310055_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

t';wC�1btv�sionofzfWaterReso•urces
.ea. . < ; - ,yamRIolaV� �
Facility Number f ', EXQ"iu ofsSoildnd';Water C ,pser�vation
0 OtherAgency *° t ,�':
Type of Visit: Co lance Inspection Operation Review Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: 9 f Arrival Time: ' tiles Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: //rr Title: Phone:
Onsite Representative:/CI1 T- �� Integrator:
Certified Operator: Certification Number: f-72 O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current . . Design Currenf + Design Current
Swine '" CMPH-, y 1'op "",Wet Po ultry *Capacity P,op Cattle Capacrty . -Pop
a '
Wean to Finish La er Dai Cow
n to Feeder ' Non La er DairyCalf FF
eederto Finish 90 °'' Dairy Heifer
Farrow to Wean' ~ "Design Current Dry Cow
Farrow to Feeder D P,o6l �Ca aci P,o Non-Dai
Farrow to Finish La ers Beef Stocker"
Gilts Non -Layers Beef Feeder
Boars Pullets jBeef Brood Cow
., �... Turkeys
-Other Turkey Pouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0'90 ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
Page I of 3
21412015 Continued

0C 10
Facili Vumber: - S Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2-- 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _2:7 f7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes DINo ❑ 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 �❑ 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 enviro tal real, notify DWR
7. Do any of the structures need maintenance or improvement? Yes Now ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable FD 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 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 Ea<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q>No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi ,Number: -4Z jDate of Inspection:
7
Z4. 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?
D Yes
ETNO ❑ N 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
ZNo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No IONA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW_N4P?
❑ Yes
�❑ 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
No ❑ NA
❑ NE
in
m
0, c 4J,-.ems d-.0, PGC M
7 D O�t1� h C C h Lam.
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^
e f 'VL-�g<_ k w dv 5�•-- 1S
f-aY rt(D 35Q 2-0 4f dtV,rJ,ppWeIC©ncAenr.�or/
Reviewer/Inspector Name: e v i Q 41k ` I .STl dt �'i ti wC/� Phone: Vn 7 Q G 7 y�
Reviewer/Inspector Signature: Z2, Date: S 3 - i
Page 3 of 3 A 21412015

(3 Division of Water Resources
Facility Number - O Division of Soil and Water Conservation
r
Q Other Agency \ / I
Type of Visit: +O' Copipliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: ErRoutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5 Arrival Time: Departure Time: County: JLQA) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title:
Onsite Representative: M-aTc uL,
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
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: a ` 93 A.
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
L
Pullets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ZrNo
❑ 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)
0 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
E!j'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C21No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number; jDate of Inspection: a
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:' LA 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3a 30 d
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
Flo ❑ 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 envi nmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ko ❑ 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
El Yes
ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[J"'No ❑ 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 D. 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 No
❑ NA
❑ NE
acres determination?
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 L No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [/] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rj ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yeso NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . 2(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ 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 E5 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ''No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [�fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes : NNo ❑ NA ❑ NE
V
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Signatui
�No . ❑ NA ❑ NE
r?❑NA ❑NE
No ❑ NA ❑ NE
S o�
21412015
Page 3 of 3

.,0 . W Division of Water Resources
FAcility Number 0 Division of Soil and Water Conservation
�-—� 0 Other Agency
Type of Visit: 0 Co liance 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: `F Departure Time:® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A j
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
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: - i� -! 3 (✓
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes X ❑ NA ONE
❑ Yes D No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of inspection:
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: � � CA6z* 2-- _3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ No
❑ NA
ONE
(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
.2No
❑ 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
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
WNo
❑ 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
P1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [/] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z(�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EKNo ❑ 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 [3"No
❑ Yes ❑/ NNo
❑ Yes �No
❑ Yes No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [?Io ❑ 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 N [:3 NA ❑ NE
2
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaGili. Number: - Date of Inspection:
..
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesrNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes tjf�N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 7 ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Yes �No ❑ NA ❑ NE
[:]Yes Oo ❑ NA ❑ NE
❑ Yes h o
❑ Yes
❑ Yes fNo'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional'pag�es as necessary). I
.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: I
21412015

® Division of Water Quality
Facility Number - L� . 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 7Rou;ine
"liance Inspection Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:l� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1' qj' _kr m =g
Integrator:
Phone:
Certified Operator: Certification Number: ((C> S�p
Back-up Operator:
Location of Farm: Latitude:
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
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Pullets
Other
Poults
Longitude:
Design Current ,
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Lj ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA 0 NE
Page I of 3 21412011 Continued

Facifl Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I ,Sttrructure 2 Structure 3 Structure 4 Structure 5 Structure 6
�
Identifier: � AC'00AI � L46ua1)z"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): JJ 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 12f No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E 1No ❑ 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 environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N 0 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes hIo ❑ 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 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes LJ No ❑ NA ❑ NE
1$. Is there a lack of properly operating waste application equipment? [:]Yes ❑ No ❑ NA ❑ NE
Reouired_Record_s_ & 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 [ to ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design [:]Maps ❑ Lease'Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [%f(Noo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F'acili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes ❑ NA ❑ NE
g
15. 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 to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ NA ❑ NE
❑ Yes tip""
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes YN(o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [I/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 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [! l ', ❑ NA ❑ NE
Yes
34. Does the facility require a follow-up visit by the same agency?
❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
-13

U Division or Water Quality
-Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
Cype of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
teason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: U�n= County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:
sif s8I
Integrator:
Certified Operator:
Certification Number:
d0%Va3a
Back-up Operator:
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
Certification Number:
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Nan -La er
Design.
Current
Dry Poultry
Canacity
Poo.
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 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.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
i
iiw
[:]Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
210'No
❑ NA
❑ NE
[:]Yes
eNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
-Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
eNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ZNo
❑ NA
❑ NE
Structure I Structure 2 Structure�3 Structure 4
Structure 5
Structure 6
Identifier: I�p8D�r, 'L J��„q'ayr� ?
�_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ErNo
❑ 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
21 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
rX'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
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[fNo
❑ 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
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2rNo
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[?r No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OrNo
❑ 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
ZNo
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ZN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility umber: jDate of Inspection:
.24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes eNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑- Yes [6No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [?fNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ZrNo
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2"No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[!['No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
�o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[;3'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
Z"No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�a
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L;?Tlo
❑ 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):
0�CDe"D
C,O?✓- ,1k L)C
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature: Date:
Page 3 of 3
1

Q Division of Water Quality
Facility Number ©- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Co liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: urine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: '1 Arrival Time: 1 ! a Departure Time: County: LIZ;7 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: N--� '�acH eu'_�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish ao b
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design.
Current
Dry Poultry
Canacitv
Pon.
Layers
Non -La ers
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 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
Daig 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 �o ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

_ 11
Facility Number: - C; Date of Insuection: W -7 1/L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i,Ac(( 1.,LA&cbA)3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health orE
onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes YNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r 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 [;YNo ❑ 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 C3No ❑ 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 [a 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 C 3'-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 22- Date of Inspection: t✓
A24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes cAo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 54 ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes dNo
[:]Yes ]�No
❑ Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ZNo
ff No
FNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑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).
r �WadrJ i NE B Q E �iZ-K D61JE #4S S�IJ As o�f,��-
E�xD
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 41t[} %1
Date: S/-7 I
21412011

Facility, Number
I
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit D0utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: ® Departure Time: 1 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JA -_Ja t& Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = i 0 S, Longitude: =
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
U Farrow to Finish
❑ Gilts
❑ Boars
-Other
❑ Other
if
Design Current Design Current DesignK Cnrrc>it �*
Capacity Population WetPoultry Capacity Population Cattle µ �Capacity Populaho n..
❑ Layer
❑ Non -Layer
'96
a -- ,Dry Poultry-; .:
Non-L
Pullets.
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cot-
E]Turkey Poults I I Ia
❑ Other
Numbee.af Structures ,.`�
Discharges & Stream I-mpacts
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? (1f 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 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NN ❑ NA
❑ NE
❑ Yes
❑ Yes
LJ N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection v
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?
Structur4 I Structure 2 Structure 3 Structure 4
Identifier: f ( LA&z* v L&eo1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes o4o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W� ElNA ❑ NE
ElYes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 ❑ 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 7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) 1
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
El NA ❑NE
5 o ❑NA ❑NE
Fo ❑ NA El NE
❑ NA ❑ NE
ol[INA ❑ NE
.Comments:(refer to question #) Explain anv YES answers and/or any -recommendation's or any other comments
Use drawin s-of facilitY to better explain situations (use _�. � 9 addtt�onaF a es as necessary)
Reviewer/Inspector Name I U rL �.L. Phone : 6 r
Reviewer/Inspector Signature: 0 Date: 12,11
Page 2 of 3
1
Continued

Z__ / /
Facility Number: — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes 7X0
< El NA El NE
El Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P6
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
7
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
V
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑No
ElNA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
�eo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dvo
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
m and report the mortality rates that were higher than noral?
El Yes
N
❑ NA
❑ NE
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
El Yes
94
El 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?
El Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Addition] Comnients'andl©r Drawings:%zy
AL
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 5S O Division of Soil and Water Conservation
Q Other Agency -
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 4eRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: WPs_-mJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: on-l- Z--
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
p
t �O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = [ = Longitude: = o = i = " -
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design �, Cnrrent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number:of Structures n„
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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes d o El NA ❑ NE
El Yes El No [I NA ❑NE
Page I of 3 12128104 Continued

Facility Number:
Date of Inspection o
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: _uA [fib t-J k - L-A&-a iJ Z LACssrsA) 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
:?'Icl D-LP
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VNo
❑ Yes []-No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes &o ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JNo ❑ 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?
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
[;I�o
❑ NA
❑ NE
[;]No
❑NA
El NE
I1J No
❑ NA
❑ NE
[�No
❑ NA
❑ NE
JNo
❑ NA
❑ NE
Comments refer to question # Explain an YES answers and/or any recommendatio ( q. )• y 'ns or:any other
Use drawings of facility to. better explain situations. (use additional pages asmnecessary): k
.- .. -
o SAw+ et—C Eb tt_ Z�9 ►J Ep 3� 0A45
tACtD t.-V PP-kS&JT
Reviewer/Inspector Name e `:; _mot Phone. Q/�� ?9 6 7 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

F Facility Number: ( - Date of Inspection 3a
keguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ 1AR TP ❑ Checklists ❑ Design El Ma ❑ Other
❑ Yes
<o
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate elow.
Yes
❑ No
❑ NA
❑ NE
tsoil
El Waste Application El Weekly Freeboard ❑ Waste Analysis Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
6 o
❑ NA
ElNE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
u No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EN.
❑ NA
❑ NE
Other Issues �.,/
28. Were anv additional nroblems noted which cause non-compliance of the nermit or CAWMP? El[] Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours andlor 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
dNo
❑ 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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q<0
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments and/or Drawings: n
Page 3 of 3 12128104

F'aciff Number;=
3
SS
Division ofWater Quality
Q`eDivision of Soil and Water Conservation m , µ
O:
:Other -Agency. ten.,
Type of Visit 6 C mpliance 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: 6 09 Arrival Time: j Departure Time; County: 12Ye _ A) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: -SA V Va tjQS. Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = o = = « Longitude: = ° = t =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Mon -Layer
❑ Wean to Finish
❑ Wean to Feeder
VI Feeder to Finish
96Y0
MLtO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: . ❑ 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 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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
elNo
❑ NA
❑ NE
❑ Yes
Zo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 1 Date of inspection
Way ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 6 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: LA&5A1 CA&MA) Z CA 6a0h/ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 21 ZL 3U
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes QNo ❑ 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 environmentaltreat, 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 ENo ❑ 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 P(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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
U<O
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
�V'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
Z;No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rJ No
❑ NA
❑ NE
� r
a ta
•Comments (refer to questron,4). Explain-4ny YES answers and/or an y:recornmendat>ions or any other, comments
'Use_d�rawtn s:of facrh to better explain situation's {use addtttonal pages as necessary).
g h p
„ t
AL
T
Reviewer/inspector Name �T-----
� �)6tL- Phone
Reviewer/Inspector Signature:
Date: L i
Page 2 of 3 f 12128104 Continued

Facility Number: 3 — Date of Inspection
Riguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ON.
❑ 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 ElWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
u No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
LNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
df No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Id No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
El"No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
d
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
WN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 1 51 ss
la Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: `y h lox I Arrival Time: Q U Departure Time: �� County: AJPUd Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: JAq Jo 0 f3 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
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: E o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
1❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [/] No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
12128104 Continued

Facility Number: (— r Date of Inspection
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (Taud 4gatj Z (AtrObL✓ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3t; 35 36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ICJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed El Yes 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 <0 ❑ 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 En No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Id No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E!J 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 acre determination?❑ Yes
�t
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
lack
ElYes
Z16
dNo
❑ NA
❑ NE
18. Is there a of properly operating waste application equipment?
❑ Yes
❑ 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):
Reviewer/Inspector Name
6
Phone: (lid) -711 � i 3 9
Reviewer/Inspector Signature:
Date: Y 1 I a8

I
Facility Number: — ,� Date of Inspection ICJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ��,, //
21. Does record keeping need improvement? If yes, check the appropriate box below. ElE Yes fo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C J No ❑ 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
E f No ❑ NA
Cl NE
❑Yes
5 ❑NA
ONE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
ONo ❑ NA
❑ NE
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 ETNNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes [�.2Qo ❑ NA ❑ NE
❑ Yes 2' o ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 3 of 3 12/28/04

�❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 1 tgz6 f j 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
V Division of Water Quality
]-Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Qrrioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: GG Departure Time: County: DU(1Qr#) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CAtri.2.d L'L' C-o
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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
❑ Daty Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
ii
❑ 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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[] No
❑ Yes
0✓N
El
[I NE
❑ Yes
LI No
❑ NA
ElNE
12128104 Continued

Facility Number:
1 — b Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Cl 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: UA &-vVM [ GA6C z ,/ I LA Gv O i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,(
5. Are there any immediate threats to the integrity of any of the structures observed? ElE Yes No ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.) ,�(
6. Are there structures on -site which are not properly addressed and/or managed El�J 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 Oo [INA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 lJ No ❑ NA ❑ NE
maintenance or improvement?
Waste ARalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
Ef �i
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detemtination?❑ Yes
IJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0� o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YJ No
❑ NA
El 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):
l5�) Gcr co Pv �F Ncw C. G
,t sENo 0(y J 6TC 1rU--PS( {'ak Z Wr -2"6 pl✓q.
Reviewer/Inspector Name 16HPJ fA( Phone: y/ - 7 3
Reviewer/Inspector Signature: Date: / �Y
19/92//iA ram .....:.......)

a
Facility Number: 'jL— Date of Inspection Y 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E(No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZINo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
IJ Yes ❑ No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
❑JNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
IJ� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1 L 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
Ed 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
21 1Vo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L2No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
- O Other Agency
Type of Visit Q1`C,o/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C7 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: to a Arrival Time: /J3o Departure Time: County: bWL-TK) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,, V G IJ (:C _
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
a
Latitude:
Back-up Certification Number:
= « Longitude: 0 ° = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
JQ
Feeder to Finish
$te `r0
$�
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
Non-L
Pullets
Poults
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 Stocket
❑ 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?
❑ Yes 2 No ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
_6o
,5
Ld
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection r o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ 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: _ LA6-wo/y 1 G_&) Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�Io ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LJ 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 9-9—o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes QN'o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require El Yes L�'No ❑ NA El NE
maintenance or improvement?
Waste Application ��/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ ETNo I`No ' ❑ NA ❑ NE
maintenance/improvement? �/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L" No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable 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
EJNO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,l�o
6d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name d Phone:1 1)6 7�1 L 3 lyp
Reviewer/Inspector Signature: Date: S J
1L/14Y/U4 [.onnnuea

Facility Number: _7f — S Date of inspection S ►o
Re uired 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 El"No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ o
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
2<o
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
9-; o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
_,
Ej No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,—, ,
Q-IG'
❑ 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,//
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
1J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
[Flicility Number a, �'S' 0 Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit
pliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
7RoutineQ Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 7114Arrival Time: 10 D Departure Time: County: A) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J�AM�S �NMS
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 6 = Longitude: 0 ° = t =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 6 L10 UM
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
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?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 7
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
2
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — SS Date of Inspection'--i--[
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Z 3
Spillway?:
Designed Freeboard (in): / 9 15- 15.
Observed Freeboard (in): X17 3.,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ao ❑ 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
environmenta7that, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes IQ 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 L/ 1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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) &&oWA ( ) 56,0
13. Soil type(s) /V 6
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
r?Nc❑ NA ❑ NE
ElNA ❑ NE
7No
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I ._Ta,v FQAJE:t t, Phone: f/o 7 t&- 1; 6S
Reviewer/Inspector Signature: Date: 5�7�0l1
Page 2 of 3 12128104 Continued

Facility Number: 31 - s$' Date of Inspection 3 7 v
Required Records & Documents �,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El 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 El Checklists El Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspectionss 0
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L��JNNo
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yeso
WN
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
3 l . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
01,0
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[(No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number j2
0 Division of Water Quality
0 Division of Soil and Water Conservation.
0 Other Agency
Type of Visit o Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $6 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 31 OS Arrival Time:
Departure Time: ; unh'ti
Farm Name: _�qR(r 5 Owner Email:
r
Region: W_
Owner Name: _C1�? P� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: M-rfC�- Phone No:
Onsite Representative: AL D jJf 5 E N' IntegratorV
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
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ DajOLHeifei
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Ca
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©,
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes / No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
El NA
El NE
El Yes
❑No
❑NA
El NE
❑ 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 gNo ❑ 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: � T� �
Spillway?: //O
Designed Freeboard (in):
Observed Freeboard (in): 2C�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [INo ❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 7No ❑ 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 �ZNo ❑ 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 ❑ NA
El NE
maintenance/improvement?
//////�No
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /2fNo ❑ 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 ind Drift ❑ A plication Outs' e of
12. Crop type(s) �, /??6s(05g ( 14 Z� � tj*t �" e , (��!/�
Area
L DQ"O'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
21/41" (Ae-5'5 � -.5zeyv
S f.5`.-, r9X
��. 5"-f-�d oCl/OC�'
Name Reviewer/Ins ector ` -� `' '`
P y�%/G � � � � = Phone: D "
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — j Date of Inspection 3 O
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 appropiiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JE2fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/11 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JCJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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
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
❑ Yes0/p`No
El NA
[I NE
General Permit? (iei discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
pp Y. #
Additional Comments and/orDraR�s► s 1 b
.�
-.. ..-. ....-,. .... ..... .-,b
4
A*41- 7. eArZe?-� 5AI V-K-
2�
,
12128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: 5 18 G Time:
FFacility Number
r Q Not Operational Q Below Th
/reshold
$Permitted [`� Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ..... ?� A`' .. �.C�2.5.............................,................................... County: h ................... .... ..._.» .».......
Owner Name: _GL 1� p l __...._.. Phone No: ....._. _. _. ..... _. ... �. .
Mailing Address:
FacilityContact: .................. ............... W_ Title: ... ......... ......... ..............
........... ............ Phone No:..................................................
Oasite Representative:
,�A .. t�. ipXl S.r.. fPa� _f ►t t'. El�....... ........
Integrator:...1Z.t?lll �12nC.0...............................................
Certified Operator:
Location of Farm:
Operator Certification Number:
P/Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 4 64
t= ❑ Wean to Feeder'
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
;ool
❑ Other
owl
Non -
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier-�3
❑ Yes ;2'fTo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Fe o
❑ Yes
P,90
❑ Yes
No
Structure 6
.... ............ ....... ......................... ..... ....................... ..... ........................ ... I......
Freeboard (inches): O� 61,
12112103 Continued

' Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes 2rf4o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 2f4o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes L'Nlo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes C?fio
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [2-90
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes PNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop h'Pe f rTYl////Cly? fW S<
13. Do the receiving crops differ with those designatedin the CertifidAnimal Waste Management Plan (CAVVMP)? ❑ Yes J�rRo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZfNo
b) Does the facility need a wettable acre determination? ❑ Yes 01�o
c) This facility is pended for a wettable acre determination? ❑ Yes Elfio
15. Does the receiving crop need improvement? ❑ Yes ,�No
I6. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes ENO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0'<o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes dNo
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 ❑ Yes 2rNo
Air Quality representative immediately.
Coieents (refer to gnestxoxi #) Explain ai4y YES answers aad/orany recommeadatioos o ayothemments.,,_i
:Usedrawn of fact ty to better czpiarn situations (use addiLonal pages as necessary} Field Copy ❑ Final Notes
� Y
Reviewer/Inspector Name ?' n %�'NF-
� , w
ReviewerAkspector Signature: Date:
12112103 T Continued

Facility Number: _ Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 010
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.) ❑ Yes ONo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2"N'o
❑ 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
❑,fqo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
EJ�No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
ONo
(ie/ discharge, freeboard problems, over application)
❑ Yes
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
28.
Does facility require a follow-up visit by same agency?
❑ Yes
1l�To
.*NTo
E
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
21<0
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
_E3"�es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
014o
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
ErNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ;Er&o
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 2T4o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
dd�tsanal Commetits�and/or:Drawtngs rs =. � ' t_ � .a.- -
0 0 eo O'a
61V -7NVC-
12112103

Type of Visit Y"Compliiance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit /Routine O Complaint `O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
01p, ermitted [( Certified,�13 Conditionally Certified Q Registered
Farm Name: .... 5—... ....` .._.... ............
Owner Name:..�........�!�!(
Mailing Address: ....................................
Time: / s
10 Not Operational O Below Threshold
Date Last OperaAor Above Threshold: .. »......
County: llzf✓-................. ....... ...... I................
Phone No:
FacilityContact: .......................... .._................... ...... Tttic:.......................... ............................oG o:a ............................ ...
/47 -�'.�s s ,�o
Onsite Representative:.�1....... .......... Integrator:...
• .....................-............ f............. ...
Certified Operator: ............................. ... . ............ . . .......... . ... . . . ...................... . .... . ......... Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` 4- " Longitude • 4 �K
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard pins storm storage) less than adequate? ❑ Spillway ❑ Yes No
Stru ture I Stir 2 Structure 3 Structure 4 Structure 5 Structure
Identifier
- ..w ..........__ .................------- ---- -------------..--- .. -
Freeboard(inches): F..............3z............................. -.......... .......... I......................... ........ I ..........................

Facility Number: ^ / j � Date of Inspection / DZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
�No
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
r (If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?j.
Yes
�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9, Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
plN 0
Waste Application
10. Are there any buffers that need maintenancerimprovement?
❑ Yes
A No
1 I . Is there evidence of over applicati ? ❑ Excessive P nding ❑ PAN ❑ Hydraulic Overload
❑ Yes
YNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14No
14. a) Does the facility lack adequate acreage for land application?
ElYes
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
1 S. Does the receiving crop need improvement?
❑ Yes
" �No
16. Is there a lack of adequate waste application equipment?
❑ Yes
/ No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
jTo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
///
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ief discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes
/No
No violations -or deficiencies were noted during this visit You will receive no further correspondence about this visit.
-n
s ars .' 1., tie :: > cam to da ei oi' 1L�I� fLli- �+Saq
v�v _,�,r v_,�:i......
- y�,,� �+ �-:il"�' viL�ti" - ,nw::,u�.:b::•;�ci�}vwC:k�:waL',,i-:"L'-i:.vi:;:J-.'<:2Ci}}:}.
�
.. ..:.:,.<<.....Copy �..:i
teld ❑FinaNotes
..ax+.,..} , .... }; �}t}?.._..__.. _k.: ..... �}: :::?}....-2k�:.:..::. .... ....... ... ....... :. .....i}}$:£"-.:?; k" h- _::C..; {L-.,.. „}.. .iSe{:!x•.KLi::::. !iNIX t:O: ^K^:{LCSSii{ifiiif{^: ^•^::x{v,Ei.KN,.. :;}}:::; `t .....
j� /�o��`S �i✓ Lire �.f�}�;
AL
,::. "'' -"• •�- w,,,.,
Reviewer/insp �::::-• - _
ectorName
v
Reviewer/Inspector Signature: Date: / 10

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(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 ANo
No
ElYes
❑ Yes Y.No
❑ Yes Y.
❑ Yes No
ElYes No
❑ Yes ❑ No
(%IJ�RA-� �� %� GODfrS �D �� C D►Q�S -�-f,/ I�CD�j�.
05103101

of Visit Q Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 3 D v/ Time:
Facility Number
O Not Operational Q Below Threshold
Permitted © Certified © Conditionally Certified [3 Registered Date Last Operate r Above Threshold:
d11
-
Farm Name:............Z.................................................... County:....Oe% x�,,...............................
..............
OwnerName:...:,J.................................... Phone No:.......................................................................................
Facility Contact: U.t[Ll%�/1' Phone f
...........`.•- •• .............Title• No:
Mailing Address: .......... ................................................
............... ...... .. .....................
Onsite Representative: r�ll�l..lC,,, �r... Integrator:.......(!. S y�...�.� /11�i
t..............
Certified Operator: .................................................. .. Operator Certification Number:...................
Location of Farm:
Vswine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �• ��� Longitude �• ��
Design Current Design Current Design Current
Swine Capacity.Population Potiktry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑Boars _E ffoW SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray'Fteld Area
Holdtng,Ponds / Sohd Traps z ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. 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 ❑ 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, notifv DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes kNo
_4;
01/01/01
Continued

r
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
ugture 1 S,ytuure 2 Suc urc 3 Structure 4 Structure 5
Structure
6
Identifier: 11�tt �� ................................ ... ......... ....................... ..................
Freeboard(inches) R
.................
...........� _. ........�7.
............. ..............................................................................................._.....
�.............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
91�0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
[]Yes
KNO
& Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N0
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of ver application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
CNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
JdNo
1 r.
Are
- -feet-ofihe spray field boundary? El Unknowno
Re wired Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
20.
Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
. No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
26.
Does facility require a follow-up visit by same agency?
❑ Yeso
tNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yeso
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
C
liquid level of lagoon or storage pond with no agitation?
/\
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
I�No
01/01/01
Continued

Facility Number: — Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes W- is
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes allo
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 4NO
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 CJNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes VNo
A &w t+a4t -
1)aw- IvIz,
J
5100

Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
of Visit (I Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date. Of Visit: 725 DD 'Time: .' ZJ Printed on. 7/21/2000
r_—__ - Q Not Operational 0 Below Threshold
Permitted [3 Certified 13 Conditionally Certified 13 Registered Date Last Operated or bone Threshold: .........................
Farm Name:.. 1... '��.Z County°:............
.................................................. ....
..... .... ..
Owner Name:....V................................. Y�.� �r... Phone No..............................................................................
y,..............................................
Facility Contact: .....•1l� .. ,� �............... "iitle:...:.".C....................................... Phone No:...................................................
MailingAddress: .......... : ,.......... ........................................................................................ I ....... ......... ......... ... . ...................
Onsite Representative: „;o rotor ,,,,,,,,,, �._
.�,..........�111
. ,.fewc�.sa........�1�.
Certified Operator:.. .a_5..........._.................. Operator Certification Number:
..... .
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 64 Longitude • �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish 7W ❑ Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
El Gilts
❑ Boars Total SSLW
Number of Lagoons
❑ Subsurface Drains Present 110 I,agnon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharaes & Stream I_mpactti
1. is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b_ If discharge is observed. did it reach Water of the State'' (If yes, notify DWQ)
c_ II'dischanze is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection &: Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
iucturc I S%dre 2 Structurc 3
Identifier: .................-131.............................. P.7 ........_..............
❑ Yes
—AO—
❑ No
❑ No
Yes
❑ Yes
KNo
❑ Yes
[KNo
❑ Spillway ❑ Yes )No
Structure 4 Structure 5 Structure 6
Freeboard (inches):
5100
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse ed? (ie/ trees, severe erosion, []Yes NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? - ❑ Yes kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XN0
Waste AppllcatloFi
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �<No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
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
IT Fail to have Certificate of Coverage & General Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
`19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Nd-yiolatioris;o:r- deficiencies •Were noted• during this;visit: • Y:ott will -receive iio; lfui-thgr ;
corres ori�ence: about: this visit.: .
❑ Yes $(No
❑ Yes %�No
❑ Yes WNo
❑ Yes 5No
kes ❑ No
❑ Yes ANo
❑ Yes XNo
❑ Yes KNo
❑ Yes 5R[No
❑ Yes %No
❑ Yes %No
❑ Yes P(No
❑ Yes b(No
AYes ❑ No
❑ Yes XNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
F llyw-�s I
� C 1-•A� Cry -v,��� � � `#-tti+ S 1�.e-,��•�
SAT,44%-V� . NCO 044\ -eWS skV4 64- 60ff 44
Reviewer/Inspector Name L_' , C Y Me e V t LKe Reviewer/Inspector Signature: / - Date: 5/00

FacilityNumber: 31 — Date of Inspection 1 10 1 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes /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, ❑ YesN0
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 kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) []Yes \ [ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes / o
32. Do the flush tanks lack a submerged fill pipe or a permanent/tetnporary cover? ❑ Yes o
Additional ommentb and/or wings:
_�l5
�U-P C��, wa5�►--�- ^i 1av� Sho� �.�- �c vis-`�
-
*10� Q� �i Ca.'� b�. VJ I vJ "S
G1I [0v\.) �_'(3w
VK4W*,A�
I
� S
v
�JAA�t
. tl�a
Re
I
5/0�t

4 e I
Facility Number: Date of Inspection:
AdAi66n—a-l.CbmM"ents a 6d/oiDrawings':-,
YVLV-. —3ovus VOL-S "cq,-j ka, C-,A&4k,� J -rcv- ar-
Z-
.� � o � �'w - fir- ��s c�„�-� ��
CJK-�� 1 r%-
4-e- C. tkvk� Ll,-k
- L �(oLs
iS
W a-wty� I � ![.c i� �2i- Dµ-. W� �- fig
C.
4/30/97

w D Division of Soil and Wafcr:Canservatian - Operation:Aeview
13 Division of Soil'and Water-Coriservafion - Comp�ianee Inspeetion
Division of Water Quality. -'Compliance Inspection
` E Other Agency - Operation Review -
Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSNVC review Q Other
Facility Number Date of lnspec•lion
Time. of Inspection GO 24 hr. (hh:mm)
Permitted Q Certified © Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
FarmName:........T.'..................... ...... ......... ...... County: ...�.-......-........................-................
Owner Name:.....2-...-.... ,•,GQ3................................ ............. Phone No:.....-..1.!.q...-'.��...... .....................
.:... q ff
Facilit► Contact: ..............................................................................Title:.......................................... Phone No:.,.l.i................-..-.... ...--.-.-......�
c�- a��
MailingAddress: ................................................................................................................................(,........................................... ................
Onsite Representative: lnte-rator• "5 ........................
...........!...�`.Q:.'r.................I................ ........... ..........................................�...............................I..............
Certified Operator:.. ............. ....., ..... Operator Certification Number:.........................
Location of Farm:
r............................................ ............................ ..... ................ ...................... ............................................................ ........................
t r
Latitude �' �� �:� Longitude
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer PC]
Dairy
❑ Nan -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)'? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b, ll' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If dischar Te is observed, what is the estimated flow in gal/min?
d. Does discharge hypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes j'$iNo
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........D , ,., ...1
...............................................................I...............---.................................................................................................
1/6/99 Continued on back

Facili4y Number: — S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 1XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 2rNo
9- Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? El Yes �No
Waste Application
la. Are there any buffers that need maintenance/improvement? ❑ Yes "No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen El Yes N No
�.....��'z �'......................................................................................................................................
] 2. Crop type ......................... ..........
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes NNo
15. Does the receiving crop need improvement? ❑ Yes �(No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes '0 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
allo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes t'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes [�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-sitc representative?
Cl Yes ['No
24. Does facility require a follow-up visit by same agency?
ElYes No
�. N�o.Vio�lation8 or. def cie-n' d were noted. during .this -visit:. You val..r.ereive nor further .: .
correspot<.. .......this visit.. ...: ............. . .............. .
Comments (refer to question #): Explain any YES answers and/or any ;recommiendations or any other, comments.....
'
Use dra mg_s of facility, to better explain situations. (use additional pages as necessary)
A-c cc A\
j\��\�'•C�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: r 3 1 q ICA11/6/99

ry
Division of Soil and Water Conservation
❑ Other Agency
E'Division of Water Quality
f
HZ Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection IffUm
Time of Inspection Q� ?A hr. (hh:mm)
13 Registered © Certified 0 Applied for Permit ErPermitted 113 Not O erational Date Last Operated:
..-_...................................................... County:........,..�a1\.......................................... Farm Name:..... ... .........
T - 1.••.....
Owner Name: ................ .................�............................ ...................... .................................................. Phone No: .........
..�� ��.......
Facility Contact: •..................... .... Title: Phone No:...................................................
Mailing Address: h .................... ........................
v
.Lf
Onsite Representative:., w �e ........ Integrator:... � ` 5
Certified Operator;............................................................................................................... Operator Certification Number,...----------........
Locati n of a G
``` �' .r.................... �............... .....fs,3 ... .rah....................... ....... ...... .^..!...... ........
�...........�.............................
Latitude • ' " Longitude �• � � 66
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 19 No
2. Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
ONo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
ff 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
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
$j No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25/97

Facility Number:3 -
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes NNo
Structures fLagoons.Holding Ponds, Flush fits, etch
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ff No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
.............. .............................
Freeboard (ft): ............2240 .......... l.......... ���
...............................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes dNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
1A No
12.
Do any of the structures need maintenaneelimprovement?
OYes
JdNo
(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
19 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[2f No
(If in excess o�WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type-2...........t.`'�.............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
"�Sj Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
O No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
J�fNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
14 No
22.
Does record keeping need improvement?
%Yes
❑ 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
(dNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
OrNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(9 No
No.violations•or. deficiencies.werenoteddtiring this,' visit'., Yodw'ill receive no ftirtlier
correspO4dekO viWit #his:visit:- : ; .
1�� l.�,J�- ����eg�� lcc
a,r,2.1 ;v, -.�.� cs�-. �Ei �i� [•.5u,�-.�2 .
�� �2Q p Lr✓l `'i c'� ►r�?C��-c�j G"� ���� i^ �` - � b� CLv ►�c��`-� �v�" l-�,, f
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ���� Date:

f
Division of Soil and Water Conservation [3 Other Agency
{ R _
Division of Water Quality
�:-
0 Routine 0 Complaint O Follow-up of DWO inspection O Follow-up of DSWC review Other jpi I1 ?,flori-
Facility Number S ,r
C1 Registered R Certified 13 Applied for Permit 13 Permitted
Date of Inspection
Time of Inspection L LSE-s 24 hr. (hh:mm)
113 Not OperationalOperationalA Date Last Operated :..........................
Farm Name: , `f
County:....I�u�1l.r
................................................................
Owner Name: ....... 4a' -.........
6-t> &................... .......
...... ... . Phone No:...��
i P�. Z..�t�O .'.�i~ ar'7
Facility Contact:......'Isla
'JAI .....................Yt.11.5,.....................
Title: .... 0,wh !... ..................�.........................
Phone No:...................................................
MailingAddress:D ............
&A.........................................................................
......4�!!I Y.�aa1r....1J.
......................................... A.Mi Xx........
Onsite Representative:..........
...........VplaB,`:......................................................... Integrator:....
,tQ� XO......................... ............................
Certified Operator................................................................................................................ Operator Certification Number:.................
Location of Farm:
Latitude • 6 44 Longitude • 06 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field PR Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes E3 No
C. If discharge is observed, what is the estimated Floe• in gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes N No
3. Is there evidence of past discharge from any part of the operation? to Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ®Yes ❑ No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97 Continued on back

)Facility Number: 3A— rss
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11oldinu Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ❑ No
❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):...............................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ❑ No
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................. ................... ...
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?
0 No.violatitins-ar deficiencies. were noted during this:visit.Aou�w'iH receive•n6-f6rther:
cO&Ospondehtc ;3i oitt this'. Visit'.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JR) No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gumments (refer to question.) Explam any YES answers and/or afny reei�mmendattons or any�otlter comYne�nts.�
Usedn►�vings of facrhty to better explain€hsttaons l(use addtgonal pages atisnece9saty)` °
•
tom= - a P :_.� , a" tea.
3. p��� d;scl� Ie rJ Iti G.r i��.t� ' f �e �i-:...
` y�seY ��tina �Ino� ay�tz,, k�' �a"a�
�0.C�(.tC1
1ot�e``�
toJ�S :r. q �pVC f �,r%6 ow} lwtdoo,- 00 `6rW Pc bpv�+na IAOUSe Nt( rV^
tj w rx -o . yrws, cl wo.�1,�t.�*, 1�10►ti 100. i[d4 rsiar, . wc,,�-br 1, N< �w,;l � �a� b1ocikp
I {
LU 4S} ]
}moo G.S� pp\?J 6AL �hl� lonvor\.
7/25/97
Reviewer/Inspector Name s y � nin I L R X
ReviewerAnspector Signature: 141. Date:

s
❑ DSWC Animal Feedlot Operation Review
<[A DWQ Animal Feedlot Operation Site Inspection
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Routine 0 Complaint 0 Follow-u of DNV 1 ins ection 0 Follow-up of DS% C review 0 Other
Date of Inspection l
Facility Number S.
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex;1. 25 for l hr 15 min)) Spent on Review
® Certified IN Permitted or Inspection (includes travel and processing)
0 Not O erational Date Last Operated: ...................................................................................................................................
Farm Name: .......... 51°�''J...... y7cann....... *........................... ........ y' bP1;.Vk.................................... .......................
Owner Name:........ .&U.,..... ft'5................................ ..... ...... Phone No: ..,�����.�gfr.�.��5�...........................................
Facility Contact: ....-5.,.......40"s3............................. ............ 'I•itle:.......... 0J.+.Kr................. ................... .. Phone No: QrO�. -`' ...1.?,S� 7
Mailing Address: ........ 9!�....0X... w................................... f!1,%(LI asi..... Nj; ................. _a. 9.3.......
Onsite Representative:......d-1.........
.................................................................. Integrator :...... C ..IG17fQ.............................................
Certified Operator :........1k%L!3 ...... &...... ..................................................... Operator Certification Number: ...... ;A.
Location of Farm:
t.414e :..s3 mat....... tr,....Wpu►rsa�.�...T�r�rt\...Ze.'. ,an ..�R,:.1.�51i., Tux r7�t ....t�r.....��!.�5� � �t �K.......
...1s .............. ....
Latitude 35 ' 03 ` ®" L.ongitude ®• l 03�` 1Z
Type of Operation Design Current ;: Design,. Current; 'Design.. Current
Swine Capacity.Population.` , Poultry, k Capacity Population Cattle 'Capacity ..Population
❑ Wean to Feeder
Ig Feeder to Finish
&, b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number of Lagoons"/ Holdin"g"''Ponds �" ❑ Subsurface llrains Present ❑ t.agonn Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprray Field ❑ Other
a. If dischar-e is observed, was the conveyance man-made?
b. If discharge is observed, (lid it reach Surface Water'' (If yes, notify DWQ)
c. Ifdischanve is observed, what is the estimated flow in gal/nun?
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
4130l97 maintenance/improvement?
❑ Yes Wo
❑ Yes RNo
❑ Yes ® No
❑ Yes No
N
❑ Yes No
❑ Yes ® No
❑ Yes iM No
❑ Yes ® No
Continued on back

Facility Number: ...... ......
6. Is facility not incompliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IN No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
IN No
Structures (Lagoons and/or I{olding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure I fk Structure 21 Structure 3 L Structure 4 Structure 5
Structure 6
.... ........ a -A—. ... ,..... ... .. ._.... _
_ ....
._
10. Is seepage observed from any of the structures?
❑ Yes
EgNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
WasttApplication
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... b arm�.L—......... ........... ......... _........ ........ ........... _ ..:fit a.ln ........__..... .... ...... _......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19 No
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
® 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
;kNo
For Certified Facilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
19Yes
❑ No
24. Does record keeping need improvement?
.K Yes
❑ No
14. FX65.0r, axeas en (o.gc'O"X olyu, w0.11 -i6UN b, 41W tA— cf'vy Q.-VI m'-weJej. &cp-
cLV'tcs or. I,)mns Ar - 6 56,)I i 6, roeeTjd.
��, germuc�p. � S%viU[� be i�ProVe�/
23, qc e S6OU13 be QIMA#Ae AeiOM
2 I Z-#-pp should '0"- u�.OW,
ce r-'6 T, c3 jk r, ,rrY Skk Ov) 0-0� ce-�-ej �+'Vv,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 911q l gam_
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

1
11
.,1ZO
Farm Na
Mailing
County:
Integratc
On Site ]
Physical
1
1� Type of _ _
lU Design Capacity: _Y Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ° Elevation: Feet
Circle Yes or No
Site Requires Immediate Attention:
Facility No. i
DIVISION OF ENVIRONMENTAL MANAGEMENT.
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
61
Does the Animal Waste Lagoon have sufficient freeboard of .1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft.. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: `e SCLc AS r� -V 6Qa57��h2'y
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?tq� or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 040
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes, or6
esorb If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Q or No
Additional Comments:/1' / r ^/i
5 .�, 149 O�•- !n AR/ v �a aP_ O� i7r�GcJ ��
r a
Inspector Name
Sig a e
h«
0
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
OPERATIONS BRANCH - WO Fax:[phone] Aug 1 '95 10:32 P.13/13
Site Requires Immediate Attention
Facility Number: 3 ) f
SM VISITATION RECORD
DATE: *i ~ [1 __W 1995
Owner: �„ _ -. y , Farm Name:
County:
Agent Visiting Site: Phone: 71
Operator: Phone:
On Site Representative: Phone; }1 Q S L 6
Physical Address:
Mailing Address:
Type of Operation
Design Capacity:
Swine Poultry~' Cattle
1000 Number of Animals on Site;
Latitude: o -' " Lonsitud.e: 0
Type of Inspection; Ground~ Aerial -
Circle Yes Or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot f 7 inches) Yes or (9 Actual Freeboard: _ Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the.
comments section.
Was any seepage observed from the lagoon(s)? Yes or(Q) Was there erosion of the dam?: Yes c Rio
Is, adequate land available for Iand application? Yes or No Is the cover crop adequate" Yes or No
Additional Comments:
Fax cc (9 i 9) 715-3559
Signature Elf Agent