310057_INSPECTIONS_20171231

NORTH CAHOLINA
Department at Environmental Qual

k/p � JA5 (b J`UNtE� I"[ �-� Q _
Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine O Complaint 0 Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: ~Arrival Time: Departure Time: �%, A;k?r I County: �t h Region:U 1.I
Farm Name:—rar"✓— F&�,j,r--L Owner Email:
Owner Name: r +t ^Gv� t �d`+Lj /, L C, Phone:
Mailing Address:
Physical Address:
Facility Contact: k,- et fit{ Title: Phone:
Onsite Representative: l( Integrator: 6d c4 [-_ pd�
Certified Operator: f! Certification Number: 16 f 'l 7
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry Canacitv Pon.
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 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 10 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O-No
❑ Yes [�No
[f'NA ❑ NE
[nNA ❑NE
[ff'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facilfty Number: - Date of Inspection: S"Jec
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o [:] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , 7 -•� �b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes 0<0 ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
L <o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑A'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r 60 /] &... 9G 0
13. Soil Type(s): A t., Co ._A(c, Q�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
52"'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[i]'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
gTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E17No.
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!fNo
❑ 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
-
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] , o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: 1.1 - Z Date of Inspection: i
34. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [B No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F N ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E2 Flo
❑ NA
❑ NE
❑ Yes
E3<o
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1 0
❑ 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
El"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
dN o
❑ 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 f No
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[jNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to`gaestion #} IE;aplam,auy YES answers and/or any�addittonal recommendations or any other eomme©ts.
E
Use- drawines of faciLty to better egPla�©stoat©ns (ase,additional pages: as necessary,.
Vo 01�S1
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: to _ qM ` V J J
Date: SS 44I1
21412015

SdDivision of Water Resources
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Com ranee Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up p Referral Q Emergency Q Other Q Denied Access
Date of Visit: (/ Zo / Arrival Time: Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: . ` 4 n, k (r f . (( H t' 4#'"
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Eder to Finish
,Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: �� 1
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pon.
La ers
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 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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0<0❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes L'J�❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

lFacilify Number: 51 - r7 I Date of Inspection: x;
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: Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[:]Yes El"No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [2 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ 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
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E2rNo
❑ 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 7No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes En No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FJ N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: jDate of Inspection: -z Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eal�o ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ErNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes dNo ❑ 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
E N
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
: No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up by
❑ Yes
Yes
]N
❑ NA
NA
❑ NE
the require a visit the same agency?
❑
No
❑
❑ 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 pares as necessarv).
q! � �rd4 { Qo hocl
cl Ir
C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
AV t � A? " _e
Phone: 1 ( 0
Date: 5 Z
2141201

1/
.a U Division of Water Resources /
11 Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Coroutcline
nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Z'j p Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: A- 7
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 16 �_ /{
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Pnnttry C`.anneity Pnn_
La ers
Non -Layers
Pullets
—.Turkeys
Turkey Pouets
Other
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
L j o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Fj o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

lFacility Number: 31 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Z_ �f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S3 31 71
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E3"'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 Quo
❑ 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 E3 To
❑ 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 [3"1Go
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []'-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E2 o
❑ 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
Q'N-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
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No❑
NA
❑ NE
Page 2 of 3
21412015 Continued

Facility N. ber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ET No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Zi Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
2/F4,16`re to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
t
No,
sludge levels in any lagoon pa A
List structure(s) and date of first survey indicating non-compliance: Z Q I Z i 1 Z a I If
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes • No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No 0-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)
❑ Yes []'-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
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
No ❑ NA ❑ NE
VNA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
omments:(refer to questjone#f)Explain anyPYESaanswers and/o .any additional,recommendations or„-any.other_comments
Use drawings,of facility, toabetter-explain sit rahons,6se additional gages as nece � ary}-
ss a
Recor4S (rpoh yao
Zo U Ll .5,(, c e— k- L P' f ,
taboo � T�yr�/► v- I Q a}� d o ^'� 11� % a 1
Z�, "Tv✓� 1 ODn A �4K T rt SEti4G
(o,44t0- 594 CNLDA- IIo 7 79 21
p�str6/e
.Gr 1 4- /as C(o
•F-+ter+ c� •`^ q. 11 Ci 11 P .. r L
(i S Tcr s q _�r "c e— r, et v\a V%a l .
Reviewer/Inspector Name: 04
Reviewer/Inspector Signature:
tol—
Page 3 of 3
Phone: to -7 Z 7'30V
Date:
21412015

Division of Water '.Resources
x
"`®�onoSo-WFacility ti
ow-,� 5
u' ... •.,.. two, �'a '-� �� '" `'
Othy"
Type of Visit: 0 C mpliance Inspection Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral () Emergency O Other O Denied Access
Date of Visit: a j Arrival Time: j 20 5 Departure Time: 3 p County: C LZtJ Region:
Farm Name: Uri, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Do yc-5-- 1t Va-gJ Integrator:
Certified Operator: Certification Number: 98 5 f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Current
a .` Poa CpacityCapacity W P u1°p a '
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Non -
Pullets
ITurkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

JFXility Number: F2 1 - Date of Ins ection: a5 L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U/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:o U Cam, 3 LA60*J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Sr) al S f �05
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 VNo ❑ 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 6No ❑ 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 Wo ❑ 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
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes�FNo
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7N(o
❑ 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. dyes o ❑ 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 Inspections
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes &No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

I,
Facility Number. '�{ - 5'jI jDate of Inspection: Is
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes aVo ❑ 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 No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �Xo ❑ 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?
11�
[:)Yes To
❑ Yes +lo
❑ Yes �No
❑ Yes 0 No
❑ Yes fi fN
❑ Yes
❑ Yes
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
nm'
Use drawings of faciUty to better ex lain situations` use addition'ala e's--a" a ems' a
P ( P g asece nsry)sa�.
Fyn LAC*aoJ 4, D&. 5 u st WOE 14AC CMPTU(,.
SaJTo ; �J1�1 �} EE b f� S`Tf�- Dc)C-� SutL-ti1CiY
Reviewer/Inspector Name: —J f 14 0
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0
Date:
21412014

U Division of Water Quality
Facility Number ©- S7 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co�oliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 3 I Arrival Time: 2 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean cm
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: g F 5 l_� g
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Non-L;
Pullets
Other
Poults
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:
Cattle
Design Current�
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes WN,
❑ o ❑ NA ❑ NE
❑ Yes
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -G Date of Inspection:
Waste Collection & Treatment
"4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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: j A (stropJ } LA67aw_L L ACfp13 �1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll 91
5. Are there any immediate threats to the integrity of any of the structures observed? El 'lies No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm!n, + threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes l ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE i
❑ 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
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Q Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
�Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
'v
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
�Zo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [3 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 V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 2 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . [:]Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] YesVNo ❑ 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 ❑ 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)
3 L 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 PO ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
PNo
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name: Phone: Lill
Reviewer/Inspector Signature: Date:
Page 3 of 3 214,4011

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 CoWpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `j 1 2 Arrival Time: (pp Departure Time: ; County: t Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: Keopgiu, NvrrfP0 Integrator:
Certified Operator:
Phone:
Certification Number: t6y147
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
131
(oi
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other .
Other
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
La er
Non -La er
Design
Current .
Dry Poultry
Capacity
Pop.
La ers
Non-Laye
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Cattle
Design Current
Capacity Pop.,,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faci ' Number: SA -5 7 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LP'C'.0r4 fir,-ozs7S �Gaa (_Q(�7q)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [dNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment t threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
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 EZ/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [! No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
hio
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0<0
❑ 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
ffNo
❑ 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 D Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
-
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: (if 2�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. A 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes &41/0 ❑ 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?
No
❑ Yes
O
❑ NA
❑ NE
[—]Yes
O NNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
-d No
❑ NA
❑ NE
❑ Yes [�lo
❑ Yes E N
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: tt 1
21412011

Q Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 12 , Arrival Time: ® Departure Time: 93o County: [UP(21') Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: j_f,,joNi_ k,)(r0A0
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:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
t ry roultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes a o . ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of inspection: 12 ( I I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LAc , j ) I Arai-0— r,13 (,,A6-c,, l 4-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Li
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Ed"No ❑ NA ❑ NE
[:]No ❑NA ONE
Structure 6
❑ Yes [2*No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E!fNo
❑ 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 LJ'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [:I/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 ENo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [1/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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? []Yes YNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2(NNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
12ryes
[:]No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CJ�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2/No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [g"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

t�
F.aciG Number: - Date of Inspection: LUJI,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C2"'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 �No ❑ NA ❑ NE
[]Yes DNo ❑ NA ❑ NE
❑ Yes EyNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [J�No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? []Yes [Z(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)..
20,) Lw".'„j DEslc-ms TOTAL' M AtcH TLa4 -LT OLMOF2 , ?LC',gsE
CjA;%0GE F.cC.A,(L=,,jG_ tb pervk. T6PULrA1-,tanj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
N
Phone: �910) - 73 Nr
Date: 'IN'
21412011

Facility Number
U7—
— —
,N.
16 Division of Water Quality
0 Division of Soil and Water Conservation
Q Other -Agency �,-�
Type of Visit Gf7Routinepliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1/[) I Arrival Time: 19=Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: v Title:
Onsite Representative: �k�t_1l i . L� go", I
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
Design Current
Capacity Population
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [ [=at Longitude: 1--] ° =, 0
Wet.Poultry
Design: Current
',',.-:Design <` Current,,
Capacity Population .; Cattle
Capacity: -Population;.,,:
❑ Layer
❑ Non -Layer
1DryPoultry
❑ 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?
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
NumiSer of Structures ! Ij
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
El NA
❑ NE
❑ Yes
❑ Yes
,❑rNq
�❑ NA
❑ NE
ElYes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection b l7
aste 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?
El NA El NE
❑NA El NE
Structure 1 / Structure 2 Structure 3 Structurel4 Structure 5 Structure 6
Identifier: L A(,WVJ (.tiC IJ � A�--f' i
Spillway?:
Designed Freeboard (in): JJ`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ENo ❑ 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 environmentaWtheat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yeso El NA ❑ NE
❑ Yes O/No
❑ Yes ❑ No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [(No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ZNo ❑ 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
ONo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 o ❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
u o ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El
El NA
El NE
18. Is there a lack of properly operating waste application equipment? .
El Yes
VNo❑ 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 (useaddition4j!�0ag" as neeessary)
_ =
AL
Reviewer/Ins ector Name o
p L:L ;..
Phon 9 —
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 1 I2128104 Continued

Facility Number: — Date of Inspection le7
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 V
No ❑ NA ❑ NE
❑ Design ❑Maps ❑Otherthe appropriate box. ❑ WUP ❑ Checklists 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JLJ 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
16 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�N.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
iNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�f
u 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
6No
❑ 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
O'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
YAddltional Comments and/or Drawings:
Page 3 of 3 12128104

1
ry Division of Waterc,Quality`
Faciirty':Number: 31 S� Q`Di�ision of Soil andwater Co Y t
Q Other
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: q o E Arrival Time: �(> Departure Time: County: r Qt.1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rwLt _ __
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o [= 6 0 « Longitude: 1=1 o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes U No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
12128104 Continued

Facility Number:-3— Date of Inspection 11 l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/ _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
&o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
P�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
� o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
o Cl NA ❑ NE
77No
(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
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�, o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JNo ❑ 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
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
Zo
❑ NE
18. is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
2A,) CO— S00 00'� CROP YICUO rot,XC-C,orco SQL PT APAKVkS1r(_0
Reviewer/inspector Name a � �(„L Phone:
Reviewer/Inspector Signature: Date: tt & e
Pa Pe 2 of 3 12128104 Continued

Facility Number: 7j — Date of Inspection 1� o
Re(Luired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[Yes
[]No
❑ NA
❑ NE
❑ Waste Application ❑kly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ZcropYield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E� o
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
o
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
7No
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ 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
E�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VO
❑ NA
❑ NE
Additional Comments and/or.Drawings:
Page 3 of 3 12128104

Facility Number
W Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C,/ompliance
CO Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 00 Departure Time: County: Qi,P►.ZA,_j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
On site Representative: kaIpA t IdtACm._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
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
h�I JE1 Non -La et
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 Stocket
❑ 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 ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3l — S 7
Date of Inspection >>
ty
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 CxmJ t l.A frft+a 7 L44 GooJ 3 LA Goer►
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 4 56
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�(
[ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta�reat, notify DWQ
Do any of the structures need maintenance or improvement?
El7. Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�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
o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
WNo
❑ 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):
s Wt7 �' 4 a 1�[rPT C w0 OF IM-1 att- ma.i,3mmv K 6 (C ►1P D ATE AS; T b " E1LE
?MOLT
.S5 ,TS
2v,) LAGooa PLC-,u&N r6Q - 146dL5 Klbrc D5 TO rb* "JPoA'T6O AC"h.0.l0C- To 96t,,.1
j 0CA"- sF CouNr
Reviewer/inspector Name 14" 1 p�� Phone: q rb `) q (, —I'm
Reviewer/Inspector Signature. Date: It IS o
l6160/V4 c.onunura

Facility Number: 3 ( — S j Date of Inspection ti tit o l
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 appropirate box.
❑ WUP El Checklists dDesign El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E2 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L'J NNo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,
IJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L�J(No
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
ElE
No
NA
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
jJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0/Yes
❑ No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
01�o
❑ 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'concem?
❑ Yes
QKo
❑ 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
ET'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?
ElL�J Yes
�f
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Cr/No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

dDivision of Water Quality
Facility Ntttnbet O Division of Soil and Water,Gonservafiori-
.w: s®..'
O Other °Ageney
Type of Visit C pliance 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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: %ZOO Departure Time: County: vl/ Region:
Owner Email:
Facility Contact: )1- / Title:
Onsite Representative: •y �' 4T FF�r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
0
Latitude:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = o = 1 I--] "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Disc�harizes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes UNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZNo
El NA [I NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

,+
Facility Number: — Date of Inspection f 4 0
aste 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: Z/ 3
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): `�� L4 j
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 QNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LJ N ❑ NA El NE
8. Do any of the stuctures lack'adequate markers as required by the permit? ❑ Yes f�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Id No ❑ NA ❑ NE
maintenance or improvement?
Waste Application J
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
[jNo ❑ NA ❑ NE
'o El NA ❑ NE
No ❑ NA ❑ NE
�Zo'
❑ NA El NE
❑ NA ❑ NE
Comm....— refer to::queshon #) ExplaiayYS`answersand/ormoranynnother comments.
Useadrawtngs�q facility taI'l utter explain,situations {use'adl .i...... pages;as necessary):
�14L. 4J, d,uS 0A1 e-4 a'IJ .SC rl�� k,4 1zq,.
L
er/Inspector Name jkl Phone: b /3ff
er/Inspector Signature: Date: / i
Page 2 of 3 12128104 Continued

T
r
*aeility Number: — Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ` J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspection/No
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElY s
WNo
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L� N
❑ 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
NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
ErNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D "'o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U4
❑ NA
❑ NE
Page 3 of 3 12128104

.,
w w wrww+
JO Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
_
- O Other Agency GZ
Type of Visit 0 Compliance Inspection Q 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: ZS D Arrival Time: Departure Time: Zi County: �� �� Region: Wi t�
Farm Name: 7ilRlafl,4Q/h'S Owner Email:
Owner Name: c—F� %G/�/��..2 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ✓ ,04 OAtf ntegrator: Ad-6
Certified Operator: ��r/ Ro4czJ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I= u Longitude: =° 0 4 0 u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean —
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 1 �L 1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Cl No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ko ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
12128104 Continued

v
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
i Structure 1 Structure 2 Structure 3 Structure 4
Identifier: fd 7i W ,-5
Spillway?: 4!�7 /Vd /lfp d
T
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 /R'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O No ❑ NA ❑ NE
❑ Yes oNo ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) X
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA El NE
maintenance or improvement?
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IgNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No El
El NE
18. Is there a lack of properly operating waste application equipment?
ElONo Yes
❑ 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):
2 � nlcF ,EC.EzrJFp pc�}c� C-4-T
DCv�n E,Jr.4T�o.J ryEf Q
•
0"�'C'Mec Ark O
Co6m,
Reviewer/Inspector Name �.1
Phone: /U 9q6-732
Reviewer/Inspector Signature:
Date: '2 Q
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 11 .
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ❑ NE
ElEl❑ Design ❑Maps El the appropriate box. WUP Checklists /
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )zNo El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers[!![[[ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
71NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
El NE
and report the mortality rates that were higher than normal?
//
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility .Number.
i
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (;(Routine 0 Complaint ( Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; /0_ Departure Time: County:
Farm Name: lzmlvek /}R/�?.5_LL Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: _ _✓z/� O
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =' Longitude: = o =' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
k ❑ Non -Layer
Other
❑ Other - - -- _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes io No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes )xNo
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 1—
Date of Inspection /Z
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?
❑ Yes XNo
❑ Yes ❑ No
St cture 1
Identifier:
Structure 2
t`Z/�
Structure 3
Structure 4 Structure 5
Spillway?:
f�
AV
Alb
Designed Designed Freeboard (in):
17157
Observed Freeboard (in): Z
`7�
El NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )dNo ❑ 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) `
9. Does any part of the waste management system other than the.waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside f Ar a
12. Crop type(s) t✓�'/e/� , Lv/Y' T ��� ��-? l � . LS(/`• (�r1��SEl_D
13. Soil type(s)
14. Do the receiving crops Aiffer from those designated in the GAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
P'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Cl Yes
'VNo
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ 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): _
Zq) >� )e!�FoL'CSs �G oa tic. r�L'gT `R /4" I—AR11 .....5 ,
Reviewer/Inspector Name Phone: /fl
Reviewer/Inspector Signature: Date:
12128104 " . Continued

{.
Facility Number: 5 Date of Inspection /Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropirate box. ❑ WUP ElChecklists ElDesign [I Maps ❑Other 10
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1Z 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 PdNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA ff NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
ElNA
ElNE
and report the mortality rates that were higher than normal?
10
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [� No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes PNo
❑ 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 PNo
❑ NA
❑ NE
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of V isit: 1'4/E210q Time:
Q Not Operational Q Below Threshold
Permitted,WCertified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ..._ .W
FarmName: ............................. County: ........ — .....-----..----
Owner Name: .....- ................. Phone No: ... ................. ....... ..............
— - _.. .......
?Mailing Address: .... . ........................................ — --- — ---------_--------_------
FacilityContact: .............................................................. ......... ..... Title: ........... ........................ Phone No:
Onsite Representative:.. �Cc,�� E(�,�[�[r#'> Integrator:
Certified Operator: ..................... ............................. ...... ......... ...................... .............. Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 66 Longitude • 9 ci
- s Design Chrrent r _ Design Current DesignCurreat
...Ca air 'Po ulatlOn aPoultry,. _a ; Ca ei Po ulatiori _ Cattle ', .Ca acr Po "iilaon
❑ Layer ❑ Dairy
r
:7 ❑ Non -Layer �„ [3 Non -Dairy `x
E��]
.:
-._ _ _
j ..� -
❑ Other
T I
- Total Design Capacl�fy
r
- Total SSLW
Number oi:Lagaons
_
❑ Wean to Feeder
eider to Finish
rj ozg b
da-n
arrow to Wean
'7!
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
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 gailmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ N
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
Z
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes7No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Struu tore 3 Strruucture 4 Structure 5
Structure 6
Identifier: ...............; - .I. .........._....................-. 1... ........�._...
-- .._...
Freeboard (inches): 3� 3 3 3 5 e4
12112103
Continued

Pacility Number: 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type Csw MT.Lu(-T . _ --- eepxm _ -_
❑ Copper and/or Zinc
C a) S66
❑ Yes
❑ Yes;1Z/
Yes 2�o
❑ Yes
❑ Yes No
❑ Yes
❑ Yes No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes7no
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c This facilityis nded for a wettable acre determination? ❑ Yes
Pe
15. Does the receiving crop need improvement? ❑ Yes 7N9,16. Is there a lack of adequate waste application equipment? ❑ Yes t
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes To
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 21<1
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes tiTa
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.
Field Copy ❑ Final Notes
'7� -r vE i,.� .tcsr�G dN G RSs cavE2 ON c,A &'OV>As t � 2
VCEC--P UPDATE-0 STOOCM)06, FO2M1 WZT4 4Z+�[a2P5.
Reviewer/Inspector Name
Reviewer/Iuspector Signature:
Date: U / Z
1 L/llIUJ uonrznuea

acility Number: _ "i Date of Inspection L 0{
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ElYes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes
25. Did the facility fail to have a actively certified operator in charge? ❑Yes o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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 /No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2�N�
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 2�Nt
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence abort this visit.
12112103

Type of Visit
Reason for Visit
Compliance Inspection Q Operation Review O Lagoon Evaluation
Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
FQ Permitted [3 Certified 0 Con ' 'onally Certified [3 Registered
/Farm Name:
Owner Name:
Mailing Address:
Facility Contact: !Title:
Onsite Representative: G,rh 4.Q
0 Time:
10 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County: . 42geG Z/j . wr
Phone No:
Amfol
one No:
Integrator
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude 0 4
Design Current
nwrne U aci ro utatton
❑ Wean to Feeder
® Feeder to Finish f)
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I FE01
Dairy
❑ Non -Layer Non -Dairy
❑ Other J 1
Total Design Capacity
Disebames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Total SSLW
Subsurface Drains Present
No Liuuid Waste
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes INo
❑ Yes /❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �, No
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes �J No
Waste Collection & Treatment l
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNO
Structure 1 Structure 2 Structure 3 Struc re 4 Structure 5 Structure b
Identifier: _� 13
Freeboard (inches):
Z �r
05103101 Continued

Facility Number: — Date of lnspection6�lJ.
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I- Is there evidence of over aoplication? ❑ Excessive
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2l. Did the facility faii to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )zNo
❑ Yes ?No
❑ Yes V1140
ElYes VNO
❑ Yes VNo
❑ Yes No
❑ Yes ZNo
❑ Yes No
❑ Yes UfNo
❑ Yes o
❑ Yeso
❑ Yes XKN
Q�No
❑ Yes No
❑ Yes IVNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
No
9No
�No
/No
PTNo
19No
VNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-. .- .. " �"` 1.'fir-.,.
-Co entsy.(refer to.gueshon #) Explain any aYES answers'and/or any reco"mneendatronsor aey other comments:
tUse_tlrawmgs o facilityA6,1 etter situations. {use as necessary) r ;
egplatn adciitiona! pages 3
g Field Copy ❑ Final Notes
'q F URA / o hFF,00a r /fff ��N� 1°S 4 �� (i-l1�uJ.� l9N
So B'!!F
�i�7
pF; FRehz,�Fo ,4�0 %fr__ /<F��mrtr=a�e.o .n r
A)0� ° Wr
dnDr��
Reviewer/Inspector Name r '
Reviewer/Inspector Signature: Date: Q
05103101 V 1 Condnued

Facility Number: — Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ?I,
o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes No
05103101

iy
"" -- Q vrsran of Sod and r Conserva#rvn� - _'
Type of Visit ')5Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 91Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 3 Time:
Facility Number
Q Not Operational Q Below Threshold
Permitted [3 Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Name• . ..v.! t.w..l...�'. 5}....L.lL.................................................... County: 11►....
Farm
Owner Name:..!%rn�r'�r``sf.. �""l�L .............................. ........... Phone No: ................................. ......................................................
...........................................................
Facility Contact:
......................
Title•. .......................................... Phone No:
Mailing Address: ......................................................... .....
.................... Q�Integrator: �.......v A r
..MU Representative: ....----.---- -- "...............................................
Certified Operator:................................................... .............. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �•�� ��° Longitude �• �� �«
Design Current Design -Current ': Design .6 rat
Swine Capacitv Population Poultry Capacity Population Cattle Capacity. Popiilatlon
eanto Feeder
eeder to Finish
j
arrow to Wean
arrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons; ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Sp
- Holdirig:Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ 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 gaUmin?
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: 1 ..................... Z.......................................................................................................................
Freeboard (inches):
5100
-ay Field Area
❑ Yes EfNo
❑ Yes Jx7No
❑ Yes MNo
h In
❑ Yes No
❑ Yes No
❑ Yes Jj No
❑ Yes dNo
Structure 6
Continued on back

Facility Number: 31 —5? Date of Inspection Q r Printed on: 1/9/2001
r 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type -9e✓nt.ydot. na.y4Gfaze mgiuA 14,v-x4 b`�'^CL et i�.nrn hG
13. Do the receiving crops differ with those designated in the Certified Animal W
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?
Management Plan (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0:. No •Yioatioos •oi. 00 icienwi Were poted 000 i9 this;visit; • Y;oo 0111-trecviye tjo Cotner
ctitzes ' dens: albaui�: this visit:.. 6.....................
❑ Yes ffNo
❑ Yes 76 No
❑ Yes §1 No
❑ Yes -] No
❑ Yes iff No
❑ Yes J9 No
❑ Yes '"No
�►A Lt 10e,gPLf
❑ Yes No
❑ Yes No
❑ Yes `] No
❑ Yes s12No
❑ Yes 19No
❑ Yes 16No
❑ Yes ONO
❑ Yes G�No
❑ Yes No
❑ Yes] No
❑ Yes fA No
❑ Yes J.No
❑ Yes ONO
❑ Yes `R No
❑ Yes ja No
Comments (refer to question #) :Explain any.YES answers And/or at�yrecQmmendations or,any otlr comctt ""
UseiraWugs ociiytrexaitn(usaddpagesateary)= abp,
ry
7h;s ; t 129-1'�o�el'atlta( vndar - L'-. ' SG4,.e— W':'Me n W4"k 3�
T Key- Fa.w.s A)eeA -fo 11QVe r)eWr�e� �t
FSs��aC -fer GaNtb;�eo( dPer'a�iah .
►�S� C� w •�:P r— n eed s k s;g n 4. da+e hew wasW G 1A ii y �p
lei. Tie sure f a se I.vGL s-f� Ant I �s; s a%-+ed t,l;�►•►n 60 del aFa! p��adin C o
h 4 h e -IRR-21f . p ,
-T-A e w h eai l c r ®p is' e spa 6 << >` 2� ; h t,„ e l+.� I a Ad recto►• s a r� well l�� •
Reviewer/Inspector NameM '�w .5 .: - _
Reviewer/Inspector Signature: Date: 3 5/00

Facility Number: Date of Inspection .5� /!`]/(7 f 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 actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;�(No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
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 26 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes C9 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes —9 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection d
Time of Inspection d 24 hr. (hh:mm)
Permitted Ca Certified 0 Conditionally Certified C] Registered Id Not Operational3t'.
Date Last Operated•
t�
Farm Name: ..... 'r`" ........��....`........ .............................................County........r.......Jlk�.......................................................
Owner Name:
Phone No:
Facility Contact: ...Title: ... Phone No:
Mailing Address: ............................
........ .....................................�.............................. ............. I.................... ............................ ........... I..............
Onsite Representative: ^Y ,. �J"lt�,..�1� ........ integrator: .................................... I—...........
............... ........... ..4-' ` I
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude ' 4 " Longitude a ° &A
Desrgn .. Current Design - Current
CaaciPoiliton Caaci CSwine attle
ean toFeeder
eder to FinishowtoWean
VFa
o
rrow to Feeder
p
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer " ❑ Dairy
[] Non -Layer ❑ Non -Dail
❑ Other I I,3::
Total D&i&_Capdejt*
• ° Tota1SSLW;
Number" of Lagoons ❑ Subsurface Drains Present ❑ Lagoan Area . Q Spray Field Area
Holding Ponds"/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ 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 gaUmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
NrNo
❑ Yes
5�No
❑ Yes X'No
Structure 6
Identifier:
Freeboard (inches)..........................................................
............................3................................................................................................
5. Are there any immediate"threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? , ❑ Excessive Ponding []PAN
12. Crop type
s,
9No
❑ Yes
%Yes
❑ No
❑ Yes
XNo
Yes
❑ No
[:]Yes
)KNo
❑ Yes
% No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This "facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified -operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �Vo yiQlaticjris:or ft#iciencie vvq, .- noted• it 4Wiiiii this:visit. - Y;oit wiil- . eceiye r. ftii thgr
cori-esporideizce: abauti this :visit: .............. -- :. .
Ciimments (refe esti 4o quon ji','Explaie
Use drawings ofrfacility"to betterexpimn
'Ii KQ_V__t� 1,:.s V r-Q
C��-- vc� vv-n)z
❑ Yes �KNo
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes ANo
❑ Yes tRNo
❑ Yes b,No
❑ Yes �tNo
❑ Yes ONO
❑ Yes XNo
❑ Yes Iat No
❑ Yes No
❑ Yes No
;ituahons (use additional pages as necessary) ;F t�--� t ,�
�lO\ CCI
O\HQ_
9) (05 OQ C L"V- I VV_ �_4�kv�q
\$iVQ& ---, k.'� &5
,lr
S'�Pe.c.i ``� \ ch��"1^�lv.S2_, �R ir�-P�eF-1� Y�-GIr�Q►' -� e U
14e-,�
1►c.��l d`Z k.luh , 30
Reviewer/Inspector Name t,„L t
Reviewer/Inspector Signature: n A , �Date: —C}v

i
Facility Number: `j — �j r] Date of Inspection 4G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below �] Yes ❑ No
liquid level of lagoon or storage pond with no agitation? .
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PkNo
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �3 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes OfNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P1140
Additional-. 'Tomments an or : rawtngs:..
_.
_`
0.
�f
J

E3 Division of Soil and Water, Conservahon Operation Review
x +0 Division of Soil and.WaterConservation :Coinpliance'I>tspection°
IS Division of Water Quality °.Compliance Inspection _ 'n
Other Agency, Operation=Review
W
e.
laRoutine O Complaint O Follow-up of DWQ inspection O Follow -tip of DSWC review 0 Other I
I Facility Number I
[Permitted Q Certified [3 Condlitionally Certified 0 Registered
Farm Name: ...G-±.G•!�•Lb.9.....'S�?w .........I ............................................
Owner Name : .............................................. .. ....
Facility Contact: ......... y
�lailin Address-
17:ite of Inspection V-I
Time of Inspection 24 hr. (hh:mm)
0 Not O erational Date Last Operated:
County:.....--.. l I..........s...................................... .
Phone No- G1 ... �6 I. tj C!!�!!- !?Cj ,
... Title: 'r .... Phone No:��`1
g.......................................... ._....................................................V................................ .............
Onsite Representative: t 'w^'k Integrator: ...... W�r ................................
Certified Operator:................................................................................................................ Operator Certification Number:.............................
Lorstion ofFarm: %A-\Ue ., i t r A 4. s i A
...._....... .,.......................... .__.._._...._.............................................................. _................ ..... t...Q.......... ....................................... ......... .. --. ........... ...................
....,................................................................................................................................................................................................................................... .
Latitude Longitude �• �' �"
-.
Design Current = = Design. Current: Design Current
Swine Capacity Population Poult -.. - =, Caftle
ty try Capacity Po elation Capacity Population=
❑ Wean to Feeder
Feeder to Finish
00
Farrow to Wean
00
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer Non -Dairy
:� ❑ Other
...
Total Design Capacity C
uTOWSSLW C
_Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ 5pray Feld Area
-Holdiug,Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: El 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'? (Il'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
tNo
❑ Yes
NNo
❑ Yes C9 No
Structure 6
Identifier: N
Freeboard (inches): �3 �o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes �Po
seepage, etc.)
3/23/99 Continued on back

Fact rty Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
,Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
CdNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11. Is there evidence of over application? Excessive Ponding ElPAN
❑ Yes
[(No
1
12. Crop �•
type O r G
13. Do the receiving crops differ with those designateS in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes
0 No
b) Does the facility need a wettable acre determination?
❑ Yes
&No
c) This facility is pended for a wettable acre determination?
PV Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
IN No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C&O
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
dNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
NNo
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
CO No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JgNo
N.6-yi6lafi6ris:oi- deficie.neies were noted• diming this:visit: - :Y:oik will-feceiye dd #:urftr
.'corresporiderrce.a�outkihisvisit_•.•.•.•.•.•.•...•.•...•.•.•.•.•.•.•.•.•.•.•.•.•. .•...
Comments (refeito•question #): Explain any YES answers and/or any,. recommendations or any otfier corifinents �= -
Use;drawines of facility to better explain sttuattons (use additional pages as necessary)
r�1 o,U [
AL
IILO vew oQ� 4(,5 4 � t,,45, 9�Lk H,
Reviewer/Inspector Name �'-� �-W?
Reviewer/Inspector Signature: Date: �1ot`•'� �`'�`-� I
3/23/99

�l
,Facility Number: 3l — Date of Inspection
Odor Issues
26. Does the discharge pipe from: the confinement building to the storage pond or lagoon fail to discharge attor below )Q Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
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 j No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �dNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? WYes ❑ No
Additional omments an ar rawtng :
3/23199

Division of Soil and Water Conservation ❑ Other Agency
IS Division of Water Quality
14MRoutine O Complaint O Follow-u ' of l)W ins ection O FoHow-up of DSWC review O Other
Date of Inspection
Facility Number31 Time of Inspection %1i0 24 hr. (hh:mm)
0 Registered ;j Certified 13 Applied for Permit ®.Permitted 0 Not Operational I Date Last Operated:
Farm Name:......... ...... IPOA...........sc►.i........Q-6........................ County:..... 111 lh ..
Owner Name :......a ............ r . .Y. J N...................... .--. Phone No: �`f.l��. 29 �. � "...74 `........................................
Facility Contact:..........% flY :....... 4s!�s.�'` ..........................Title:...... cy...................... I............ Phone No:........................
,1
MailingAddress:....�.�... X.......-�`� ................................................................ ....! .lQ A ,2....1.......................................... ..? 3 1.........
Onsite Representative: ..... NV � ...cyo-.............................................................. Integrator:........ ..................-..................
........................................... .. ........................ .
Certified Operator:.............................................%..................-............................................. Operator Certification Number :.......... 1.,?.-!-� :F�......
Location of Farm:
curn,.....IS .... .... i.. :...� a ......4. -K..1 4Q • �.mi 4 s m :. s ...13 l ..............................
................... .......... ................ ........ -..................................... .............................................................................
Latitude 0•.0' 0'c Longitude
Design . rCurrent Design , Current Design. Current
Svtne' Capacity Populati©ri Poultry v `Capacity Population :Cattle Capacity,, Population
(� Wean to Feeder p ❑Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean (,pp v
❑ Farrow to Feeder
❑Other
[I Farrow to Finish Total Design Capacity OD
❑ Gilts r..
t Totai.ssLw `j 1 [ AVZ ❑ Boars
Number of Lagoons I Holding Ponds �3� Subsurface Drains Present ❑ Lagoon Area pray Field Ares
w ❑ No Liquid Waste Management System g 7
General
L Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gal/min?,
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes %] No
❑ Yes ® No
❑ Yes
® No
❑ Yes
[3 No
❑ Yes
® No
❑ Yes
® No
❑ Yes [21 No
❑ Yes P9 No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: --
8. Are there lagoons or storage ponds on site which need to be properly closed? [I Yes [P No
Structures (Laioons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes D4 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ # M............... ...............1 ............_.................._................................. ...... ..
Freeboard(ft):............11........................... `�...........................z" ........................ .......I........................... .................... .........................................
10. Is seepage observed from any of the structures? ❑ Yes [50 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes W No
12. Do any of the structures need maintenance/improvement? lB 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 P No
Waste Application
14. Is there physical evidence of over application? ❑ Yes gNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I5. Crop type..rblatld.+xr..............` ..... ljlt�L.................C'_.l? ........... F ..........F�e,.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes QNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
f1 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
Q No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[3 No
22. Does record keeping need improvement? ffYes ❑ 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 No
• 24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ll No
0 No.violations:or de deneies4ere noted-&iing this:visit::.You:wiii: rece'ive:no_ftu-thei, ::
bofrespondence AWO this:visit:::
S+��°}t 6r �CSeCnsZ d'#3 s�� be vc.�Let#�-
'�. &'rMV a �� S%e�ir} Ise :rk �vt •
y.Z� CoYrCG��0.'ls 4o s�tr ,nrccxt3Q �4uA-4m�J bz} 1,t2. , '�r&y v ai4s sha,(d
`` '' ff
bY �[ (�[I mil- �iP�d t1Vh�1�3e;`1 ti�in� Lp � G.ev-toy �v- ljos{ CCk61O'# W-3. �icta
i-- ocYeo�e i^ NJ,. 3, 3B Sxo(A 6e e�rtwad. ElLyo, dQ,��n s�nujj
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �•lj,���/�,I A h Date:

County
EP:
in
Owner
tan raug on
manager
IMark Craft
Address
P.O.ox 645
Warsaw,
Location
Certified Permitted
Farm Name
I r arrow -woos bow r arm
Phone Number
essee
Region
s AK ' MRO 0 • ..1 ' 1 s WSRO
*FRO u RRO o
arm. otation•. • w. #q t . mi es oar
..........: .... ....... ... .......
Certified Operator in Charge William S. raug on Certification #
Backup Certified Operator Certification #
Comments
Date inactivated or closed
M Swine p Poultry p Cattle p Sheep p Horses p Goats p None
Design Capacity a
�$soiff*0 J)r0W-P;eArjt : v Lagoon Area : : j Spry Fiefd Are, :

Higher Yields
Vegetation
Acreage
Other
p Request to be removed 0 Removal Confirmation Recieved
Comments •
Regional DWQ Personnel Assigned to Facility
Date Record Exported to Permits Database Basin Name: lGape Fear

0 Routine O Complaint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
R Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated :... ..._.....
_ .. ...... .. �. ............ ..... ... �.
Farm Name: 'C�...11at.d U.a. .... .......... ........ ..._....... ........ ....... ..._..... .......... _....... .._ ....iL1,.�
Land Owner Dame: _.i _.. _.L�� k� !�s .... _.... _ Phone No:
Facility Conctact:.M.r.. ..[,era .. .................. ........... Title: . Phone No:
Mailing Address: Q Q.. .f� lS. .LH.� ..... .........._..... .......... ..... �V.�_S.r��... N..�.....+4
Onsite Representative: ....urY......�... ...... Integrator:.lJ f..
. I !
Certified Operator:... +.����.. � :......�. %Gtr�� •Yi.. .. _..... _........ Operator Certification Number: --f -ft,�.
Location of Farm:
__t...
.5 .t.A. Via..... is +.fca. _...5.^!.` ........ --...... _ .... _.
Latitude 3$ • o t 20 Longitude D2 (o
Type of Operation and Design Capacity
Design Current Design u ; Current Designs Current
Swine _ . Paul,T Cattle
Ca aci sPo il'ahon
tiYi. Ca aci Po hlat[ona a n Ca aci ':Po"' ulat�ou`="`
Wean to FeederF ❑ D
[] Feeder to Finish ❑ Non -Layer ❑ airy
Farrow to Wean s
Farrow to Feeder Totat Design Capacity
Farrow to Finish
- t
other m Natal SSLVV 11
Number of"Iagoons f Holding Ponds y 9Sttbsurface Drains Present°
au.fE Nk -
AreaJUSpray Field Area tr
enera
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes ® No
❑ Yes ER No
❑ Yes E� No
❑ Yes ERNo
❑ Yes 19 No
❑ Yes IR No
❑ Yes JM No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes §2 No
Continued on back

1F;cility Number:..ZV.... �.....�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E5 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
19 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
allo
Structures (I,a;oons and/or Holding PondsPonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
JR 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?
9Yes
❑ 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
CK No
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 s? �c.+ .Y ,c o.._..........a.V_A s. ..GS W.M!-� -------S.e
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?
For Certifled Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JR No
❑ Yes Q No
❑ Yes CgNo
❑ Yes E. No
❑ Yes Jallo
❑ Yes JRNo
❑ Yes JR No
❑ Yes ELNo
❑ Yes ® No
24. Does record keeping need improvement? ❑ Yes JR No
Comments:;{refer ta.questton"#) ` Ezplain�ariy YES'ansvrers andlor-any recommeridations or any£other comments
Usedrawings of facility to better ezpiairt situations: (useadditional pages'as necessary)
r I• Z• F'O Lo -.. a 1 l %1. ,r e e i �- q Va o �n s. P_ e-v F cG �(2 '%►. �5
a.r.0 a „,.R-0-1 V a La t-L► e 1 j t o.-L
"t-t,L 'p-
`iL Z ,
+ P ,
yv\
IA -S ar
[
T p .f r c�v
`JS o {
Reviewer/Inspector Name
ReAewer/Inspector Signature: q , _ j") _ �� � pDate:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attentiw
Facility No. 3-1—
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
4 DATE: I—Z 7 , 1995
Time: ¢� /f7
Farm Na
Mailing
County:
Integrator: H U h _ i Phone:
On Site Representative: '3I"Qboel Phone:
zap- ZC03P(W�c��
Physical Address/Location:
Type of Operation: Swine _z� PoultryCattle �,C�
1_41Cr
Design Capacity: 19 Ct � Number of Animals on Site: VMT
DEM Certification Number: ACE *344" DEM Certification Number: ACNEW
Latitude: Od ' '54. Longitude: _�3 ° 02 'V. $ Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: -Ft. Inches
Was any seepage observed from the laQoon(s)? Yes o No Was any erosion observed? Yes o No
• Is adequate land available for spray? es r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: rn �r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. es or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:
0 Leyul,:5
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.