310183_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Inspection U Operation
Reason for Visit: 034outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Z p Departure Time: 3 v County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
("/ 1�a Ct,-.w.�-e�S
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I / / j__Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.Q§N
Wet Poultry
Layer
Design
Capacity
Current
Pop.
-
Design Current
Cattle Capacity Pop.
Dairy Cow
We o FeederI
jNon-Layer
I
Dairy Calf
eeder to Finish
Farrow to Wean
ZBa pp
Dr P.oultr, •
Layers
Design
Ca -acity
Current
P.o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0<0 _❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0--K�o❑ NA ❑ NE
❑ Yes [,_J_NO�❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: jDate of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0—go, ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '=-ii
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:]Yes [Z No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ N ❑ 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 T ❑ NA ❑ NE
maintenance or improvement? YYYY
Waste Application -���
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L�-d11O ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I — LNo ❑ 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?
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?
Reunited Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Ej�­No ❑ NA ❑ NE
[—]Yes ]o ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes [31 o _ ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection: 2
241. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D-N�o❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes " 6 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes [—]No F A
.:�'C3 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
�'"
I , No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7"
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�❑ 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
fn No ❑ NA
❑ NE
Comments (refer to question #):;Explain any YES answers and/or any additional recommendations or any other comtnepts., c
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 06, v t PQ —e—
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `(� 170 3 ' jt
Date: y (7 /
21412015

Type of Visit: QU Co pliance Inspection U Operation Review O Structure Evaluation C) Technical Assistance
Reason for Visit�.� RRoou.,tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1v 9 Departure Time: y County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (t's 1 (C c C N' "40--3
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
o Feeder
Non -La er
DairyCalf
E::
to Finish
to Wean
to Feeder
to Finish
z.
50,90
WTIit ,
Layers
DesigqP_o
C_a aciNon-Dairy
DairyHeifer
D Cow
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood CowTurke
s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes L_I ❑ NA ❑ NE
[—]Yes No ❑ NA [_]NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection: /
6
Waste Coilection & 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
OlNo ❑ 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
Ej No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EjNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes <0 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M rvO ❑ 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 ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
U No
❑ Yes
EZ No
❑ Yes
[ No
❑ Yes 0NNo
❑ Yes ENo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5'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

Facili Number: Date of Inspection:
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No ❑ NA ❑ NE
Io ❑ NA ❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
❑ No
fNA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [J'No
❑ Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
LJ No
❑ NA ❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). : ­ 1 ., .;
AC C
Reviewer/Inspector Name: CIA tt(, n1(o LQ-/Q% t' / Phone: Q (oo 7 7 G 73o y
Reviewer/Inspector Signature: /' ---rt/ r I— Date: S �F_ /6
Page 3 of 3 21412014

Type of Visit: UComp ' nce Inspection V Operation Review U Structure Evaluation V I echntcal Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: ® Departure Time: 3 County: Region:
Owner Email:
Title:
Onsite Representative: o • I / i(C` '4 cls
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: f 7/ �— 2—
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capaeity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
P.
Design Current
iiiiiiiiiiicpggi2mP.
Dairy Cow
n to Feed
Non-La er
DairyCalf
Feeder to Finier sh
5 try
SVo
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P�oultr,
Layers
Design
Ca aci
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Other
Other
Turkeys
TurkeyPuuets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Io ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412015 Continued

acili Number: Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: z—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 `d� 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 ['
1Vo
❑ 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? �es ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10: Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E:fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
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
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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 ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �J`No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: 5 f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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?
Reviewer/Inspector Signatui
No ❑ NA ❑ NE
[]'No ❑ NA ❑ NE
[] No ❑ NA ❑ NE
❑ No Q'1IA ❑ NE
❑ Yes []'Po ❑ NA ❑ NE
❑ Yes E]�No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [:I —No ❑ NA ❑ NE
❑ Yes [3'No
❑ Yes ONo
❑ Yes []-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: S
21412015
Page 3 of

Type of Visit: eCompliance 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
Date of Visit:/ Arrival Time: Departure Time: County: ,►' m Region:
Farm Name: 4t '�plm Fj WVI, Owner Email:
Owner Name:
Mailing Address:
Physical Address: '
Facility Contact:
Onsite Representative:
Title:
Certified Operator: ! ' A G L. Q-6"6^
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: , 1 O" QO''
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
I
Current
Pop.
Design C•unrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish00
D . P,oulh.
La ers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other IOther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State?(If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes X] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes No
❑ Yes e'No
❑ NA ❑ NE'
❑"NA ❑ NE.,,
❑ NA ❑ NE "
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
Page 1 of 21412011 Continued

Facil ity Number: Date of Inspection: -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
ZfNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
;KNo
T
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L�
a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
YJ 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
[7fNo
❑ 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
I /I 1
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
'ff7T-'1�' 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
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I/ I No ❑ NA ❑ NE
maintenance or improvement? Y1
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V I 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes o
❑ Yes No
[-]Yes P!No
❑ Yes Z3No
❑ Yes VfNo
❑ Yes e,,,,,,No
[-]Yes KNo
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. . ❑ Yes 0 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 ;KNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection: — •.::.�ki.�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ONo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes* ZNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE_
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZjNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNo ❑ NA ❑ NE
Other Issues �/
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I iI No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 7"
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.
❑ Yes ZNo ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VrNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
V(No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
4
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
VrNo .
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[XNo
❑ NA
❑ NE
rComments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: —Sm11 , 0417
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0`D'3 _ Mp
Date: 5-o-14
21412011

G
Type of Visit: p-C�ommpliance Inspection V Operation Review U Structure Evaluation V Technical Assistance I
Reason for Visit:: C�7 RRoouutiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1 ,)
Date of Visit: I�//;fit si/I S Arrival Time:EM—K Departure Timer County: � Region: W/ Q
Farm Name: —/VI I---t�*—'�i c6ft � . 7 Jh~ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 1 •fty�.t L. G�
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: " /7l�p 0✓)� �5
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , + P�oult ,
La ers
Design
C•a aci
Current
P.o _
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
TurkeyPoul[s
Other
0
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
[:]Yes 0 No
[:]Yes ONo
❑ Yes
allo
[:]Yes
V!rNo
❑ Yes
ONo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

i
Facili Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: t
Spillway?:
Designed Freeboard (in): _ 1 .
Observed Freeboard (in): 3 1 ,L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑/'Flo
❑ NA
NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
F;-No
❑ NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
,fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZrNo
❑ 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
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C2rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vf No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
Page 2 of 3 21412011 Conlinued

lFacitity Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
PNo
❑ 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
V'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
jn No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o 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
J!j No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
ZNo
❑ 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
Reviewer/Inspector Name: -�Yyj4w\ oay. z Phone: 4 Pro2D%
Reviewer/Inspector Signature: 1%601 , Date:
5
Page 3 of 3 21412011

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
Date of Visit: Arrival Time: Departure Time: County: UN Region:
Farm Name: M ( f=e- Cy/9MefeS �—_A(ur) Owner Email:
Owner Name: I ► 1 1 K F (�t.b/ /A CnFV_S Phone: -1 I O - IDT3—18� S
Mailing Address: Z Q.G 1JCiX �3`y o56 NtLf_,Nc o%v68-38TS
Physical Address:
Facility Contact: Title:
Onsite Representative: ( ' t IICE (IF)AmF3EV-S Integrator:
�7 �(a
Certified Operator: / r l l lc6 L • C�Ff141r1 seg _ S Certification
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Number:-poC
Certification Number:
Longitude:
L
I
Swine
Design C•urcent
Capacity Pop.
Wet Poultry
—
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
OD
I) , P,oultr.
Layers
Design
Ga aci
Current
P,o
Da' Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow7-1
Other
Other
Turkeys
TurkeyPoults
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)?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
][
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
I /y, 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): �� S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
��((
No
❑ NA
❑ NE
waste management or closure plan?
i�
1`
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application 1
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 7777\\\\
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2 , et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of `Wiind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i g (FESCL4F_ Cry J
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes -0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -in 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?
7�
17. Does the facility lack adequate acreage for land application?
❑ Yes _S� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 40
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
�.,{
❑ Yes I XI No
❑ NA
❑ NE
Q Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis
❑ Waste Transfers
Q Weather Code
E] Rainfall [:]Stocking 0 Crop Yield El 120 Minute Inspections ❑ Monthly and V Rainfall Inspectioons/
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes jpyC� No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 1 Bj jDate 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
I�
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
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ,,
3.�"+rq
Use drawings of facility to better explain situations (use additional pages as necessary).
W.A..
► 4�?
aJyl1)
J.& ]-':T
1.0
�I►�I,�
I. i .�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/412011

Facility Number )
V Division of Water Quality
Division of Soil and Water Conservation
Other Agency ✓
I Type of Visit Q(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Compliance
0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Arrival Time: � Departure Time: County: (-IN Re ton:
Farm Name: (1�1 K— C"19M OC-QS P'A2M Owner Email:
Owner Name: f'(�,i/✓,�R�_-- C-7N/alYl13,Fy% _ 1 nPhone: 6-D63 '3c4�5
Mailing Address: 1 .lJ. VJ�X 7� f 05E HIL(-. N� p/gyst�-38}5
Physical Address:
Facility Contact: Title:
Onsite Representative: �M 1{� COAMy'$
/ ' � Certified Operator: 1 X- 6 L . CHAM g-S
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
Phone No:
Integrta)r cGn
Op n Certification Number: � -418 L
Back-up Certification Number:
Latitude: [ o = ' = « Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
—� ❑ Layer
❑ Non -Layer
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
allw�0
Design Current
Cattle Capacity Population
❑ DairyCow
❑ 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:
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 4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes rNo
o
El Yes
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

n
Facility -Number: — /
Date of Inspection N //
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: _ I
Spillway?: n pppp
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 ❑ NE
❑ Yes ✓❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes t�,l No [I NA El NE
El 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) K
9. Does any part of the waste management system other than the waste structures require ❑ Yes JNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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.
Soiltype(s) Al )&3co LumgeC i�CRdt/7V�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t�5
No El NA
t����y
[I NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
{{{{1
� No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
b( No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P�No ❑ NA
❑ NE
Comments (refer to'question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility In better explain'situations. (use additional pages as necessary) r
Reviewer/Inspector Name j' ' Phone: 9/6 -4q(a -3�
Reviewer/Inspector Signature: Date: '�Slt/l/[
—?�t7

Facility Number: Date of Inspection 3 TI l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tANo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ pmual Certification
❑ Rainfall [I Stocking 0 Crop Yield El 120 Minute Inspections El Monthly and I" Rain Inspections /❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Eles
I
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
y❑I
qtl NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes *o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ;6No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Additional Comments and/or Drawings:
CAC.IgG� i lon/ nuE adi � .
w.A-. (
of
111Z11D V v
/.o
Page 3 of 3 12128104

type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Jam(,/ Arrival Time: Departure Time: County: U%( Region:
Farm Name:
Owner Email:
Owner Name: 10 11i« C'Un(nolews Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:
�t II
i t I
y-�I (E
�
VC��li�(17g�t2S
Certified Operator: I IGg L.
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: JS_
Back-up Certification Number:
Latitude: n o n' n 11 Longitude: I I 0F_1 I I
Swine
Design .'Cprreot
Capacity Populahon
- Destgn Cprreot Destgn
. ` Wet Poultry tCa actPo lahon C itle '
. .-, P v tY_ P , _.K.,,, .w....,ru Capacity
Cnurrent
Population
,;
❑ Wean to Finish
�' ❑ La er '
❑ Dairy Cow
=.
:
'i
si
❑ Wean to Feeder
❑ Non -Layer I
Dairy Calf
Feeder to Finish
El Farrow to Wean
rj
OD...
µ .*� '�•hr,. -..
e
-* .
Dry Poultry «..:r -;
❑ Dairy Heifer
❑ D Cow
❑ Farrow to Feeder.,
❑ Farrow to Finish
❑Non -Dairy
Beef Stocker
ers
❑ Gilts
❑Beef Feeder
❑ Beef Brood Co
❑ Boars*
PE
•"._Other
Nuritbergof Structures:'
oints
❑ Other
is _,—�.�-�-.- r .. .w? .t. tea. ..a Y'�+.Tvr— — :..lY^3a
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 �w ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
1I No
❑ NA
❑ NE
12128104 Continued

Facility NumDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I StruT 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
pp
Designed Freeboard (in): / (•
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JKNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) 5 , Y �Fendr`{ _ /� 'Fesc Ae N�
13. Soil type(s) fiago c) Lt,rngT:e 1 (_Ayr7ON
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�ko ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No ❑ NA
❑ NE
Comments(refer to question #): Explain any YES answers and/of,any recoidkiiifendationsg6 aany other comments
Use drawings of facility to better explain situations. (use additional pages.asnec'essary--)
Reviewer/InspectorName
Phone:
Reviewer/Inspector Signature:
Date: Q s &fs
12128104 Continued

Facility Number: ( — B3 Date of Inspection ZTLM
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 ElNE
the appropriate box. ElWUP❑ Checklists Q Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. !!! ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis [Iyvaste Transfers ❑ *ual Certification
0 Rainfall El Stocking � Crop Yield El120 Minute Inspections El Monthly and II"" 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
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
b(No
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
NA
❑ NE
Other Issues
1'
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
I2128104

rype of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit oRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
M
Farm Name: _ � t 7 I I-fG CNAfn tB c2 FA (Z.m Owner Email: /� o
Owner Name: Mmc-_ L— C44ArYteE2g Phone: gJ(d�—o[g9—JBiS
Mailing Address: �' 0 + x�x J SY �� H j LL . L ot6 � S LS
Physical Address:
Facility Contact: (y'� Title:
Onsite Representative: 6414-Muc--S
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = , O
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
#'No
❑ NA
❑ NE
❑ Yes
Pj No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Nurilber: ' — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: oC
Spillway?:
Designed Freeboard (in): / • S
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
[INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
DQ
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
wl No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
w`Y No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O.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
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
0,No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ NA
❑ NE
'Coinmen[s (refer too question #) Ezplam any YES answeis and/or any recom endahons or' any-0 It om' dents'
lUed�ags of facdrty to betterrexplam sttu ha ons (use addtGonalip ges'as o essary) ���
ID✓v"n t,i, Y.T i.-kva'N h " n x .u.N.i. 'rc.` .V ro W x� Ka M s K
7p'w U0oL5 600t>
r 7
Reviewer/inspector Name I �AtofiE Phone:
Reviewer/Inspector Signature: Date: aq I Llb
rage z of J raiZaioy uonunuea

Facility Number: —) 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑tryaste Transfers ❑ nnual Certification
0 Rainfall El Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and I"/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 'N No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1KNo
❑ 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
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)6 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
OkNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JXNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
lb�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Q Division of Water Quality
Facility Number r3 g3 O Division of Soil and Water Conservation
0 Other Agency
Type of Visit I& Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit .D Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I __J Arrival Timer Departure Time: County: p� UN Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: t' I\I�F CNAMEF-e-S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Longitude: I=] ° I=] I M "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — 1 g Date of Inspection Fl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ERNo ❑ 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: LAe>00N ( LAcootil o�
Spillway?:
Designed Freeboard (in): 1`� • S ii• S
Observed Freeboard (in): (9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[@ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
as,,�
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[A 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
D�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
W 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 > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
5 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[�] No
❑ NA
❑ NE
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):
NEEf] `lw8 OIC . SEN1�!' COPyo
IReviewer/Inspector Name I AWjqArDA G N % O HN q ELF I I I Phone: C /Q - W6 -_7c?a I
Reviewer/Inspector Signature: Date:
Pnoo 2nl2 12/2R/Od CnnHnued

Facility Number: ;� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Z 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
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
[0 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
4 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
Comments and/or
12128104

II r Division of Water Quality II
Facility Number /�3 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 I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: E�ounty:
Farm Name: ?i Owner Email:
Owner Name: „/�k.F Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
In Other
Phone No:
Integrator: t lki( IY '
Operator Certification Number:
Back-up Certification Number:
Region 1-
Latitude: = U Q ' = Longitude: = o = ,
Design Current'`' Design Current
Capacity Population.' Wet Poultry Capacity ..Population
inish ❑ Layer
ceder ':- ❑ Non -Layer
-inish
Dry Poultry
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
L
Cow
❑ Dai ry Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes XNo
❑ NA
❑ NE
❑ Yes '00 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 41 A:?, -
Spillway?:
Designed Freeboard (in): 4
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 ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes gNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application IV
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I(J No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �& ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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. Croptype(s) �sG6nn/E �y^^.�f�m!//7tTANI �Cl /%d�CSF_�O 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ,❑.,/Yes
15. Does the receiving crop and/or land application site need improvement? yJ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
/YJ No
El NA
❑ NE
❑ No
❑ NA
❑ NE
No
❑ NA
❑ NE
INo
ElNA
ElNE
Zb 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):
--orm f� v2 .Lev 'e5Aqe94dA •
IReviewer/InspectorName Phone: (/O)
Reviewer/Inspector Signature: Date: 3A0A
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2I. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
)zNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ 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
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes y' No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
rrr��X
y� 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
11No
❑ 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
RfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
/S�
2,j5) '5�' "7, , //"�o /V'9
/v �A2J�57
Page 3 of 3 12128104

Division of Water Quality
Facility Number I �71 rl 7 O Division of Soil and Water Conservation
Oh
-- - — � Other Agency
Type of Visit r Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JZ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 22 0 Arrival Time: ;eta zn Departure Time: I oM I County:
Farm Name: //fit y�/i�Ll-EG e/�/f I X �/LS / /`;/y' Owner Email:
Owner Name: / !?�Ciri EL e&le'184Q5 Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No: Q
OnsiteRepresentative: .��/gEe5 Integrator: ��i�/,%!%�!-�)/lOaJi✓
Certified Operator: 61'%-776605 Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = = [�'. Longitude:
Design -Current
Swine Capacity Population Wet Pool
Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design .Current _
Capacity Population Cattle
i E]Dairy Cow
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?
o=, =.,
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 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?
Page I of 3
❑ Yes I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
El NE
❑ Yes
No
El Yes
rrr❑
y� No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

:I . • +
Facility Number: — Q Date of Inspection ?2 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo El NA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_ ��—
Spillway?: /— �p
Designed Freeboard (in): 1495 I9
Observed Freeboard (in): % %t'O ��,///
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes yZ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ 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 YJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes yJ No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pointing ❑ 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)
"5. a. ` xwif 56A�)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes FfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
,9,(No
❑ Yes ,YJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /No
❑ NA
❑ NE
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):
y)�SDi✓I F � SEi �✓ C. �2,
Reviewer/Inspector Name I f ,B = Phone:
Reviewer/Inspector Signature: Date: 2 O
Page 2 of 3 12128104 Continued

i
Facility Number: z/ 3 Date of Inspection 2 O
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PfNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other ,,..,(
21. Does record keeping need improvement? If yes, check the appropriate box below. El!
Yes P No ❑ NA ElNE
ElWaste Application [IWeekly Freeboard ❑ Waste Analysis [ISoil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �rrryyy��� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes /yam No
❑ NA
❑NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes /rrrX���///No
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes y� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �No
❑ NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes] No
ElNA
❑ 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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
zf�No
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
���///
❑ Yes G1 /No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
"��/.
%G� zy /r �� 'ena
6AJ Z-,f 67- 7 ,�. 4,5.
Page 3 of 3 12128104

i
Type of Visit 0compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit
$ R—ouutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y//S�LyI/Q 51 Arrival Time: Departure Time: A ,',SQ County: ���!✓ Region:"��' `
Farm Name: I:. �tQ�AmRf(I i rAeo g Owner Email:
Owner Name: I*A-I ellAY 66IS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: //j/2 ;/ �iS�/�/I7�7e5
Certified Operator:
Back-up Operator:
Phone No:
Integrator: e4K- ems« 5
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: � u L-A . LALongitude: � ° r] ,
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
El Yes
V No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
Spillway?: ��
A9
Designed Freeboard (in): /I, .5
Observed Freeboard (in): E4
2�
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 RfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ 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? ❑ Yes 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V1 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 ElNA ElNE
maintenance or improvement?
Waste Application ���{{{
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes �I No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ 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 �D/rifi ❑ Application Outside of Area 1
12. Crop type(s)^
13. Soiltype(s) �19 H r/ �/ /f, 41113
/ z
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /� No
❑ NA
❑ NE
21) eF_V0 7Ak- 2's-�5- /�y.E
`,POPS, /✓CEO /o GrOs� �. Z(�j �02 ACxtS 5-i A/o ©.a
�5� Z�S .� PA!✓�� F2 JT/iRtti� �qn/ ,�XJ�fii✓c% f o2
Reviewer/Inspector Name B " Phone: /O—
ReviewerAnspector Signature: Date: /
1212&04 Continued

Facility Number: ,3 Date of Inspection 17%Y�OS I
Required Records & Documents ry
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ty No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes /� No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
rrr�
y� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,/rrr�,,,�tttt No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'9 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
Elw 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
Additional Comments and/or Drawings;
2iJ /SOT (.f/R'j> T T6 6.do Pe- �F y 712 lveeG Soc,k Sly,
/1/0 �zp Sgm'e,6 f z 200�_ J�OZG �p2 7 DAB<� ZI��S
G1lzTla 4-692o s
G'6P0f -s
& 7,45 L t�� 7 /, 3
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JeRoutim O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ( Date of Visit: q 0 Time:
ICY Not Operational 0 Below Threshold
ermtttedertified 0 Conditionally Certified u Registered Date Last Operated or Above Threshold: _
Farm Name: .....__M�._. �_µ �ME L._._.._....__......... County: _. Q V�.__...........
Owner Name:
Mailing Address:
Phone No:
Facilih, Contact: ............................. _.................. ........... Title: ................................ Phone No:
t
OnsiteRepresentative: .... �aI(C__..j—A.CnBt 9-?.._._.........._. . Integrator. ----- Cf6QR02i!S
Certified Operator:-_ ................. ._...................
_....
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =11 Longitude =• =, 0«
Swine
Wean to Feeder
-- eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
Cl Boars
Discbarees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... j...... _............ _._._._�------_.___ .._._._.._...------._._..----- ___------...._------------ ..................
Freeboard (inches): 37 - Z 9
❑ Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes Io
❑ Yes ;;
Structure 6
12112103 Continued

Facility Number: 71 — I S 3 Date of Inspection 04
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
p(No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
B No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
NN
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
QN
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes
B<�0
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
pNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type FegWF_ (i lC(LMU rA C44) S;Go
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N%
14.
a) Does the facility lack adequate acreage for land application?
[I Yes
[ N
b) Does the facility need a wettable acre determination?
❑ Yes
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
eo
15.
Does the receiving crop need improvement?
❑ Yes
2<0.
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Q No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
/
❑ No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19.
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)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
2rNo
Air Quality representative immediately.
Comments Mr.to'gnesfmn #) &Eaplam any}YFS aas" s and/or auy recomme�a6ons or any other commeuLs
✓IL- MiE�1va ' :. "F "$t
3j
Use drawmgs offacihtyto better exp)arn stloahoas (ase addthonal pages necessary) ❑ F Copy ❑ Fm
z Field al Notes
R:.
-
Esc t�E FTEt� l "t- C-000 K(SEEDEO GQSt Yr,&vT-
PLEASE eklIA004 SEUEtLAL bLO BA(. -ES •DC NAY
C (Us Y r Q_D (o vs N E.Et7 S Tog 6 U�(�gjEJ
IZEco20S dolt &OMO
Reviewer/Inspector Name_ �` -
Reviewer/Inspector Signature: Date: V ( q
12112103 Continued

FacilitytiNumber: 31 — Date of Inspection y f4 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 2 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 31
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑iQo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes � �o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes p2 O_'
28. Does facility require a follow-up visit by same agency? ❑ Yes QNW
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [7No
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35) es
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes N
34. Did the facility fail to calibrate waste application equipment? ❑ Yes No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall []Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
12112103

t
of Visit Y Compliance Inspection O Operation Review O Lagoon Evaluation
on for Visit o Routine Q Complaint O Follow up 0 Emergency Notification
Facility Number Date of Visit:
O Permitted [3Ce 'fled Q Co yitlonally Certified Q Registered
Farm Name:
Owner Name: �yC�
Mailing Address:
0 Other ❑ Denied Access
Time:
Date Last Operated or Above Threshold: _
County: VwPGZd
Phone No:
Facility Contact: / Title: Phone No:
Onsite Representative: y1iF HgYli- e2Z 5 Integrator: �iS4/1Q?)LL 5
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry []Cattle ❑ Horse Latitude 0' =` 0- Longitude =0 01 =_
Design
Current
Design Current Design Current
Swine Ca aci
P,o ulation
Poultry Ca achy P,o ulation Cattle Ga achy Population
❑ Wean to Feeder
❑ Layer 1 11❑ Da'
❑ Non -Layer I❑Non-Da'
Feeder to Finish
1,62,9j19
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
��❑
Subsurface Drains Present Lagoon Area ❑ spray Field Area
Holding Ponds /Solid Traps
_❑
❑ No Li uid Waste Management S stem
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?
WasteCollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strpcture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: #
Freeboard (inches): 05
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes XNo
❑ Yes XNo
Structure 6
05103101 Continued

Facility Number: — 'j 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 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 smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1No
11. Is there evidence of over applicapon? ❑ Excessive
P�onding /ty—nI PAN ❑ Hy\draulic fOves,,load //, `1 ❑ Yes VJ No
12. Crop type `/E.�A)d/I/} t�TH4 1 �/., - ! TQAJ� t f�/fQ�iGfr7 1 . l is/l/F / zz 1 /
13. Do the receiving crops differ with thide 13esignated in the Certified Animal Waste Management Plan (CAWMP)? ' ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes /1!1 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ,�JNo
15. Does the receiving crop need improvement? ❑ Yes ,IA(No
16. Is there a lack of adequate waste application equipment? ❑ Yes �[JT No
_Required Records & Documents /
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes JOINo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes /No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes IrO No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes (((/'tJ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to quespon # Eaplain-any YES answer`s and/or any. [ecommehdattons or soy o er mOr tsjr r ix `��
IS,,
Tse'drawrngs of facdity't`o better explat situations` (usetaddtUonal p ra`s necessa`r'y)`�'V ' '{ Corry ❑/ Final Notes
�., ;17 Field
� Cil� �E %r�BF_eR�/ F...F-OS o�.JO �++Gooi✓
���¢g���l/
7 rok///C Ov7 OLznq,JC F_ <N S P� CYZo^/II �� ✓�/GI o/)
/&M1y)f-J
�T)L!%7T�0 /TCIlES J/E7F�2/11Zi✓ffT�o„/ (_-Og1rQGFTF(J.
Reviewer/Inspector Name .q.%1:77M ;
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of Inspection 2 n
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located new the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
El Yes _�
❑ Yes VJ No
❑ Yes XNo
El Yes
Yes //,,,__No
El Yes —,,,((( No
El Yes' No
Additional Comments and/or Drawings: ,.
- zP1v7zW4,6 % �O,0h 4,) IAOCKE7 ZR /7 y
/+44AWOVs �-A9 E5 /�Lot�G �ZE�O /c. OG�S /47-
,�Fdb.e�-�
lzlk �A,1 /' Zi��O.
�XdFG 0 0
O5103101

• J$f Division of -Water -Quality
Q Division of Soil and Water Conservation
.. 0 Other`Agency�_ - -
(Type of Visit 7i Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility, Number
Date of Visit: �� c�Time: d Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
FarmName: ......1,w� e ............................. County .... 1 ...............................................................................�.....................................................
OwnerName: ............................. ..................... ........................................................................ Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ..................................................................................................................... ..................................................... ..
Onsite Representative:.... w!R�......................................................................... Integrator: .... :.' -c.. S.....
............................
... .................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ��•
Design Current Design Current Design , Carreut
Ca aci Po Solution Poultry Capacity. Po tilation Cattle
Ca aci Po rdatioo-
Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish d ILI Non -Layer ❑Non -Dairy
Farrow to Wean u .
Farrow to Feeder ❑Other
Farrow to Finish
Gilts Total Design Capacity
r..:. Gilts
Boars Total SSLW
=Number of Lagoons ® ❑ Drains Present❑ Subsurface DraiLagma Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
10 Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
( No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:.......................................................................................................................................................................................................................
Freeboard (inches): 30
5100
Continued on back

Facility Numb ernj — $ 3 Date of Inspection
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 KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or �I
closure plan? ❑ Yes [a No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type YjQyy���� V_V 2. c1� 4�evi , Scl QbCVs2
P4 Yes ❑ No
❑ Yes Of No
OYes ❑ No
❑ Yes 14 No
❑ Yes ONO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes []-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes )gj No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? - XYes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 9No
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
'ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XYes
(ie/ WUP, checklists, design, maps, etc.)
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
kNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
)Vq Yiolatit?Iis or d$f c..... were .... djlri . g this:visit; - You will-i•&OW Rio further' . ; -;
coriesuorideitce: aN36f this visit:
Comments (refer to question'#): Explain any YES answers and/or any recommendations r any'other rnm[nents 3
A•-���a �s�ect���� atdesT, �e�e oti 1`•rnQr— •
4A k
_
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

r Facility Number: — Date of limpection printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 16o
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
,,,[FFFFF--�,,,,, """"IV''''o
o
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
I� No
7�
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
RINo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
WNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
4N No
Additional omments and/orDrawings:
l f+l�
►
7
;5�� <"�a mod.
tt_ LA� L�' e .
t 44'-\ !"'VAf % d y kv. iS
SQ Ibe Ceb t l (' t
cxyfw
5100

Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit J°C Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number '3 a Date of Visit: ® Time:
MED
O Not O ¢rational C Below Threshold
Permitted 0 Certified 0 Conditionally Certified E3 Registered Date Last Operated p or Above Threshold: ... ............ -......
O
FarmName: ....... . ..... ... ...C...................................................................... County: ..... .► k-4. 1..................-....---...
OwnerName: ............ . ..................................... ........................................................................ Phone No: ................................................................................. __:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ............... . ....... . ............... . .......................................................................... ..................................................................................... ................ . ........
Onsite Representative:.....1.��— 2✓........................................................................ Integrator: ... ��-a v�W
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..................... -
...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F--]• =' =" Longitude =• 0` 0.1
Design :' Current
Design :Current Design Carrmt
Swine Capacity Po ulation
Poultry Ciiaeit , Po ulation Cattle caliacity.Po` elation
Wean to Feeder ..
❑ Layer ❑Dairy
Feeder to Finish
❑ Non -Layer :` ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
❑Other
-;' ❑ Farrow to Finish
- - Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
=Number Of Lagoons.
. ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds/ Solid Traps:
❑ No Liquid Waste Management System
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ 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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Idcntificr:...........................................................
Freeboard (inches): a3
5100
Continued on back

Facility Number:3 — js�J. 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
9No
(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 maintenancelimprovement?
❑ Yes
VNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there eviden of over ap(plica`tion? ❑ Excessive Ponding ❑ PAN ❑t Hydraulic Overload
❑ Yes
kNo
12.
Crop type "N d �a C. S ` ci�cl�.
! CwPt�P zli
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
P. Q•yipl;ttiptjs:ohdQfcpencie •wireP4teS��lixM tjiiS. Isit;-Y:oojN%•#ee$iyegofuttiter':::::
:•corresporideike:abi)6fthisvis..:•:-:•:•:.::•:•:•:•:•:•:•:•:.:.. :.:.:•:•:.:•:•:•:•:•:•:•.
❑ Yes P�rNo
❑ Yes S�No
❑ Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes XNo
❑ Yes N�4o
Yes NoO.—
❑ Yes No
❑ Yes ONo
❑ Yes J4No
❑ Yes gNo
❑ Yes bfNo
❑ Yes JUNo
❑ Yes d No
tO&C7
A,, ►���e^� � 9 �.� t pw�.p -rne�t
Reviewer/Inspector Name
Reviewer/Inspector Signature: �J & I Date: (y-';L �_G 1 51M

_. . %/a, 01
~ Facility Number. — a Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
[t'�Io
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�YNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
1j 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
[dNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
,W No
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ONo
CommentsAdditional an Dr
awings:-
rawgs:- ->
- �
v / v✓ `�'(`'� �ii f�1 �'`� it�°�,g� ° h d�5`-�� r-e.co� S — P w �b�y
cv" t-e- ��-. e , �,�►e�- 6� e�- h�,► end
5/00

:- E] Division of Soil and Water Conservation - Operation Review
0 Division of Soil and WateeConservation - Compliance Inspection
Division of Water Quality --'Compliance Inspection _
Other Agency - Operation -Review - -
Routine O Complaint 0 Follo\v-up of DWO inspection 0 Follow-up of DSWC review O Other '
Facility Number .3 1 3 Date of Inspection
lime of Inspection 24 hr. (hh:mm)
0 Permitted ❑ Certified [3 Conditionally Certified 1] Registered 0 Not O erational Q4LaslOperated: .' �n S County : .........../Farm Name: 1......... ...... ............................................................. I.. ................. `��...............
Owner Name:.......... l!/A .... �,.Gy�.., ,,, Phone No:
.......6.4.............. ... ... ........ .. .......... !ll .................... ....f(.......................................
Facilih•Contact: /,,.,,G�',,.,,,Title:...,,Z%�(j'�,Q/1� Phone o: 1 ����0,./..3a-/�
MailingAddress .................................................. ..........................................................................................................................
... ......... ..........................
.......... /
Onsite Representative:. ... l! ... ._.............. Integrator: -,,...,_,.,,,.,,, Y.... s
..................... .....................................................
Certified Operator: ................................................... ............................. ............................... Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =1 Longitude =• =' ="
zziwtne t.:apactty roputatton
❑ Wean to Feeder
Feeder to Finish 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 ❑ Dairy —�
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps F---] ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
St�� L,Ie 2
Identifier: /ytrrL
v�j�'
Freeboard (inches):...........//
......r.....,_.................................
a� rr
❑ Yes gNo
❑ Yes [-]No
❑ Yes
E] No
❑ Yes
❑ No
❑ Yes
[9No
❑ Yes
JKNo
❑ Yes Q(No
Structure 3 Structure 4 Structure 5 Structure 6
1/6/99 Continued on back

Facility Number: — Date of Inspection
6. Are the ,4tructures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNO
(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
\(a No
7\�'�Io
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes
'\
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
ElYes
L
fki No
11.
Is there evidence of over application? []Excessive Pending ❑ PAN
❑ Yes
XNo
12.
Crop type 'I _ Z- /
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
'VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[YNo
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?
KYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
A'No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
5(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
EXNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
-] No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 1$(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gjNo
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
dVdwiol'atitiris:or def►ciend mere h6fed. during �his:visit; You will-teceive Rio rutther
coriesporider&ahotitithisvisit :...
(A)p--IL G t VJ c614+(c)( `Ih .F &CA-, A_ J j
2
G{r0ll
Reviewer/Inspector Name
essary)i_
Y�1
Reviewer/Inspector Signal
Date:
3/23/99

Facility Number: — g Date of Inspection 0
Odor ssue.4►
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �No
❑ Yes XNo
❑ Yes KNo
[]Yes ,,VNo
❑ Yes p�I No
❑ Yes . NNo
3/23/99

EDivision of Soil and-WaterConsergation -,OperationReview, "
s =z. - a _
_ 0 Division of Soil:and WaterConservatign Compliance Inspection
:Division of Water Ouality;Compliance Inspection
E3 Other Agency,- Operation Review . " _ -_ "'' , '' ,' _
AffRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 9� Date of Inspection r3
1"ime of Inspection p ; 0 24 hr. (hh:mm)
,Permitted Wcertified [3 Conditionally Certified 0 Registered Not O erational Date Last Operated: ..._....................
FarmName: .....M.`.. £,,.....A.MIS—Z4L-S'............................................................ county:........(�...d.C.L: ..................................... .......................
OwnerName : ................................................... ... ............ ......................................................... Phone No:
Facility Contact: .............................................................................. Title:
MailingAddress: ...........................................................................................
Phone No:
Onsite Representative:..!!.-.._C.:� h nn� FR-........................................ Integrator: ....... A.I.Q.iwL:._........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number: ...
�.7�._9�................
Location of I, arm:
.............................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................
Latitude =• =` =1 Longitude =• =' =­
' Design Current." Design - Current, Design Current
Swine' Capacity PopulationPotryt Cacity. Population- Capacity Po iulationa
❑ Wean to Feeder ❑ Layer . ❑ Dairy
AffFeeder to Finish s2zo ❑ Non -Layer I airy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other I_
❑ Farrow to Finish -Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
'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 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes fiTNo
❑ YesIN'o
El Yes ,r No
❑ Yes )1Go
❑ Yes �Io
❑ Yes ONO
❑ Yes 2�No
Structure 6
Identifier:
r .
Freeboard (inches): ....................................................................................
Z ti.........................2.R...................................................................................... .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P
seepage, etc.)
3/23/99 Continued on back

Facility Number: ,?/ — /$3 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 „ rNo
(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
O'No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application ,
10.
Are there any buffers that need maintenance/improvement? _
❑ Yes
,�
,yam No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
U;'fgo
12.
rlAr
Crop type G gEAAA Je P-- 43-G - FE-5-c, i; M !�!f_a, QFs iyg-e,
13.
Do the receiving crops differ, with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
12No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
f�o
b) Does the facility need a wettable acre determination?
❑ Yes
21/,,,�N"o
c) This facility is pended for a wettable acre determination?
❑ Yes
y1 tvo
15.
Does the receiving crop need improvement?
OTes
No16.
Is there a lack of adequate waste application equipment?
❑ Yes
,❑�
ld -rvo
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?
Yes
ONo
fie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigatidn freebo/ard, waste anal sis & soil sam reports)
❑ Yes
4"No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
[:]Yes
YJ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )�!rNo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes J�kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
.. .. yi....i[....... e.... were . Ofed ....►g this:visit; You :will -receive 66 rut thgr
ctirres oridence abouE this visit
Comments (refer to_question #): �Ezplam any YES -answers and/orrany recommendations or any'other comments ^-
Use drawings of facility_to better explain situations. (use additionalepages as gecessary): - - _
S.1 n
Fict./)s Aez cDre.�pus r"uc- cur dt I Ocovy DOG FE.A.L- PoPVLJ�T°� /N I •
FEs"£- Ge-r- rocs£ rpor� C4'tt, tP O-N 1b,)d As'
w1,2o 9to)39T-39OJ
Reviewer/Ins ector Name
p a,j
Reviewer/Inspector Signature. ea (- i r.T Date: 9 3 �f")
3/23/99

J
Facility Number: 3 — Date of Inspection q ;
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
P40
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
O 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
71No
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
ZNO
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
NNu
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
ElYes
��
? No
3/23/99

6,1 10 Division of Soil and Water Conservation ❑ Other AgencyIM
�4
tvlston of Water Quality
�j I I Date of Inspection 6 t
Facility Number
Time of Inspection �J24It
Registered ® Certified [3 Applied for Permit M Permitted 113 Not Operational D, ate Last Operated:
Farm Name:......n1At.,(� .r..._ oit:�s0.r.5....... rrtirt................................................... County: ......417th
................................. :... .......................
OwnerName:..........1 `1i 1aC�.........C.L....................................................... Phone No: .... M(A.)21.`Lc.3.$.?.5........................................
Facility Contact: .............................................................................. Title:.....................:.......................................... Phone No:
MailingAddress:. A....&....IL4............. ..:.................. :.......................... ....................... .... oSS..... N?,ll.... $
Onsite Representative: ......%>�kL........:Ciiiw/a--_�.?r_5..................................................... Integrator: ...... t_ L%rmxL......................................................
Certified Operator:.... .I. ..._C. .Y �..................................................... Operator Certification Number:..... l&...............
Location of Farm:
W.LS ...S.i..:A.....:.SI�...1.5.IxD...}...Q.:. ...xnl :5.....Ml.,......¢.......LR..I......e..............................................................................................
........................................................................................................................................................................................................................................................................ �
Latitude ®•_ 03 1 = " Longitude =• 0, w1:1,
❑ Wean to Feeder
-
Feeder to Finish
TZ&
<.: ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
't ❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ;al/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes [%No
❑ Yes l9 No
❑ Yes ® No
NW
❑ Yes ®,No
❑ Yes M No
❑ Yes ® No
❑ Yes t' No
❑ Yes 0 No
❑ Yes P9 No
Continued on back

Facility Number: 3t — 13
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons.11olding Ponds, Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
Freeboard ft : 'L A 2..:.!�.
...................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers"
❑ Yes
MNo
Waste ADDlication
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff enterin�gt waters of the State. notify DWQ) _
15. Crop type.........)Nevmula.....................tCSLJ.._............... -....................................... .......... ............. ......................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑.Yes T No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes E4 No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
22.
Does record keeping need improvement?
;B 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
QtNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
I$)No
0 No.violations or deficiencies were noted duringis.isiill further thvt. You receive no
...... . ...... . ...... . ...... . ...... .............
correspondence ahout this visit
wings of -facility to lietterexplain situations. (use additional pages as nece
IZ• tkr Gxco.z o,. t&!. doy ill M.wall skoult) 6 MV%-,frlkt)-
I3. Voloti�ctr .,Y Sts^all r, sN,4,)Q toe "-wwet) ko- berrvwd#_ Iles Odd •�- I _ .
12. S\,ray r-c" S4Covir) be- �,� V t pull h e,.In r 1 ive,ld hvvx6r, vc;�� -f{,� corvc�f
f�CKa9Q 1 6cja1cu.A (g..v¢lS Slntx/(r� 6� rt.covt)e� l4f f
t-G�n.. rccG(dS• hu. im•c�e.`4to.�,W,trtj SIwJ\� b2 �r—'fl,, ila.A,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: t 4

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
JG Routine O Complaint O Follow-up of D%VQ inspection O Follow-up of DS1VC review V Vther 1
Date of Inspection
Facility Number } . 1 g
Time of Inspection 24 hr. (hh:mm)
Registered E3 Certified [3 Applied for Permit RPermitted JE3 Not Operational 1 Date Last Operated:..... ..........................
Farm Name. ...................................... Countv:....hy..p.Lrt...........................
...... �.1...R
Owner Name: .............. ........0 1...a r. ............................ Phone No: ... L'i.1v..) .. ..s�.............
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ....V.-O........ g.Lt.X-..........IM........................................................... .Z-U-..L`.ii.1.1.1.....t!1�.t............................. �r..�.��...
Onsite Representative:.. skl..kR........C'Is -.k,n..�a..'1.................................. Integrator:......a.vfd..l.....I...................................................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
.Qtn......:e►.P sl....S.s.t12...�...... _R.—. .. ....1..... SL.ri.r..a.x,:t..t^..'t.si:........ .....0.:_:I.........^..i,?cS.....S.o.u............9.......1.nI.... .fw.c .�a.
k....kv>.L.....SR .I.p.O.}:..................... ...................................................................................................................................................... .
Latitude ®• ®` ©" Longitude ®• ©` M"
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑Yes No
❑ Yes [k] No
❑ Yes
[ffNo
❑ Yes
® No
4 LA
❑ Yes
N No
❑ Yes
® No
❑ Yes
ENO
$ Yes
❑ No
❑ Yes ® No
❑ Yes KNo
Continued on back

Facility Number: 3
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (La2oons.ttoldin2 Ponds. Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
J-No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: ........,....I ................ �...a.
...................
Freeboard(ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
®,No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
KLYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste ADnlication
14. Is there physical evidence of over application? ❑ Yes H[No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... P<✓ .. ....................�kra.L�.�.. z�x.n........................ ............................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ($NO
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
ia- No.violations-or deficiencies.were noted during this.visit..Y.oii'wil} reeeive no furiher .
corresp6ndence about this visit.
❑ Yes ®.No
PSYes ❑ No
❑ Yes RNo
❑ Yes IgNo
❑Yes RjNo
❑ Yes M'No
❑ Yes &No
❑ Yes lffNo
❑ Yes QNo
e E0.F+ Lo-+ Q- a -LeL 1 Wr rdx^+f Q 41, C u a a 1 �eL tti+d 1-11 [e r 1
/ 1 2.
Jy . ,.E t
wat 11 c (.o•.e o O �/ # z a ,..oL
A t i e t
b 0. r g n..•ta- Ova. inn v�.rN y.10. 1 1 O p �/ � � o y,
Pµ4- v`L i t-e-d-e-cl- avwe-w3 J I
• W e . k 0.,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: n_,—j . n r r/ j " a Y_ _ _ __ — 0 , Date:

•
•
Site Requires Immediate At hO
Facility No. i 1 —i 4 Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: t/ 2-46 11995
_ Time: i q l o
Farm N
Mailing
County:
Integrator.
On Site Representative:
Physical Address/Location:
Phone: (:?/o) -a 'O=l — J b 7 )— C
Phone:
Type of Operation: Swine Poultry _ Cattle
Design Capacity: 3 S d C� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3S 'S3 V3F Longitude: Elevation: Feet
Does the Animal Waste Lagoon h
(approximately 1 Foot + 7 inches)
Was any seepage observed from d
Is adequate land available for spra
Crop(s) being utilized: C-0
Circle Yes or No
.cient freeboard of 1 Foot + 25 year 24 hour storm event
No Actual Freeboard: 7J—`� Ft. Inches
n(s)? Yes or(@ Was any erosion observed? Yes or No
or No Is the cover crop adequate? or No
:3y � v
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l@
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 or 00 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:
Inspector Name
Signa e
cc: Facility Assessment Unit Use Attachments if Needed.