a ji-4 toY rAonn (3; 30 -r. 0
q1 zo ot( jr/t0 T
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�iefou
12112M3

P6
Facility Number: `� j — 2'L Date of Inspection Z/ O l_ -
OPrRA,-roR 3 i e I Fc G-rLB::Rr .5A2-0 'A,41- Me i9acc
Q LJA 5 4rorvA,cc.y 5f•l, OP .�N l� `�. dpotj 6s�-OOND API
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V
l
7/25/97

r Division of Water Quality
Facility Number 'J� Z 0 Division of Soil and Water Conservation /
� V
0 Other Agency
Type of Visit (6 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: la o Arrival Time: ® Departure Time: County: L12P LT-�J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: MXCHAfrL_ GJ7-eG*Z-r I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =] I = Longitude- = ° =' =
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ La erI I ❑ Dairy Cow
Other
❑ Other E
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
❑ Dairy Calf
❑ Dairy Heifej
❑Dry Cow
U Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number 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?
❑ Yes �No ❑ NA ❑ NE
El Yes El No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes P/No ❑ NA ❑ NE
12128104 Continued

J
Facility Number: 3 — '� Date of Inspection o
Rectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C2/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 Ld 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? ElYes El"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6No ❑ NA ❑ NE
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
❑ Yes
EfNo ❑ NA
❑ NE
❑ Yes
UNo ❑ NA
❑ NE
❑ Yes
Q40 ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1? o
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [] Yes eNo
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E(No
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 2(No
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
33. Does facility require a follow-up visit by same agency? ❑ Yes Zo
Comments and/or Drawings:
El NA El NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

Facility Number: 31 — A;L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CiNo ❑ 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: jam_A i Arm L-ACrow C LA&=0 D
Spillway?:
Designed Freeboard (in): _ 1 °1, 5 q,, lR. S L S. t
Observed Freeboard (in): 3_L 3l �fo 1-f tF
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2�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 [2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ,.
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes IJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
hd No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
�No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[jo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;/No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
LAcrow_) O LV_k E,j l?%t..A - G-k-)(-K_ WAS SynPa.oVL t'
Reviewer/Inspector Name �IhJ �AGU}C-I.l� Phone:(ffiJ 794 ,)3 ?8
Reviewer/Inspector Signature: Date: (oz, LJp'7

J W Division of Water Quality
Facility Number 3 � Z 0 Division of Soil and Water Conservation
- — -- 0 Other Agency
Type of Visit
Corupliance 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: $ ! p y Arrival Time: ® Departure Time: County: 041JOU41 Region:
Farm Name: Owner Email: -
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: + LE irs Lt Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = , Longitude: = ° = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�. ❑ Non -Layer
Other
❑ Other _
Dry Poultry
❑ Layers
❑ 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 ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
I
E
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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?
Page 1 of 3
❑ Yes [�o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
[:3 NA
El NE
El Yes
�[;KNo
Lifi10 ❑ NA
❑ NE
12128104 Continued

Fa' lity Number: — ZL Date of Inspection Y �L
,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [/To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure Structure 5 Structure 6
Identifier: i:kAJ 4 6A&VV ./ C LA Gyy_io
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): 7 3.7
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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. El Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _ C L.0 13 L if) _ �_ +:-%'
13. Soil type(s) d a. Alm
11 L is
14. Do the receiving crops differ from those designated in the CAWMP? !'t ❑ Yes NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑/No El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes // ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes To ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
LAG oav 4 v- S
'EE,ps f rm(_ k/c)( t
oxi &.4A S.f CW QE
L
wer/lInspector Name I CJu A I Phone:/O 7?4 -131dwerllnspector Signature: Date: Sp/. ey(o
Page 2 of 3 12128104 Continued

cility Number: — 7,'Z Date of Inspection 14 GL
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes L7 No ❑ NA ❑ NE
the appropriate box. ❑ W1JP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Qxo ElNA [INE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,2 N/o [I NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes L� Nc ❑ 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?
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
2 No
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes
Bl�o ❑ NA
❑ NE
❑ Yes
ffNo ❑ NA
❑ NE
❑ Yes
b Nc ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page 3 of 3 12178104

Facility Number
Division of Water Quality`
0 Division of Soil and Water Conservation'
O-.Other Agency- . F '
Type of Visit if Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (ORoutine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ///15! Arrival Time: Departure Time: t ounty:
Farm Name: i� dTi�2_ �(�YSdn� Win'\ Owner Email:
Owner Name: kAjcjr_ �/ I�XTf� fTS�i+J Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �4eAk A) / " �2K� Integrator:
f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = r = 4f Longitude: = ° = ' E
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -Layer I - —
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 511
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 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 9fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
m No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No El NA El 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?: Ab ! vt9 _ / 0
Designed Freeboard (in): e7. 5,fg
Observed Freeboard (in): _0 __
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes gNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;ZNo ❑ NA ❑ NE
through a waste management or closure plan?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment7No
7. Do any of the structures need maintenance or improvement?
ElYes ❑ 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 El NA El NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ NA ❑ NE
/PlNo
❑ 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 ElEvidence of Wind Drift ❑ Application O tide
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
, O No
❑ NA
❑ NE
aucu w; �a cac�r-av aiuwuvaa: �r� a���a,. �caaa> ,itva�.sa+an nc■
.sazG s�� ,�o,�� �y G/��/, � /f���cu�y�r�,�ir cis-
Reviewer/Inspector Name Phone: — 2
Reviewer/Inspector Signature: Date:
121281041 Continued

Facility Number: — Z 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 (INo
❑ NA
❑ NE
the aIppropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [�No
El NA
El NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El 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 V1 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ofNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes VrNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [�No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes P No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes / No
❑ NA
❑ NE
Additional Comments. and/or Drawings: , > y 4
�..5-
co
�,� DQ�FR
12128104

m.
DSWC Animal Feedlot Operation Review
t .
:l ;[5DWQ Animal Feedlot Operation Site Inspection. h'
t
IQ Rbutine 0 Complaint 0 Follow-up of DWQ ins ection• 0 Follow-up of DSWC review 0 Other
Date of Inspection I I t z Al
Facility Number 2
Time of Inspection Q 24 hr. (hh:mm)
Registered ® Certified E3 Applied for Permit © Permitted [] Not Operational Date Last Operated: ..........................
Farm Name: a c� -S.o.. ...... -^r.Y" ................................ t.. .
. -¢�Y..
Owner Name: If\1 b ` ............ 1�.�.tn.+�..... ..t.t4..Y.......ra.--?.t^............................. Phone ti'o:... ..`1..1.`��....Sa.S.�...-S.Z.`�....1.......
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mai ling Address: ..A.'1...... Le......... 1,.�L..1.:.....�z.l.f.�.t .7 !\i.L......................Z.....�
Onsite .,..
........ .,.. ..�.---...........................................................
Certified Operator,....L.G1+4at ...... ...... ......r...�..,EA ....................... Operator Certification Nttntber,...l.L.13...2..-....-.
Location of Farm:
Q.�....t 5..�....s..:. .R ....9...... .... �......a,..ap.�... - o..)c .i.......... ., .....ram..,'. t'S;......0 ...L +c.. �....
��.G .�.!-.......[W. t-t�.....-.t-1. ......,.t?............................................... ...............-....................... ........................................ ..................... . ........................
.......
Latitude ©• ®` " Longitude `[ $ • "
Design Current
Design Current
Design . ::.Current, ..:
Swine Capacity Population
Poultry Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
10 Layer JE1 Dairy
Feeder to Finish
❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
10 Other
❑ Farrow to Finish
Total Design Capacity
I Li -T o r)=
❑ Gilts
❑ Boars
Total SSLW
Number. of Lagoons/ Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ 'o Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes I&No
2. Is any discharge observed from any part of the operation? ❑ Yes §4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 91 No
b. If discharge is observed. did it reach Surface Water?,(If yes, notify DWQ) ❑ Yes J4 No
c. If dischar-e is observed, what is the estimated flog' in "aUmin?
d. Does discharge bypass a lagoon system'' (If yes, notify DWQ) El Yes 1@ No
3- is there evidence of past discharge from any part of the operation? ❑ Yes 5d No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JffNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes K No
maintenance/improvement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of desi'-O ❑ Yes ® No
s
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1KLNo
7/25/97 Continued on back

lE'acility Number: - L
8. Are there lagoons or storage ponds on site which need to be properly closed? []Yes KNo'
Structures (Lagoons,tiolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes E(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboardtt.-..?......... ..2.:................ ........ ...'...•.1.............. ....... ......................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
1 1. Is erosion, or any other threats to the integrity of any of the structures observed?
19 Yes ❑ No
12. Do any of the structures need maintenance/improvement? R1 Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 0 No
Waste .Application
14. Is there physical evidence of over application? ❑ Yes 9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... b..41!r.err, 4!-. - ................Sp. s_�. _ .t1.. .............trJ.�+. a .............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes JQNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RLNo
18.
Does the receiving crop need improvement?
❑ Yes
IR No
19-
Is there a lack of available waste application equipment?
❑ Yes
K No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
10 No
22.
Does record keeping need improvement'?
® Yes
[I No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JR No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
1LNo
0 No.violations or deficiencies.were-noted-during this;visit. You;vvill receive'no further
to: qui
o be4_^ or watt '6
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C-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: R j _ r J-4 1d 4 Q_Date: q . ] tZ / 9 -]