310109_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Water. Resourees
Facility Number -
p
Division of -Soil andWater,Conservahon ".
-
Q OiberAgency
peof Visit:
r
Com ce Inspection
Operation Review Q Structure Evaluation
Q Technical Assistance
ason for Visit:
Routine Q Complaint
Q Follow-up Q Referral Q Emergency
Q Other Q Denied Access
Date of Visit: `/j - ')I Arrival Time: Departure Time: ® County: Region:
i
Farm Name: m AN 'l �j Y; r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J70 vwtYl $I Q-JL
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design Current . De4
Swine ` Capacity' " Pop. - " a.Poultry Capacity Pop m Cattfe �' Cap.
Wean to Finish
Wean to Feeder
e-Teeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Nan -La er
w
Design Current R
:._ . r:
'Dry Poui#ry Capacity _;P� .
T ------ _
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Dairy Cow
Daig Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Broad Cow
v
f -
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
0No ❑ 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[z o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: ,?, - l Date of inspection: / �!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5_ Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 environmenta rest, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S0�j,r �(�?An S f -r _
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ YesrN_p,
❑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
co ❑ NA
rN
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z; ❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]"Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection ❑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 Number: -_j Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check L3`Gs ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
[ FJailure 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 o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer tanswers';and/or,-an additional recoiiimendatrons or hn other co fi—ft
Use drawiags:,gf facility to tietterexplain,situahoris (use;ad Y Y „
ditional-.pages=as, necessary)
1� use r
51�� sue►-�ey r--� - 3. 3�
d5
S _ G
1°= S. o Cum -ref Hai ? Slw���
C�C11 ��r�-r�•c�• 3-l�-Jb
Reviewer/Inspector Name:
Reviewer/Inspector Signature: -C— II
Page 3 of 3
Phone: (� ?�j L1200
Date: /5—f7
21412015

—AF� , , ID�vision ofWater Resources
"* ,;
Fac�laty Number , �,� Drvis�on oPSo 4iffid Water Conserwatiorr
� Ot Qr�Ag�nF.
a e cy
Type of Visit: _(^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 0 Denied Access
rrr_rr Sri it ir. r �r i
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: j F,�, r� �.F Owner Email:
J
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
"
Desigi
`Swine Capaci
=r �
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Title:
Latitude:
ji
Turke s
Other Turkey Poults
Other'K 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?
Phone: '
Integrator:
Certification Number:
Certification Number:
Longitude:
pry Cow
iry Calf
i y Heifer
v Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [DNo ❑ NA ❑ NE
❑ Yes OWo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ,E]'Ro
❑ 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 ,e'No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ETNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes ,E] TVo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

31
Facili Number: 7 - Date --of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [EfrNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes '❑'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes JTNo
❑ 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 ID -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑/ " o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes M -hio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes LD-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 _QNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fn-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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q- o ❑ NA ❑ NE
❑ Yes _EE-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes .e'lsio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,E3-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 L -No
❑ 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 T_'-F_No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J[D_ao
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: �( �� Date of Inspection:
Ila
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
Q No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
rf'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P�rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes c�fNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes '6No ❑ NA ❑ NE
❑ Yes '!] No ❑ NA ❑ NE
❑ Yes 4No
❑ Yes o
❑ Yes 5PNO
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: 1/ Date: 2"r
Page 3 of 3 21412 15

ivisiou of Water Quality
Facility Number, y - 0 Division of Soil and Water Conservation
0 Other Agency
='
Type of visit: PO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Tech nicai,Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15- Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email: '
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: az,,,,.M,,, ryo n 8y,�
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
Other
Other
Latitude:
Integrator: �^
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HLaycr
Non -Layer
Design Current
Dry Poultry Capacity POD.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current -"
Cattle Capacity Pop.::.�.--'.-
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E�'&o ❑ NA ❑ NE
[:]Yes [:]No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
❑ Yes jNo
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

I
[Facility Number: - Date of Inspection: r f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 7f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure St�� 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):1-�
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 ;�JNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ff 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 (fj No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J21PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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 17 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
5TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[XNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
n/ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A No
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C3"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection: -j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W!f14o ❑ NA ❑ NE
f
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 ,0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes F
,,eTNo ❑ NA ❑ NE
[—]Yes L�fNo ❑ NA ❑ NE
[:]Yes 3 No ❑ NA ❑ NE
[:]Yes ZfNo ❑ NA ❑ NE
[:]Yes ZpNo
❑ Yes Ej No
❑ Yes J;�rNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments .(refer: to question ff): Explain any YES answers: and/or any Additional recommendations pr any other comments < ;
Use drawings -of facilitytwbetter explain situations (use=additionalpages,as, necessaiy). x;
,I'—
Reviewer/Inspector Name: -SlDn' "
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QIDIL i JD
Date: J _ I `7
21412014

/'.
Division of Water Quality
Facility Number [!!= - L3L ] O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 6Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: ORoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: D
Departure Time: ]
county:
Farm Name: �`�YWv�,
g�''}
Owner Email:
Owner Name:
Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region:
Onsite Representative: &JA LD s [/ e— Integrator:
—IT 4V
Certified Operator: Y Certification Number: _
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[41Layer
Non -Layer
lY 2_-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes iffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes [:]No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes E-No
[—]Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VfNo ❑ 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: y1 `a 1'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 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 VrNo ❑ 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 EfNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes KTNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes V!fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
7 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'Ga'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0"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 V No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 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 O'No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes KJ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

a �
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [?fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j!jNo ❑ 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 Mcture(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 in No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 4No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[]Yes E!fNo
❑ 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 4 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes CfNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes Vr 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 ,fNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 2TNo
❑ NA ❑ NE
Reviewer/Inspector Name: I<AS`�—�� � Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

rqkDivision of Water Quality
rt
n
Facility Number ) �j ; 0 Division of Soil and Water Conservat<oo.°
0 Other Agency
ype of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: �CountyRegion:
Farm Name: �l MM Wy U 7—r F&�f,& Owner Email:
Owner Name: Jl MMIJA C4�ctac-QI T'r Phone:
Mailing Address: D'471 � 1 Mkl t G Irk e 1?-a Q,A K t,4i 4 NC dE—S,=�
Physical Address:
Facility Contact:
Title:
Onsite Representative: _ ( LAN&
Certified Operator. rK L TT
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrato
r
}}:
ertt6cation Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design ,Current
D :'Poult '" Capacity. Popi.'
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 DWQ)
Longitude:
_a10a's
Design,9 Current-';'
Cattle . Capacity Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
_Dry
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes *o [_]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes kNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

i
FaciRty Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 0
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? )4
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes kNo [DNA ❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accccp+taable Crop
/Window
� ❑ Evidence of Wind D/riift� :] Application Outside of Approved Area
12. Crop Type(s): �(N �H�*T S �I � �� l_C►� `1 C'— P IL c M i Ll-C-7 %
13. Soil Type(s):
LSE
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes ' No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
0 NE
Yes
rNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yeso
ko
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes kNc
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis Q Waste Transfers
Q Rainfall [:]Stocking ❑ Cry op Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 16 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes (No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [:]No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
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?
❑ Yes
[�(No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NfNo
❑ 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).
A-6b, -ci �F� �P� ors- d NI I sc_u t s v(w � F�M �(-c-sr#4Ri� — w/
R-Ecoq_�s r..)Ql0 6�Fk_L715 0K ; 7N -SIN ► =S To DwC c 8�rNG ro
Nl�,X7 5iE,'r Cor- I n►iQFx TI tWs I W 5 yacz
D,1 (). 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0' 1 1&TI D1
Date: 5Z/ kQ
2/4/2011

Division of Water Quality
FaEility Nutuber - / 09 O Division of Soil and Water Conservation
p Other Agency
rype of Visit: VCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O'toutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: \(Y)�I TT _AWk Owner Email:
\ _ (_G)5M Sua-Ll to
Owner Name: _ J I M m Lk t�C-C_ ?4L Cy I Phone: 561} 55�r - 0 aSo C w�
Mailing Address: 0 � 1 rn(n) E LE Yc�! 1 A) IC i A 1 L L
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: �-A L„A 114 �1V1174
Certified Operator: I ih M QOC� li
� C' gQ �R
Back-up Operator:
Location of Farm:
Swine
can to Finish
eanto Feeder
eder to Finish
crow to Wean
rrow to Feeder
rrow to Finish
Boars
Other
Other
Latitude:
Integrator:
Ali
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop..
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
i
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Wastelbollectron & 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 j Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {'(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?] Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 7❑� Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 0
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
ft � ❑ Le,ApplicationOutside of Approved Area
12. Crop Type(s): ( rAm U3HC-'4T s a S r� 6 _,(O i` F A o,(_ M I t.-E T7
13. Soil Type(s): 1 0 t UU )11-4 / 1n (L ("ouc. H t V Lk Ut I
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
C
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [ 4 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ! No
❑ Yes No
QWUP QChecktists QDesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo
Q Waste Application 0 Weekly Freeboard Q Waste Analysis Soil Analysis ❑ Waste Transf rs
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rO No
Page 2 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facili Number: jDate of Inspection:
24. DiXthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? . ❑ Yes PNo ❑ 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).
Qc_r,�}Sfc CAUL- GE0.T 1 FIEn 1LCFIIVICAL- 5Q€C,IAt4sr S16IV A)%fly0m,6WT Td WU
CA c 16Q-P v CYV
I
c� ��-T
14
L,46WNS 0V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(Y16(tCT14AL-Al apDVS aF C_lME
Phone:
Date: S CQ
V4/2011

Div sion of 'Water -Quality y
Facility Number 1F DlvrSl©n of Soilgand Water Conservation ��
Type of Visit 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: Arrivals Time: ® Departure Time: County: LI N Region:
Farm Name: m tJ Owner Email:
Owner Name: fzgCLL 0-1 TT Phone: S8- SS9-b�So Cw}
Mailing Address �1 f1'? l�liil= E 1 i1V IL f�11 t-�- ,-fiC_
Physical Address:
Facility Contact: % ` Title: ,� Phone No:
Onsite Representative: C. �y�C, Jl MM (}tea` 117 Integrator:
Certified Operator: �l R�zl T� Operato,Certilication Number: �S�C
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = f =44 Longitude: = o = 6 = {l
,.
Swine Ca act P,o ulatton Wet Poultry Ca acih Po
Design Current Design ; Desig Current Current
P P ry .. pn.! . pu[ahont Cantle , .:.mPac'ty;P°Pulat°
❑ Wean to Finish
❑ Wean to Feeder
FdFinish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
m rilts
oars
Other
❑ Other
LJ La yer
LJ Dairy Cow
❑ Non -Layer I
Dairy Calf
r
ry Poultry ;��
.-...-
❑ Dairy Heifer
El D Cow
�, ❑ Non -Dairy
❑ Layers
❑ Non -Layers
m ❑ Beef Stocker
' El Beef Feeder
F] Pullets
i urKe S
.. ❑ Turkey Poults
.1❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
to No
❑ NA
❑ NE
❑ Yes qiNo ❑ NA ❑ NE
12128104 Continued

Facility Number: - J — J[�g
Date of Inspection 0
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L Q_
Spillway?: }
Designed Freeboard (in): !� - n�• S H . 5
Observed Freeboard (in): "oc� b� t—/
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 No El NA El NE
[I Yes ��I No [__1 NA ❑ NE
Structure 5 Structure 6
❑ Yes * 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 DWQ
7. Do any of the structures need maintenance or improvement? Cl Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. . ❑ Yes I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) `
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
�A
12. Crop type(s) <ce--f31 L;V W 14c:- T S � 'SC g EQ- V�u C ` &A{t-L (A I LC E7 T
13. Soil type(s)
C
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
ONo
DNA
❑NE
No
❑NA
❑NE
No
❑ NA
❑ NE
6No
❑ NA
❑ NE
�No
❑ NA
❑ NE
,Co 'innients (refer to question, #) Explain any, .YES answers and/or any,iecommendativns or'any other comments, R
'Use drawings of facility to better'explain situations: (use additional pages as,necessary) .�
S Ji�t11(j 3 . 3.
�ut_L-s 1413+14No►o N07,NgU—' j4,-,L3r*jv6 pLANVEs
S
t,7 7 � N• r OF //s 5e CTsdN • Pc'r� ASF
�' 3
�jICoJIO 1 • oZ
��ka 12a �s �o )>wa of_ L T JAC _ a=Waw 1 Ir 1413* N 1Y
I1m/ol '�yS • S
• S w(-,t_E 9c"MQC_n oN IN NtA%. i~'�t�l 3GDA�S
LQ 9 1 • t`
�.
r
Reviewer/Inspector Name
Q G4ZN y ;may Phone: ���'
j -
Reviewer/Inspector Signature:
Date: (o f2Jjd
Page 2 of 3 12128104 Continued

Facility Number: 31 —joll
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No [I NA
Xt.
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA
A
ElNE
the appropriate box. I] WUP ❑ Checklists ElDesign 0 Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NA
❑ NE
;ijal
ElWaste Application ❑Weekly Freeboard ElWaste Analysis ElSoil Analysis ❑Waste Transfers Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections I] Monthly and 1" Rain Inspections 0 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 VNo ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? A Yes [INo ElNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document Yes �No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA
❑ NE
General Permit? (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 56#o ❑ NA
❑ NE
Addi.tional:Cominents a4d/or:.Drawings:
�Ac.i g 3TlON l � F `oZ� 1 l r ?(LC-_S rRGC- w RS Davr-_ I .v 'OR J �.� f10 -IA/ 'p
`
& D TU A A b - 1N ci '3'10'!o r s& l-1 A' Fo(L N S 1 O % eit
-Ta Gt��}1uGE 70& DATF- ON t RRa% 'ro M4TCJV ►VVI Fo(�- L'�)4�9 }-i1 f Q��.p�a�•�
N t ;p
K/P(9169 �kAMVIAlG Foti S 7o i ac tt�S
N�
►u��� A COr OF 714f 09 5(_— DbCE3U¢uC- sC.vr TO 16WQ L41A13aoa�s
�F �nf t69 Sueul✓ wAS nraT �ahE 5�oAt � �E.�►►1> 70
L_NI 1)v 3
jq-mv : AmAM)A QiNEs A77A/ : A %-All DA C,vIA��s
/vc
I a--� G4R-0 I KA�L 1EY7
Yos
Page 3 of 3 K & Cn c, � c UV Ci ON 51 O^1 r O 7- S C3.1/ G o0?V " 12128104

,._ Division of Water
Faettity`Namber, �j] d� Q Division of Soil and Water Conservation. "
_ I Q.Other_ gency ` �k
Type of Visit )0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I.� Departure Time: County: Region:
Farm Name:. l m m t� Q¢.1 TT �� 2 1 Owner Email:
Owner Name: n fYl frl U1 C_A R- U_ `I_ (ZA TT(� 4 Phone: 0— (� �
Mailing Address: n1 � rnr»Ir� f- `-' 'r"1 Nl� i'ii �-�- I ��5 �� O' 1 7CX
Physical Address:
Facility Contact: // (� Title:
\\
Onsite Representative: Ace U/yi ESZ
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Bach -up Certification Number:
Latitude: ❑ 6 = 6 ❑ « Longitude: = ° ❑ C 0
id
NoDesign Current Desrgnr Curren-Desrgn Cure t
3wrne ua. pacity ,iropuiation,
❑ Wean to Finish
10 Wean to Feeder L_
WA _. . . I,r- .� 7
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Vet Poultry:.
ILJ Non -Layer
Dry Tou ltry
❑ Layers
❑ Non -Layers
{
El Pullets
ElTurkeys
❑ Turke Pouets
❑ Other
Discharizes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection QI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 `Structure 3 Structure 4
Identifier:1,4(C<203al Y;la JQ3
Spillway?: G g
Designed Freeboard (in): . J /l.
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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?
El Yes VNo ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
El Yes )�No El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do -any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 ApRlicatian
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
WNo
El NA ❑ NE
[3 Excessive Ponding El Hydraulic Overload El 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) S'L W N IGA-T CC LN S C
13.
Soil type(s) fiQA A(A,P,,
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
OoNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
rVl No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
gkNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA ❑ NE
w.H • N&i
c0191O9 7.
l�sc�g r . tf
II lit )a9
1�(V a.s
1•S �•�
o .9 .
1VldwC32 r,%S lAlS tDC O
,.ome e (2pSI 4N HIV A u._.'T }1.9-EC- C-A CcxyV S - )Y aeb s
-TO psolL* v6-CzETOQ71CW(ceas-S"�
ar,-r COPLL, of 1601 O) C CAaD*9LA7j c.J UcaKDS 4C7'IQE
Reviewer/Inspector Name l 6 A X - S Phone: c) —196-�
Reviewer/Inspector Signature: Date: la9LO
Page 2 of 3 12128104 Continued

4
Facility Number: J�1 Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP 0 Checklists 0 Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
C] Waste Application [3 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑nnual Certification
❑ Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JVNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
10 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DO No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
//f�`
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
ElNE
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
9(No
❑ NA
❑ NE
Additional Comments and/or Drawings: ;
Solt_ tZF_PO� Z-T V-o[Z- a608 c9-0�) c�Ea2 1�caEs nro7 inlcc DC aGStA( r
CA;-
LA?OWJ�n wUXP - Cu�N1- 0 A % AUS of mA�� ot�Ts y.
uAavt� wQ-IrrE� I}DD z'-r► oN S
CALtt3Q_P,710X (,A3A-S )IV
C 4L-%S t-AT! can/ 7O :
p m)xon GQvyeS 1 o :
NCbENR--bL-� o� Prrry : AmgneDA QrArET
19'4 CAaZ)1AIAL bQ PY; 916-350-90�'L-1
W>F�m,LuCiC�ry NC
ONC)S
BEND w jiN DAu s oR IF No
c.Rc-tga,p-rlo�c/ q-s�tD ��9 GALt��71ON
Page 3 of 3 12128104

_ IN Division of Water Quality •-;
Facility Number O Division of Soil and Water Conservation
- — — - — Other Agency
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit x Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �y og Arrival Time: ® Departure Time: r County:
Farm Name:
Owner Email:
Owner Name: _� m ft 'Jg- L Tr Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _� A M r S U) M (3
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = O = 4 Longitude: = o = A
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
F ❑Non -Layer —
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
i
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
1 -1
Number of Structures: �h
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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�fNo
❑ NA
❑ NE
❑ Yes
P&
❑ NA
❑ NE
12128104 Continued

T4acility*umber: 4 — JO
Date of Inspection I V v 6_9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ( drr) 3
Spillway?:
Designed Freeboard (in): q. S )9.5 1 9. CS
Observed Freeboard (in): 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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )d No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes (l No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE'
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus El 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
IX No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
CQ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
CC Kl T lit/k r - V.
•
Reviewer/Inspector Name l f1 j4AI OA C j4F S
Phone:
Reviewer/InspectorSignature:
Date: �VQL1��
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection ( a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RTNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
ElNA
❑ 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
DoNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
iqj No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
flo No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

N
Division of Water Quality
Facility Number 3 j l Q Division of Soil and Water Conservation
Agency
Type of Visit 0 C mpliance Inspection Operation Review 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: I I0W621 Arrival Time: Departure Time: County: DLP_.F.3h� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: JAmIS LAnn6
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
Sy?,t
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layer's
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 1:1
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?
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
12128104 Continued

Vacility Number: 3 — ! Date of Inspection 1a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Je I (M 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);Z-
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 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 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? ElYes 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 11 Yes E3<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Ll No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C: No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
El Noo NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes
L}-1Vo ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
QNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [-IYesVN.
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes
LJ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
fg, j 1cEEP Copy *r m-sr
R ceE,Ali (.a r ,� Pc -A' lst Wzr/4 j5eed"-.
miar 2A(IUAL,' )7.0
r%X'JVFt-DJS'?6C'X0'gf-orPamArIJGW9609Q fIL
CdDG. %t Y AP(
OA"h
'Va f-, L90 0MV6 IbWLOr"n A104/
T
Reviewer/Inspector Name
��/ �jq G L Phone: -ZE L — % 3 8f
Reviewer/Inspector Signature:
Date: /0111
12128104 Continued

Facility Number: — p Date of Inspection ro 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes G3 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. 9<s ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboar Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ual Certification
❑ Rainfall ❑ Stocking El Yield 120 Minute Inspections ElMonthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�_,Ko
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U�o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
12N
❑ NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
L� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L2�No ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IT 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
2 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L IIVo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

,Division of Water Quality
Facility Number J , Q 0 Division of Soil and Water Conservation
- - - -- Q Other Agency
Type of Visit O'Compliance Inspection O Operation Review Q Structure Evaluation
Reason for Visit VRoutine O Complaint O Follow up O Referral 0 Emergency
Date of Visit: O Arrival Time: O ! Oa eparture Time: ounty:
1
Farm Name: ��tn� .ems a �M Owner Email:
Owner Name: SLY! /YI 7 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
J
Certified Operator: M Z�
O Technical Assistance
O Other ❑ Denied Access
Region: 5._6
hone No•
Integrator: C14
Operator Certification Number: ? 5? Z3 _
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: [= n Q d=SA Longitude: =° 0 g=
SA
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imoacts
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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: lal
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 f
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

i
Facility Number: N Date of Inspection _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �j,rjt 2
Spillway?: WA N0 AD
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 No El NA El NE
[3 Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes /EfNo ❑ NA ❑ NE
❑ Yes XNo ❑ 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? XYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes XNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
IJ6
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) 6W
� p) i
13. Soil type(s) /Vi /4, l�" /¢
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes XNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes GrNo
❑ 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
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes b(No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
doer 7_0 G..--47 G��ss (ov�z �,�/j Sso r� u/. &.:::-
,¢55 /1%fD(� �i✓ �s� F� T �jl2ou v�J G o�i✓s �62
Reviewer/inspector Name i— --1 Phone: la w/��
Reviewer/Inspector Signature: Date: 6 fZ0
Page 2 of 3 12128104 Continued

a
r
Facility Number: — OF Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes/glNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other .
21. Does record keeping need improvement? If yes, check the a propna b x below. PYes M o ❑ NA ❑ NE
G� 17� t ///
Waste Application ❑ Weekly Freeboard�120
aste Analy s 'L! Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield inute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes X'o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes QgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZO 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 )2rNo
❑ 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 gNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes�No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes'XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
TZ-D �v
So �
X /�F 7,4fP��zc�7zo�✓
l �`t/= 6 /79 �2C' Z�C
��� 5 �p� � S-k7 Zi✓ s�'j cow
Page 3 of 3 , 1 12128104

Facility Number. J
Division of Water Quality
O Division of.Soil and Water Conservation
0"Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )f Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / /O Arrival Time: Departure Time: County:
Farm Name: 2�'4 onn tA_ �T2 L'L\ Owner Email:
Owner Name: -Zink �T> __ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: tZZY1M L/'&Z-_�7-
2Z�
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
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: = o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Other
❑ Other --- --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region: _ •
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: LKI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ), No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
yfNo
❑ NA
❑ NE
❑ Yes
)?I No
❑ NA
❑ NE
12128104 Continued

It 1.
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure I Structure 2 ..--St��ruccture 3 Structure 4
Identifier: —Z•+Q I �� 2— zjp_s
Spillway?: O /Nd NG
Designed Freeboard (in): Ct
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes No
//❑
El NA El NE
El Yes No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes JZ(No
❑ Yes 10 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Xyes ❑ No ❑ 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 I[J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Ara
12. Crop type(s) 62,40
13. Soil type(s) %UD /y,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes XNo
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,eNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 21'No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary);
17)
Romer ��° Z -zrIV
Reviewer/Inspector Name Phone: D�%(p-�Z
Reviewer/Inspector Signature: Date: 111161

a
Facility Number: —/00 Date of Inspection / /D
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
El NA
El NE
the appropirate box. ElWUP El Checklists ElDesign [I Maps - El 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
/11No
Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and P 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
A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z(No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
0
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
ElNA
El NE
If yes, contact a regional Air Quality representative immediately
/
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
• No
❑ NA
❑ NE
AdditlonalqCommeatsrand/orDrawi gs
5/o7. 5�,rr A z 7'v,�cJ�,o 0 5
4MO A 0 Z
1 gig)4--aago 5 4-tv WtA446A7 �154'0 fin► 61"05 Igdo OORA) �, f
i CCDu.��E,D �qGz ��Qcl AkV46 /1%/ r;r'
/11T416—
yQ'ECaz,o s N�. 0 /�w
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit v Roane Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
cility Number
Date of Visit: 9 �� Tune: 3 Sa
Fa1 a
tp Not rational O Below Threshold
Permitted dCertified ❑ Conditionally Certified Q Registered Date Last Operated or Above Threshold:
� Mvt(Y� iL County. 1� ilPt
Farm Name: _.» ... __ ....., .
Owner Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Phone No:
OnsiteRepresentative: (!Tn=.t_ Integrator: Pj =GF
Certified Operator: _ , _ , , , ... , , _ . , _.� _ _ Operator Certification Number:--._--_
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • u Longitude • 4
Discharges & Stream Impa
I. Is any discharge observed from any part of the operation?
❑ Yes [�10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes 7No
El Yes
❑ Yes C N
❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
Freeboard (inches): 29 7_7 2 If
12112103 Confiviued

Facility Number: F=Ibq Date of inspection
Ej
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes 7No
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 maintenancerimprovement? ❑'Yes ❑
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Zo
❑ Excessive Ponding ❑ PAN [IHydraulic Overload ❑ Frozen Ground [ICopper and/or Zinc
CP
12. Crop t} -, e P, <# ,V o A (- 0) S"
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ne
14. a) Does the facility lack adequate acreage for land application? ❑ Yes l,—d" 9N
b) Does the facility need a wettable acre determination? ❑ Yes rNlp
,.,r
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes G4
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 31110
liquid level of lagoon or storage pond with no agitation? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q/
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes dNo
roads, building structure, and/or public property) — f
24. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes L3No
Air Quality representative immediately.
=Cammmts refer toy m 0 YI�Szanswers aad/ar ar. �-�
�IIse�dr"awu�;af faaTety�to burr c�gtam'sataahoas. (tree $ddrttoi�al pages as!)� C�� � Notes
q
GEt kScw wUP QY FUU S APO CHAR AckaAr,f-- 4' DATES,
as� tJpc*- E Coop Fc-wl Ds. KEEP C%f'r of
WuL At--_ LEtt� 6R�(YL,
7.} C.L�AR Sr+�Lt1 Y�CG aV6r��G-2A1.1T1-b �N L�{�-��Af J1� i -
-
T
Reviewer r Name Reviewer/Inspector
Reviewer/inspector Signature: Date: $ 9 D+-I
12112103 Continued

Facility Number: _ j Date of Inspection
Itequired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
Q Stocking Form 01Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections-B-Annual Certification Form
❑ Yes FNo
❑ Yes
El Yes
❑ Yes
❑ Yes No
❑ Yes
❑ Yes , , No
❑ Yes 20
❑ Yes �!'1vo
cry/es ❑N
❑ yes
❑ Yes 121
❑ Yes 7No
❑ L3 1vo
Yes ❑ No
12112103

e � L
Type of Visit O Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine JZrComplaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Date of Visit: Time:
Facility Number 1
Not O erational Below Threshold
Permitted 0 Certified © Conditionally Certified 13Registered Date Last OperatA or Above Threshold:
Farm Name: County:
Owner Name: i�)Pzz—r Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Rra :3--
Certified Operator:
Location of Farm:
Phone No:
Integrator 'FRCns
Operator Certification Number:
10 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 Du Longitude ` 6 Du
Design Current
�wme CapacityUapacity ro ulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish Ell
❑ Gilts
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacitv Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
- -- - - - --
❑ Other
Total Design Capacity
Total SSLW
ILI Subsurface Drains Present IILI Lagoon Area ILi SDrav Field Area I
No Liquid Waste
Discharges & Stream ]mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 5�3 1 -::5139— J R
Freeboard (inches): 2
05103101
❑ Yes Z No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ONo
❑ Yes 10 No
Structure 6
Continued

Facility Number:. — Date of Inspection 3a D
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 ves, 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 maintenanceiimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic f.}verload
12 _ Crop type GR tz' Ftt ,,
13. Do the receiving crops diher with those desil-nated in the Certified Animal Waste Management Plan (CAXVMP)?
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?
Reouired 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Oyes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
(ie/ WUP. checklists. design. maps. etc.) r
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. rail to notify regional D'N*Q of emergency situations as required by General Permit?
�C
(ie discharge, freeboard problems. over application)
❑ Yes
o
23. Did Reviewerllnspectot fail to discuss review inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
�� ... ,sue ems+=:rF:.__:�..�..T°v..k'.uX7;:.e�.-Tr'r.:�.�.;.�F"ar
is, ,(re to questian`#j. "Eiplauisny YE.S atis�rers andlor:.any tecommendahans yr any atlhcr,comments. _�-
Use drawings of facfitty to better ezplam siinateons {use addshonal pages as necessary)
❑
- —. Field Copy
- u,.3,.-�w.�-•_�._,.- _.._--_::: ..,-r �':�x;.
final Notes
.,..-..
-T,V5 P90-=v/,� �aN Ea�#v5E OF !� 7�RES S cc1-/y�.J �Un7OFF �c�n L�'+�o
�J sP,C 5 ftK � y
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number: r — Date of Inspection
Odor Issues
36. 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?
37, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
38. Is there anv 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 ❑ Na
;0. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
33. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: UJh6rrf—
f 2� A rUr140 ,-JCE 101C AMA +�=se,�1�R(�S f�'�m Gl�,✓d /�?f°tu�9-��; �
%V� ` FIB � � G� TF LEFT
�T � /d � � r
f',�� ,ice4-5
war�Ds, �,a r Ley >�,�
PV fR,'---65QRU7 L'---!/61S A�-'C-v /0
,BF 7,- 'S;roO rfl07P ✓f—L /7G1. GA'U&JS "" �uG�57
/T/tf �A? go 'POPa
00 40OFF,
05103101

y
Type of Visit 91' Compliance inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit Z Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilitv Number 1D Date of Visit: I / Time:
Not O erational 0 Below Threshold
Permitted © Certified 0 Conditionally Certified U Registered Date Last Operated or Above Threshold:
Farm Name: Counh: ' y0G'x/�
Owner Name: /1► Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Phone No:
integrator: —� .��z e�
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' u G Longitude �' 0
Design - Current`. Design Cn'rrerit D,esrgn:- ' Current
'S*iine w Ca achy Po uiatioin`- ;Poultr} Ca scity Pa ulation.. ;-Cattie -•Ca acity- Po utation..;
❑ Wean to Feeder ❑ Layer Dairy
El Feeder to Finish ; ❑ Non -Laver ❑ Nan -Dairy
El Farrow to Wean _ ,
[] Farrow to Feeder ❑ Other
❑ Farrow to Finish - -
❑ Gilts _
Total DesignCapacity ❑ Boars -Totals L-W
Numb
of Lagoons ;: . ®i - ❑Subsurface Drains Present ❑ La oon Ares ❑ 5 rav Field Area
-:
Holding Ponds Sol Traps . '�; ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (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
Stru lure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r� �h
Freeboard (inches): 2 P_d 29
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ,TNo
❑ Yes XNo
Structure 6
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
ONO
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
;gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic verload
❑ Yes
ONO
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
21No
14- a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes��No
IzNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15. Does the receiving crop need improvement?
❑ Yes
)ZNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
21 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;�'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VfNo
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
VrNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ZINo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PYNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;�No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cominents.(refer,to question_ #): Eirplaut any YE5_aasvrers and/or any reconinteodstions or any;other:ooatruet►ts.
Use drawings of:f'a to -better ez' laEt situattcins use.additional-
g _. _np "( ddttiona{ pages as necessary): ❑Field Cory ❑ Final Notes
moo.✓ ��c o2 G�aaa.✓ . �/ /�,�v s
04V0 /`
�' 1✓ �P�}Zi✓P ��FS. `' /��0�/✓y l�G /rs N� i T�/`� � U.e�v2PE
[r ti1
Reviewer/Inspector Name 'S'�f
Reviewer/Inspector Signature: Date.
05103101 r Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours?
29. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i_e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawings:. nn
O5103101
[] Yes ❑ No
❑ Yes IE� No
❑ Yes 17No
❑ Yes y No
❑ Yes ,`No
❑ Yes / yNo
❑ Yes ❑ No

r - a
Type of Visit J5 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint. O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: /% Time:
Q Not Operational Q Below Threshold
Permitted [3 Certified 0 Conditionally Certified r] Registered Date Last OperatedorAbove Threshold: ...... .._.»»..»-
FarmName: ................................................................................................... ...... County. X42-e ' r
Owner Name: M— .... !L............................................. Phone No: ............................................ ... ...._ ..» .
FacilityContact: .............................................................................. Title:................................................................ Phone No:............................... ... ..... _
MailingAddress: ..................................................................................................................... ...........................
Onsite Representative: f� r ............. Integrator: .. ...
..?�..
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
zrslwine ❑ poultry ❑ Cattle ❑ Norse Latitude �' �� ��� Longitude
-. Current
Swtne >;- . - - - -. -ciii0adty Population
to Feedereederto
Finisharrow
Vean
to Wean
arrow to Feeder
arrow to Finish
Gilts
Boars
Number of.Likgoons :-
_- ,- Holding Ponds:/ SoBd�Tiups'.
P - Il�gi Current Di
oultry- : , .Ca aci Po ulafion _Cattle .. = -Ca
❑ Layer ❑ Dairy
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes A!No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struuccture 1
7�1
Identifier: ..... J22.....................+.C..
-SSttructure 2
...................
Structure 3 Structure 4
................
Freeboard (inches):
hhiGl
5100
❑ Yes QfNo
Structure 5 Structure
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ! No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 2No
(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 PrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes R(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Zf4o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Ove�oad ❑ Yes RfNo
12. Crop type (_'VIAL 4(1145W 7_t '�D!(ACYW "
13. Do the receiving crops differ with those designated in the Certified Animal Waste Managefnent Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes L;Wo
b) Does the facility need a wettable acre determination? ❑ Yes j2'No
c) This facility is pended for a wettable acre determination? ❑ Yes ,'No
15.
Does the receiving crop need improvement?
❑ Yes ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes ONO
R
uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Of4o
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 9No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
AYes (3 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,0'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes )0190
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑ R<o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes eNNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes Bl o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
"yiola(igUS.Ojr• defcje>ni ies -were pO(e# O(Wift this;vlsit; • Yo(r wit]-teeeiye po tu(rt�trr
coriesbinidence'alwuf this visit . :... " .....:...........
.... .
.
Cnmrnetnts•(refer.to-question #).. Egplaih'any YES answeiws and/or any recommendations or any oilier comments.
Uiedrawnr3igs of iac ty to betterAex laity situations (wise additional pages as necessary)
j _
Tiff �FEa� =0 �� �ry7f>fl/� 6goet'f Z"4a'9O /'i —1-el SO 4/-rG m.
I q) I �i►! �PP� �,q sod �f�� D< ZZ p�N ��s � D� G� Ay
/� �N / '� 2 �'F s �F LET S �� Awi-,
Q R
G�%s�� R�u� �'�� ass �✓� lyl�q � � Gr���-r .r,✓ /yj�a_
Qc �OgO'fV ANp
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: MINA 1 5/00

l "ft
Facility Number: — Date of Inspection /[g,
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ,01 i�a
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 IdNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Addifiona1:Cqmrnent& an or D
r�Dl �L'Zll�r✓G. .Ql%O / �/E�,Q� A
/ " �/f���f !f /G �'!/'� ��/ �iZG��G O/tJ �/sOLI�%/tom ..G/✓OZC�j¢��r4
f��97 1� ��19-T
_
/7
42Z2eO % OA,����
4540
Q
5100

6Division of Water Quality
Q tDivision of Soil and Water Conservation r1,000000004
Q Other Agency
Type of Visit 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 d L1dL�Lr�
Date of Visit: lilne: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted [3 Certified [] Conditionally Certified 13 Registered Date Last Operat d or Above Threshold
Farm Name: ....................j... l...... ............-.....�.:.t ....� V.lrl� County:.-....-.......... .................. .........
OwnerName: �...? ..................... Phone No:............................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No: ............................. ......................
MailingAddress:.................................................................................................................... .. .........�..
...............-.................
��tor:.OnsiteRepresentative- k............1..-....... to ..............._...............`.....�.Q
Certified . Operator: Operator Certification Numberr:..........................-.-.............
Location of Farm:
IN
w
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' Longitude �• ���
Design Current
Swine CaDacity Population
❑ Wean to Feeder
Feeder to Finish
5 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer I I Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag—n Area JE1 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 gallmin?
d- Does discharge bypass a lagoon system:' (If yes, notify DWQ)
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
A—
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes S(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes e<No
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes S�No
Stw&F31 Stroy 2 Street Structure 4 Structure 5 Structure 6
ig I
Identifier : ......... ....•.1....ff.��....t!....... ................ ..... if................ ri................
Freeboard (inches): !
5100 Continued on back

Facility Number: I — O* Date of Inspection JO /. Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes 4No
.r
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes dNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
19. 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: N,O•vio hti6 is:or• deft.ciencies w re noted• during • bis;visit; • Yoit wiil-t, 'OK, 06 futftf .
corresnoridence. abautithis :visit.:::...... ....:............... .
IRYes ❑ No
❑ Yes KNo
(:]Yes EJ�No
❑ Yes fil No
❑ Yes KNo
❑ Yes KNo
❑ Yes �<N o
❑ Yes tftVo
❑ Yes , ffNo,
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes gNo
❑ Yes ENo
❑ Yes Z�'No
❑ Yes RfNo
❑ Yes ,No
❑ Yes mivo
❑ Yes 5�No
❑ Yes )(No
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):
7 4
lam G (0,5S r � -�° atr )
I (.*-Y;4,--- r o o k'. �oo/_ f I C I
Reviewer/Inspector Name !
Reviewer/Inspector Signature: Date: r 7 -2a

Facility Number: — v Date of Inspection /Q �[ ppt.J Printed on: 7/21/2000
Odor• Issues
26 Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below []Yes �kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes (V] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes CNo
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 -IQ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes EKNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes q&0
Additional omments and/orDrawings:
5100

Division of Sail and°Water Conservation ;Operation Review
_ 13 Drnsion of Soil and Water i onservatton -`Compliance Inspectiop=
_® Division of Water (Quality .Comphanee Ins— pectionx
E Other Agency - Operatk Review -N.
-- __..
a-
k
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of inspection 24 hr. (hh:mm)
13 Permitted 0 Certified 0 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
Farm Name: ...............' 'KM.........�...... County: ...+h
Owner Name ............ 5.1..l. !My"� �� i ..................................................................... Phone No:.....................
FacilityContact: ................................................... ......... Title:........................ ........ Phone No: ...................................................
Mailing Address:
Onsite Representative:.....V .l�.e......... d ............... ........... Integrator: .... 13 G.ar A�.e......
(f
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
r..................................................................................................................... .. ...............� _
Latitude Longitude �• �' �sr
Design Current _i __ Design= Cur `rent
Swine Ca acity Po ula6on ::Poultry_ ' 'Ca achy_ Population Cattle
❑ Wean to Feeder
® Feeder to Finish
ZQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer Non-Dairy
airy
Non -Layer
-----------------
-
❑ Other I-
Tota1 Desiga Capacity
Total:SSLW
Design Current
Capacity Po ulation
Number of Lagoons ]❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps �, ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus,storm storage) less than adequate? ❑ Spillway
Structure I
Identifier:
Freeboard (inches): ................g........
Structure 2 Structure 3
J-6 Z D-Ln
36 -73
........... ........................ ..................... I.......
Structure 4
❑ Yes .0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 5a No
❑ Yes No
[]Yes No
Structure 5 Structure 6
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes g No
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? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes b? No
Waste Antilication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type S,4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes $1 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes [:]No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J9 No
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
-
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?'
❑ Yes
•® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
V No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
:P5 No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2fNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
j$No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
$No
0_ Rio yiolaticjns:or def ciencie5 Wi• re nq(ea• during this:visit; • Y64 will rebe V4e iJ fuir her -
correspondence abauti thi Nisit...,.
Ctimments4re6r_,46 question M "-Explain any Y"FS answers and/or any recommendations` or any oilier comments;,
Use,drawines of facihty'to better explain situations: (us4C dditional pages -as necessary)
S. Spyvle tvve4 Mgy_lIq em l+ needed '01 6001S741 -t`7414-C
Off%y I;me
h : X rrna ii"e�lLGdGroz�y'3n ) �e6-e#jaei]Y-]ees_-4� ,4 selG;�iJ r
dh �icJd T�Z.
Farr_ J;� is ;i 9Dej d GD!'Y���iaY1 , /ar0anf Otte U01 kef4.
cJ
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:W JR 9 of
3/23/99

Facility Number:? --1,9471Date of .Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes g] No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?- ❑ Yes] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc_) ❑ Yes nNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )6 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ffi Yes ❑ No
ahona omments an or Drawings - 7,
AL
3/23/99

I '1
:a _
13 Division of Soil and WaterConservationOther Agency
(� Division of Water Quality M
JULRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection o —59-°ly
Facility Number 0
Time of Inspection 30 24 hr. (hh:mm)
13Registered © Certified 13 Applied for Permit aPermitted 0 Not Operational Date Last Operated: ....
Farm Name: r • ... . ��. .......... ............. ..........
!""y! .. f--..#`"-�............................. county ?1.....
Owner Name:....... Phone Yo
Facility Contact.... ................................................. .. Title: ..... Phone No:
Mailing Address: ... 2... l....f........ �` ' ..... .4. .. 5 s.. ,.`. `I! 1 t t .... 'oc .................................... ................ Qnsite Representative: �^'!*Q�.(..14-v.. ........ ..... Integrator:._...�-�—� fir. -� .................
CertifiedOperator:............................................................................................................... Operator Certification Number, ................ .........................
,itcation of Farm,
0110-- A -
Latitude a 0` 46 . Longitude ' "
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
W No
2. Is any discharge observed from any part of the operation?
❑ Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
N No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gaUmin?
146
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
l9 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
9No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[XNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

`.n
.' Facility Number: 1.3l — U�
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaQoonsAolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes $ No
Structure 1 Structure ? Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ......... ............................. 3.........................................................
.................I ......
......................................................................
i q
Freeboard(ft): � �........................ •. ....................... ! i....1......................................................-...................................................................
.................:.. ....
10. Is seepage observed from any of the structures?
❑ Yes
[d No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
[g No
12. Do any of the structures need maintenancelimprovement?
DdYes
❑ 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
M No
Waste ADDlication
14. Is there physical evidence of over application? ❑ Yes Dd No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I5. Crop type ...� Lt.:f �... l ��o .............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ONo
17.
Does the facility have a lack of adequate acreage for land application?
❑'Yes
rZ No
18.
Does the receiving crop need improvement?
[9Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
v
❑ Yes
IM No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0' No.violations°or deficiencies. were -noted -during this:visit.• You.Hrill receive•ito-ftirth:er•
:. • eprrespQndei�ce ab:out this:visit.-.: • : - : • : . :. . : .: . :: ; . : : ... - . . , ..: : � : :: .. : -
j q t t
rT�� . �- ,� s � M z"
PP fkc.Al
�e�-e�.�e ���e �-e ]rem( 1,��U,,-�e�►�,�,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
G

.... _-
�° kk DSWC Animal Feedlot Operation Review
�DWQ Animal Feedlot Operation Site Inspection
WItoutine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-un of DSWC review 0 Other
Facility' Number
©Registered U Certified ElApplied for Permit © Permitted
Farm Name:.... t..r -N-R ...... -....E.fr..t.��...�4.Y.�r+.. ......................
Owner Name: ..................5......... =... ......r...a.. ..............
Facility Contact: ...... Title:
INlailingAddress: ...Gr......1's.v,r,....�.�.
.......
.t...
Onsite Representative:. •!r.. .....$.,.AA ........................................
CertifiedOperator....................................................................................................
Location of Farm:
Date of Inspection
Time of Inspection I I I : 2 Q 24 hr. (hh:mm)
Not Operational Date Last Operated :..........................
County:..`..�.�l..M.- ...............................q
}'hone No: ...t..4... �..�.4...� ....1.�7.
.............................................. Phone No:........................................
.:�... + ..... .. 1..i..,... C....................�
Integrator:... r..c..S.,......................................................
Operator Certification Number, -.....Z_- . D,�.........
....,. ...s,.;...A.. �..�.s............
W--- 4U-5.5.........:......................... ................... .............................. .......................... .--..---.----.--..........---.----....................---......---........
Latitude 1 .4 Longitude " 4 "
Cyr
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
; •o
tatton
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I JE3 Dairy
❑ Non -Layer - ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds ❑Subsurface Drains Presein:tJ111 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes f9 No
b. If discharge is observed. did it reach Surface Water' (If yes, notify DWQ) ❑ Yes ®,No
c. If dischar.,e is observed, what is the estimated flow in --al/min'
J. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
IR No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
7/25/97 Continued on back

Facility Number: — k
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Cd No
Structures (Lagoons,Holding_Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier Z • Z S
.................... ......••--........................................................................I................................ .......................... ........ ...........................
Freeboard(ft): Z .................................... ..............:............... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes ONo
I I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes XNo
12. Do any of the structures need maintenancelimprovement? 0Yes ❑ 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? ff Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ELNo
(if in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type .a.,r r-r�-�1. c-w- ............. ur+ .................... .....................���✓`..�..�.... ...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Yes RNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
19 No
18.
Does the receiving crop need improvement?
R1 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
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EgNo
22. Does record keeping need improvement? ® Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes RNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? RYes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes IR No
0 No.violations or deficiencies. were noted during this.visit.- .You.Will receive no further
:-' cbrrespondenceab"out�this:visit:-:���:-�, :-:• -:• -:�;�: ;���:- -: -: ��: :-� :-�•.• •.• �:�:�.���.•
n ..
Comments:(refer to question #) :,Explain any'YE answers and/or any recommendations or any outer cnmrnents:
Use drawings of facility tq better explain'stuations (use additional pages as necessary)
. _: r
IZ. Cu0, a-, -purr aL c.1V-Ar wti,![C o i°vout. AASa, 14ayl1 AL
v k .L %,e_ f-" _ l I w- F-d�d ; { T d 1 b-�t L
S `�z. wa ti
0", t S . V '
°'ICJ vc
ILA ai 'CL H ti " 5 s k a .r 4L 1u VA --.a �.�L�r�IL i w S ••� 7 ,.,e Ca
P
'.i �-o f + e.�d� �- t� a �1 �-►-e o jt u n L (.y 11 s
4 1�'�-0 .
A t c`c,r ` A � ; c=t t 1 [ L s v- • t �a f Lc w ,� vt.�r % 1 i e_,L
7/25/97
Reviewer/Inspector Name : -
Reviewe 0 nspector Signature: n __I . n _ • r M. NO U —, ,-, , „ Date:

•
Site Requires Immediate Attendj : r�
Facility No. 04
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIOPJS SITE VISITATION RECORD
DATE: �% , 1995
Time:
Farm Name/Owner: ,.d
Mailing Address:
County: / PL/ 1
Integrator: Pe
On Site Representative:
Physical Address/Location:
Type of Operation: Swine V Poultry Cattle
Design Capacity:" 5�p8 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Longitude: _Lj ' _ 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 e r No Actual Freeboard: Ft_ Inches
Was any seepage observed from agoon(s)? Yes or No Was any erosion observed? - Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes 4r No
Crop(s) being utilized: dim✓
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e r No
100 Feet from Wells? /Yes�hr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 1No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover cro )? Yes or No
Additional omments:
n� -7--)s ro -'F�rcI-DS 'A
1 -0, � C
w Inspector Name
Si
NO
cc: Facility Assessment Unit
41
Use Attachments if Needed_