310214_INSPECTIONS_20171231

NUM I H CAROLINA 'dM
Department of Environmental Qual

3
Type of Visit: (rYCom nce Inspection V Operation Review (� Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:yP Arrival Time: Z p Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: �t�'1{ ("-( �Cfij�I /
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
n /FZ��'.r't
[ C 4 u InTegrator•
Certification Number:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r. $ouI ,
Layers
Design
-a acit +
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Pouets
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
No
❑-NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�?iR ❑ 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): 3 ( 3 to
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 E]' o ❑ 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 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes � "o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes 0<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L G<o
❑ 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
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F3<
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑lTo_
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ ,?to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the ropriate box below. es E j 5' ❑ 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 �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 7 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes b "o ❑ 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 P�'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CIA _❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ['iTo ❑ NA ❑ NE
❑ Yes i o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes C].Nil' ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes []'Po ❑ NA ❑ NE
(Comments (refer to question'#):_ Explain any: YES answers and/or any additional recommendationssor any other.: comments., f
Use drawings of facility to better explain situations (use additional cages as necessarv).
Z(r pt--& y470 L '(0 o l S f C {'..-.A. k-. 1 o 1ik —
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AIV Ot--cr &,ippt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J_ Po'-C )
✓ A
Phone:? ,CV 72673o�
Date: 6l. 1,4,ltl
2/4/20

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(Type of Visit: 0 Co fiance Inspection O Operation Review O Structure Evaluation O 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: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: r?WDY ?An-6
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: Ip-1 p
Certification Number:
Longitude:
Design Current
Design
Curren[
Design C•urnent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
11-ayer
IDai
Cow
Wean to Feeder
Di5 I
JNon-Layer
IDai
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dq P,oultr,
Ca achy
P,o ,
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
[—]Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑///Noo/ ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: L
Waste Collection & Treatment
t4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes 2(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �Jl iYl/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 171
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 VNo ❑ 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 environme 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes;//Nc
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0o
u o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
J/
[,J o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
tc
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Vyr,
21,,.//Does record keeping need improvement? If yes, check the appropriate box below. s ❑ No ❑ NA ❑ NE
21�
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? ❑ YesZN0o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: JDate of Inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NEB
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [.NNo ❑ 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 Evo ❑ NA ❑ NE
LJ
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes 2 o
❑ Yes .No
[—]Yes 0/No
❑ Yes /No
❑ Yes
❑ Yes
❑ Yes
J
V
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: Q Co Hance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0yDeenied Access
Date of Visit: S Arrival Time: Departure Time: County: �Pt2; Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
OnsiteRepresentative: �AN.�4' 1?A-rte_C&J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: i16 qj p
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Desigtt Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Zino
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
1) . P,oul
Layers
Design
Ca aci
E-uraren
I,,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0o ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: 17Date of Ins ection:
Waste Collection & Treatment
44 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier: !j) VLG*--Z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S _�> S_
❑NA ❑NE
❑ NA ❑ NE
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 ETNo ❑ NA ❑ NE
[—]Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ mineonsal 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 ❑ 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 01 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [a/No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1Noo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
[�<es
❑ N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
["o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
El Yes
V
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: Date of Inspection: (15
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25r� 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:
7o ❑ NA ❑ NE
o ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ 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
❑ NA
❑ NE
pemrit? (i.e., discharge, freeboard problems, over -application)
7No
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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
[/No ❑ NA ❑ NE
�o ❑NA El NE
No ❑ NA ❑ NE
Comments (refer.to question #):,Explain any. YES answers and/orany additional recommendations or any other comments.
Use drawings of facility to better explain situat'ions.(use additional pages as necessary).
3�b n 2J LCU/LL Zoly WAS vNiDCR_ 1000 Zd ,
T,M-cb WAS 1T_i LEO AFTGp,
L'cu 1HA� 3a(x) Ls-:L/<L-.
5.) o6-c:7 ro LbctrE 2o(f CbC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Do oor t LjPA P L*j -rxLL
Phon :)-o ( 3 '6 O
Date: S�
21412

Type of Visit: la Co�ppliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: lRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: =Departure Time: County: P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Rj 4b%'/✓, YAIj'e"a\)
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Capacity Pop.
CattleNON
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Fatrow to can
Farrow to Feeder
Farrow to Finish
Design Current
Dr. Py oultry Ca aci + P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
lBeefBroodCow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes ZNo ❑ NA ❑ NE
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [NNo ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Nuutber. fL,Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EdNo
a. If yes, is waste level into the structural freeboard? ❑ Yes (:]No
Structure 1 Structure 2 Structure 3
Identifier: LA (�6otj I Lp/,&V Z/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
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 0NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes [�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable 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 ❑ Flo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ��J(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes C3 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes YNo ❑ 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. Q Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility N mber: 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 Z'X0
o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 17No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
CZrlNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
2/No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
do
No
❑ NA
❑ NA
❑ NA
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
RA) SVMM L Zo e3 YK-155_Lw- r W45K AMOSTJ
,vow WV P06
W f J%v &�e
Reviewer/Inspector Name: ' . /y Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2141201
❑ NE
❑ NE
❑ NE

Reason for Visit: QS Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: \ PLelltj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Title:
OnsiteRepresentative: �fiOJ�� Pyrm�6s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1 GJ 1 9
Certification Number:
Longitude:
Swine
Wean to Finish
Design —ue rM
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Cucrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
t{ (o OO
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D�, P,oult ,
La ers
Design
Ca aci
C•uarent
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
—E
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 VlNo
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [—]No
[—]Yes Zo
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZNo ❑ NA
❑ 1
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ k
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
V p`1I
Identifier: CA oN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
FeKo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 F240 ❑ 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 ICJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes VNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yeso
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2 N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 90
❑ NA
❑ NE
Required Records & DocumentsZl�d19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑O r:
21. Does record keeping need improvement? If yes, chec a appropriate box below.
ZYes
❑ No
❑ NA ❑ NE
❑ Waste Application eekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Inspections
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3 2/4/20II Continued

Facility Number:bAff—Date of -In p /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes z ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes r?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 ILI 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 L�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 2�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 �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El Yes [%o ❑ 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. I
Use drawings of facility to better explain situations (use additional pages as necessary).
21,) Plimssco FALL 2ory uas fi�- AMACj)SAS f ur WED ktR-
NJ VAW6, TKO Yhow i C✓Ep.v 0966 m0 rie to
ovEQ Auu CKa rs,
Cpof y-T�Lp ,v«0s It, 3e REOXV(D yCAAL`,
Gwrma_ coN,�zP0_zJCr7 c-AaWC, fiam, G"55 To Qoti/ �a�S
W OP. ,TNti O c,6'GE
Reviewer/Inspector Name:
(9i0> q IV o03)
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I /, }//;,L Arrival Time:® Departure Time: County: IN Region:
Farm Name: S 0 aoc /V S N q-50Z� /°C Ca Owner Email:
r�t,}SloB-'il SLw
Owner Name: V-01/QLA ?j4 l � (E:Q-S(W Phone: 259- 99?-1`i0�(Cl
Mailing Address:
Physical Address:
Facility Contact:
_SQ(9'S Ill IVc I I I q6"S Nczeg)-s(w,/VC &Rsae
i
Title: Phone:
Onsite Representadve: LA.A/l C 2 �(1�,nca1P�frc
Certified Operator: `K.-fiNTM -'� 1'.4TT4S SCVV
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
I ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Op
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oultr,
La ers
Ca aci_
rijen
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
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 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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Pagel of 21412011 Continued

lFacility, Number: ) - Date of Inspection: /
WastelCollection & 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: p�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes It(I No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TTT���
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of fWind Drift
ft ❑ Application Outside of Approved Area
12. Crop Type(s): L "5aM COTTON l_LAC�Mg�i %V7 !3'yU 3/1 �� 1 / SC j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes LEI No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
Q WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
[-]Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )� No
❑ NA ❑ NE
Q
Waste Application Q Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Q
Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes JANo
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes '[)�No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes I ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
� NA
❑ NE
Other Issues
�[
J�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IXI 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
DLI 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) TTTCCC
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 &'o
KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #p Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain, situations (use additional pages as necessarv).
ri
w•A. � a
31 �J,a y r) n. L4 Ilgl1a
9.� �•Co '1'//' �> ply/�a
g).a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cq�Q•(p����
Date: 5
2V2077

Reason for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (ply/ / l i Arrival Time: /® Departure Time: County: I. \t„(D(JA1' Region:
Farm Name:
OwnerName:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: \)Gr La41vlER Integrator:
Certified Operator: "N QJ A J . \ A-TTEQSCYV Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
1 :(09 2
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulh.
Layers
Design
Ca achy
L0.1111ren
Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
Other
01 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 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 I J{ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

FacilLq Nun• er: - D I y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes %� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ 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 ppp�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? Q�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I/ V 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 tom those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
ElYest No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes r� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
❑Yes o ❑ NA ❑ NE
Q WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1A
No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
s
Q 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 [3NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ P Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: y I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ YesOkNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NA ❑ NE
777TTT
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
y�
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
TTTT
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)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes V 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 il): 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).
- `s
Z"NIA16. C O-Y& IjSLi <nX i 1+6 wA
Nt t� ortC L-AGOON pESI(S/✓ -W1CL C1- G(xCZ F)t-ES FoR
=A DES16N�
G�a�Jgcr ��icw ouE
Lz'a• 1 a
a131►� 2.e� Sul
R�a�lio G q� 6.bq
rs wH G Al (k-:�- A comEs i �/
caaj'��e�%
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 116 -) l 6
Date: (p / �4 f 11
214/ 011]

I ype of visa Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: % yI IO Arrival Time: ® Departure Time: O County: ICY Region:
Farm Name:
Owner Name:
Mailing Addn
Physical Address:
Facility Contact: Title:
Onsite Representative: _�CDANNGJ LANIE2
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 171 " Longitude: 17° Q n
r
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
® Wean to Feeder tp
10 Non -Layer I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
[--]Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El❑
Laers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Other
Number of Structures:
❑ 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)
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 )1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104
Continued

(A
0
Faciht?Number: ) —aI H Date of Inspection �! 1
Waste Collection & Treatment ,,.,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes l�(I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
Structure 1 Struc e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �- a tr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?'
❑ Yes
No
❑ NA
❑ NE
8.
Do any of the stucmres lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
12. Crop type(s)
13. Soil type(s)
❑ Evidence of Wind Drift
QL�e_ Can/
❑ Application Outside of Area
s
14.
Do the receiving crops differ from those designated in the CAWMP?
Yes
❑ No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ErNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
OVo ❑ NA
❑ NE
Commeuts;(refer to question #)::Eacplain any YES answers and/or -:any recommepdations or any, othei comments
Use drawings of facilitg to betterezplaio situations. (use:addmoaal pages as necessary) =s r
--
NEED CoP�o F A16W) COC 4 POLlrn I T
is O�GCA�rr��a,, a EcoaQS -c�D Qlms rt a1cAC7) U�
GET Co?(A
V-1-kP LO//A/ JCJDQt�3 F"6keR- CMAIV6 e qZGW CROPS TO BC-QM`DA
AfEw
GucuMgrjzs IVOT /K 9(-4)V
Reviewer/Inspector Name DAM _ADA c; "„ Phone: 10 -1% -W
.64Q
Reviewer/Inspector Signature: Date: luo
Page 2 of 3 12128104 Continued

Facility Number: 3! —,9Jt.! Date of Inspection Vaoillb
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 CA WMP readily available? If yes, check !!!!❑ Yes XNo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists El Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. llllTT_____Yes [INo/ El NA ❑ NE
❑ Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis ❑ Waste Transfers ❑/nual Certification
Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections ED Monthly and I" Rain Inspections Q 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?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
t
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
SLu706E. LC>r�eNO"G1} - C4 / ASK FoQZEXGA+PT'CW IA' BDT4 t-4-GOOJt/
Need ACoPu�0 CACtG3¢A?ION-wAS
0 3.1 3.1 puc )TI f � - IFNoT DO'V& - NC-Ebs 70
�!6/1� /• j / . 3 PEE Z�ancIS d s EVT 7o w/rni 38c yS
I►/9�Ib9 < `'� /.5 �rcv�l-�> o� Faro 9ro �Stl�arN
p n l9-4 CaVl�IIL % Fir
F5//�//6�1 •D d•� v._31L'r1A470P,,AjCAgoS
5�0 �m'l c k DO10) PoU-Mitb F FL&eL?t V6 — AMM TO Re�i
�01a1 S 6 �xAmpl/jCt -PA(6) 3 o ltcAl�
IQ(L�i nNEEt,� 7-0ar kPfJRrEN 70 //vcLIkU-� �FC of
fyr� Pcx(h�lnl� — R-E CdK_ Q/ -rGGS ; SOME DOM S MRTCN I1ZR I
Page 3of3 t,�3"lAIC ON WGGDS lJl/ F1EL11 45&H1NU e,4ho01V I2128104
3 -q

Type of Visit .Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �+�1 Arrival Time: � Departure Time: County: ►'y Region:
Farm Name: "At
���LAQtK �- S(Za Owner Email:
Owner Name: VC AtD--\, �AI—rozzSG&/ /� Phone: �sD-5L0W_9jV
Mailing Address: Sgto'L N ZVC I 1 C) J HL Q��7SQN , A/C O U
l
Physical Address:
Facility Contact:
Title:
Onsite Representative: \'_'OC LAW1 oc-2_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o =' =„ Longitude: = u =' = „
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
El NA
[I NE
El Ye
No
❑ NA
❑ NE
12128104 Continued

'Facilii"'Number: —al Lj Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ���,❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I �_
Spillway?:
Designed Freeboard (in): 1 7 • )9 .S
Observed Freeboard (in): �a )9.5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes f4 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )�No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 XNo
❑ 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
XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
v
Do the receiving crops differ from [hose designated in the CAWMP?
El Yes
VNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Commentseterto queshon #)Esplmn anyYES answersxand/or any recommendations or any other comments.
r1ift.draw��n s offfffacrhtytto�better�'explmn situations (use addttmual•pages as necessary):..
o�" �Xi*'•i`§�j_F,'i'�r r± �� �.N`j ^K i6�C..f•m�.'#1����i�x e'I''K .
R• ?)VI9- PN44
/p4oai 9.-4- 9.(.*
n-039 P. Ll P. s
►1/Va l.&
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: _ Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 1 Date of Inspection[
R_eguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists ❑ Desig
n 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ANo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis [3 Soil Analysis El Waste Transfers ❑kual Certification
0 Rainfall El Stocking 0 t /// Op Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes —%No ❑ NA ❑ NE
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes Ix No ❑ NA ❑ NE
❑ Yes ❑ No LbI NA ❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
L�No
❑ NA
❑ NE
❑ Yes tR No ❑ NA ❑ NE
❑ Yes 'XNo ❑ NA ❑ NE
❑ Yes
KNO
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings: .;
G� 1 bpi �l QA�� `4Qu r w� Pcotzo� CK� �1 AA S
oA/ Q�6tmuafl t��A 1n+ FRoNr or LXbov
I
Page 3 of 3 12128104

Facility Number o� 1
Division of Water Quality
0 Division of Soil and Water Conservation
O'Other Agency
IType of Visit gCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (p 0 Arrival Time: 3 Departure Time: County:
Farm Name:
Owner Email:
Owner Name: ANnU\ 'S41 E.2=S C36 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: 1--] o M , M 11
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
AP No
❑ NA
❑ NE
❑ Yes
*No
❑ NA
❑ NE
12128104 Continued

1
-------------
Facility Number: I — Date of Inspection
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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I�Jtl3� �Nla
Spillway?:
Designed Freeboard (in): P5. S g, S
Observed Freeboard (in): -3 N4 �S
5. Are there any immediate threats to the integrity of any of the structures observed?- ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.) aar���
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (y No El NA El 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 No ElNA [INE
(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 9�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
Eq 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
1� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
IgNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
J�lNo
❑ 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):
19•GETco(�joFco�v�Ectrmlr dP�� w/RLLoRi�S
6ET co?�Ir AV6,141VN(&4-LS7_oUCIN6 d �ttiTc�1�FLE�o�n�
Er cAFL�oir o 1 c- `o $ c An-� V- ?L&7T- L"/ P-Eco(Z17 $
Reviewer/Inspector Name I R u fN S ( Phone: CDC) `N}%-ii
ReviewerMspector Signature: Date: [p/ o41t �dd
Page 2 of 3 12128104 Continued

Facility Number.1 —,QJDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? X Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JXNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El 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
D(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
FVr No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
El NA
El 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
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,f� 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
El 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
Page 3 of 3 12128104

Division of Water Quality
Facility Number Z/ O Division of Soil and Water Conservation
Other Agency
Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine o Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Q Arrival Time: �3O eparture Timme: County:
Farm Name: , ✓J��2- Owner Email:
Owner Name: %F2S�n� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: o!/i✓d�� ,A-�JGLl7
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
�o
Latitude•
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
-
�o t100 I — I ❑NonLa et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region: O
" Longitude: = 0 M ' = "
Design Current
Cattle a Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: © l
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?
❑ Ye�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes [] N. o
❑ Yes No
❑ NA
❑ NE
❑ Y%No
❑ NA
❑ NE
12128104
Continued

Facility Numbec�� —� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I 1 re�� Structure 2$ tructure 3 Structure 4 Structure 5 Structure 6
Identifier: FF.a�ill C /5 /l
Spillway?: /VP N®
Designed Freeboard (in): l- 5 /% _,�
Observed Freeboard (in): 0
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.) ,,,___d ,,,III
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes L,No ❑ NA El 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 VJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ll/
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? ,.,e/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes yJ No ElNA ❑ NE
❑ Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) /
❑ PAN [--IPAN > 10% or ] 0 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)
c ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Ye No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ ye Vl No [I NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes YN. ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes' VNo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name 6e ' Phone:
Reviewer/Inspector Signature: tr Date: _
12128104

Facility Number: — Date of Inspection
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,,,___..F(,,,((( No ❑ NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I[J No ❑ NA [I NE
the appropirate box. ❑ WUP El Checklists ❑ Design El Maps El Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No El NA El NE
El Waste Application El Weekly Freeboard [I Waste Analysis El Soil Analysis [I 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes '0 No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
�No
❑ NA
El NE
El Yes
VNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes
In/ o
❑ NA
❑ NE
❑ Yes
/�LJ No
/,�,,,{{{
❑ NA
❑ NE
❑ Yes
No
//y��(No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
/VJ No
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
Additional Comments andd//�or Drawings:
a 086'-Z_
12128104

Division of Water Quality
Facility Number `j' / Z / Division of Soil and Water Conservation
Ll ]
_
r — — 0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dateof Visit: z// O Arrival Time: Departure Time: 00 County:
Farm Name: Q5,6# `Owner Email:
Owner Name: -. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
�r
OnsiteRepresentative:—�*J�� ✓Z .2
r Integrator:
Y Lu� Region: w f/
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number: -
Latitude: O o a ' = Longitude: O
Design Current Design Current
Capacity Population , -Wet Poultry Capacity Populatioi
Finish ❑ La er _
Feeder 44 0 ❑ Non -Layer
) Finish
o WeanT_I Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets "
❑ Turkeys
❑ Turkey Poults
❑ Other
=. n
Design Current'
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes jNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑.Yes /No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —2/ Date of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: A-V W Z
Spillway?: Ak /4/92—
Designed Freeboard (in): 19
Observed Freeboard (in): 3 _3 a
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 J[J N
Yes o ❑ NA El NE
❑ /❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes /((No ❑ NA [I NE
❑ Yes 1,,,� 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes TTT�No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application _
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I!I No ❑ NA ❑ NE
maintenance/improvement? T
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q� No ❑ NA [I NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El 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) 4u
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack,of properly operating waste application equipment?
❑ Yes
0, No ❑ NA ❑ NE
I[I No ❑ NA ❑ NE
No ElNA ElNE
XNo ❑ NA ❑ NE
I/I 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):
/S 3 Zq o� SD<c f�, EPo27-
S� u/6D ZVIW--
/V05, ®�
�,�4�F 7Asf� -��✓ ��oon�5
r
/��GOS � �,e= /QFl/JOt/FD,
Reviewer/Inspector Name ! g
Phone: � /0 i(,- 73 Z'7-
Reviewer/Inspector Signature:
Date: 1111r
Page 2 of 3 12128104 Continued

Facility Number. Z/ Date of Inspection 'f !
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Y(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 )ZrNo ❑ 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 PrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes ❑ No ONA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes JL,IjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ZI�J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
�dNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
,�,/No
El Yes XNo No
❑ NA
[I NE
and report the mortality rates that were higher than normal?
T
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
JVNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes XNo
❑ 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 XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ILI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
2� n%,.�o SToc�z�G EcoQ.os ovz Zook. 2aoS" ��T� `
z� zoo
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �! O,y Arrival Time: Departure Time: County: U 44_/ Region:
Farm Name: �7/I�{QIJ�J u�`ft1t #� 4- �l/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: & AllJ-01y '7
Certified Operator:
Back-up Operator:
Phone:?
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = u = ' = Longitude: = o = , =
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
[I NE
❑ Yes
No
El Yes
r❑
y� No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
►�
12128104 Continued

Facility Number: — Zl Date of Inspection I /O/1A05 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PrNo
❑ 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:
Spillwaylw
/
Designed Freeboard (in): l'7 •5
)
Observed Freeboard (in): 4441
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 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?
10 Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ONo
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ElNE
maintenance or improvement?
10
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes ❑ No
rr��
❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
ONo
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
r) 7&) Lf�dF_G ©F y525
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
IReviewer/Inspector Name r ` ��2 ' Phone: 910
Reviewer/inspector Signature: ,�/ Date: OS

Facility Number: —'�/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? XYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
Waste Application Weekly Freeboard ❑ Waste Analysis ZSoil Analysis ❑ Waste Transfers ❑ Annual Certification
ZRainfall ❑ 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LdNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9NA
❑ NE
Otherlssues
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
❑ 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
El Yes
,_,(
VJ No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
_l.>ip�//.-5/t'f.///Y�OGr-cf�f(TrO.J/.S ��55/tr.�G-� l�,f�'SP
��CjO•t/D,E�o
�ir��li,QG^�-
y
Fuo�.
12128104

(Type of Visit gYCompliance Inspection O Operation Review O lagoon Evaluation
for Visit 9'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 13 Certified 0 Conditionally Certified 0 Registered
Farm Name: 7%�CfI •®/ Z�s�._ �1! <.-S/GC..//�... /�,�...lR`__.......
Owner Name: ±�'1�Q�1.... jf .... ILU.(�./Q r`6l<. ../..L.......
MailingAddress: ................._._............._...._...._......./_....._._...._._..__._..................._.........
Date Last Operated or Above Threshold:..
County::4a/L....................
_......
Phone No:
Facility Contact: .. Title: ........ ... ........ ................ _.._.............. .... Phone No: _ ........... ........... .......................
OnsiteRepresentatiye:�/j`14�?�(�� Integrator:a/�,,r^-Gy_...... .......... .... _... _....... __
Certified Operator:
Location of Farm:
Operator Certification Number:._ .............._........_.............
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =11 Longitude =• =1 =11
Desrgn Curreut Destgu Current = �- Desrgu Current
Pultry.
SwmeaacPo eerCaci_.P
Ga ;;Po
adt ution.
Mahon
Wean to Feeder
❑ Layer
❑ Dairy
ElFeeder to Finish
1 *
❑ Non -Layer
I
Non -Dairy
Farrow to Wean
n
❑ Other
i
Farrow to Feeder
Farrow to Finish
Total Destgns;Capacrty
Gilts
❑ Boars
_;
Ff -
ber of La
a,Numgtiops
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation? []Yes Jallo
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 gal1min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E!rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structgre I Strpcture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _._.�_._.�..._._.....__ _._.........._... ___..._....__....... __._.._......._._....__._ .
Q� ...._._...._..._._...._..... _..... ..................... _...
Frechoard (inches): _ aU
12112103 Continued

Facility Numb er:3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN/ ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
12. Crop type Rel ln,' A ( 44 I -5a 100,66e4f� 1 . /�'bl� (,nQD P
13. Do the receiving crops differ with those designated in the Certified
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?
Waste Management Plan (CAWMP)?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes XNo
❑ Yes f, No
❑ Yes OfNo
❑ Yes XNo
❑ Yes VNo
❑ 4eso
o
❑ Yes f21No
[]Yes JZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�Vo
❑ Yes /❑'No
❑ Yes XNo
❑ Yes [J�N0
❑ Yes /I ,
❑ Yes �o
Comments (refer W gaeshon #) Exp�hun any YES ers and/or a recommendanons or any other rnmmeriis
Use drawings of Is hty to better exphnn sttnanoffiaddhonal Pages as neceswry) teld COPY ❑ Ft nal Notes -- ;
Zj LEve5e r—,so.e uec_21q # ZN ZEv64©F
Q�nl6�P ,�/ f_c�F dFS l.�qT tT Z� 1/%r✓L- � /fi J�'m Jl_�c
NO GZ9STE r �EA
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
I2112103 Continued

Facility Number: 3 _ Date of Inspection
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
O'No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
.'Yes
❑ No
Waste Application .O�reebtiard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)zNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[/No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28.
Does facility require a follow-up visit by same agency?
❑ Ye
� No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES
Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
R(No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
11 ao roe AVO
4elh r ;r,
-/►�`E/Jn
-, //p �FcoRos ©f "/��1ir10Z�c ��Enl S F" Zt?o
/
.S'4-0o / ifA; f
12112103

Type of Visit Y Compliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason for Visit � Routine O Complaint O Follow up O Emergency NotWtiog Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted D Certified 0 Conditionally Certified Otte istered
1
Farm Name: /
Owner Name: PQA119 V �7�f�
Mailing Address:
� Time: I / O/r/ I
10 Not Olnerational 0 Below Threshold
Date Last Operated or Above Threshold:
County: ,,016?G7�/V _
Phone No:
Facility Contact: Title: Phone No:
/�
Onsite Representative: L�"I�EA%T %/.l`� t [.t �R� Integrator: / rOGA61�n eo s
Certified Operator:
Location of Farm:
Operator Certification Number:
[ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0' 0- Longitude =' =` =`
Design
Current
Design Current Design Current
Swine Ca aci
P,o ulation
P,ogltry
Ga acifv P, ulation Gat[I_e C•a aci P,o ulafion
Wean to Feeder
❑ Layer
❑ Dai
❑ Feeder to Finish
❑ Non -Layer
❑Non -Da'
❑ Farrow to Wean
❑Other
❑Farrow to Feeder
❑ Farrow [o Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present Ho Lagoon Area I0 Spray Field Area
Holding Ponds / Sofid Traps
Htdm ❑ No
Liquid Waste Management System
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 rrr❑ 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 �f
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes 1[J No
Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6 /
Identifier: 0Lp
Freeboard (inches): 3je 3V
05103101 Continued

1
"- L
J'/
/{
i
1 !,
1,
J,
Y
i.
�:
1'
/
( �:
i
.1
� ,

Facility Number:Ji — / Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
❑ PAN ❑ Uydraulic Overload
12. Crop type Beef? / a& I Nay I ] I/O�t,L) (;?,Op13. Do the receiving crops differ with thosesig�nate in the C8 ertified Animal
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?
❑ Yes/1,40
❑ Yes ,,,,(����No
El Yes No
❑ Yes ,,,___,,,///No
El Yes Ld No
❑ Yes ZFNO
❑ Yes
Management Plan (CAWMP)? ❑ Yesr,,eNN'o
❑ Yes go
❑ Yes No
[I Yes [2 No
15.
Does the receiving crop need improvement?
❑ Yes
V] No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�No
Reunited
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
1[J 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
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
������t""""""
(ie/ discharge, freeboard problems, over application)
El Yes
o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/ No
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ube urnwmgq or mcmry to unner expramibitummns tuse.auwuonar pages as necessary/-1 -
r. ,� ,� r ,, - •?.. yy .� ,_., Field Copv Final Notes
1R) 44-4 -),9 64 49Re A'66-1/R14Q _, /g wit/ /f%s>� 5�,sq.
P6apInIn 6j)0 �yvpodc_ 1P6CO�POS �zR?Z,BeyD1J T� —NOL✓-,�uR� ps,
Reviewer/Inspector Name
Date:
05103101 / Continued

,�
,yl
I
\ , J

.. -
Facility Number: -z Date of inspection 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
P(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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?
ElYes
'1
YJ 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
WZ/N
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or Drawings:
O5103101
O5103101

Dtviston of water Qaaltty
'
O Dtviston of SoB amf Water Conservation
P
*'
�
O Other Agency'
Type of Visit 91[19ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit I Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:-x % d Time:
Facility Number "
O Not Operational O Below Threshold
Permitted 0 Certified ,E3 Conditionally Certified 13 Registered Date Last Operated
/3r Above Threshold: . ........
hreshold:............................ County: .........
/.... ... l :................._ v.:........
Farm Name: ............. (.. ............�f r........................................ ..
Owner Name: '/',,,�
......................y.../d...:.s%............................_Phone No:............................ .
FacilityContact: .............................................................................. Title:.......................... .......................... Phone No:
Mailing Address:
Onsite Representative:
Certified Operator: ........................................ : ..........
Location of Farm:
........................................ ........... .......r:....
egrator:...... '....`:.....tZ1W.'Y.[...Y. /... ....Operator Certification Number:.........................................
ly Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' ��
Design Current e
Swine CaDacity Population Poultry
R
ean to Feeder (J
eder to Finishrrow to Weanrrow to Feederrrow to Finishltsars
;tom
f
Total Design Capacity
Total SSLW
Number of -Lagoon ® ❑Subsurface Drains Present ❑ Lagoon Ar
Holding Ponds / Solid Traps- JE1 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 DW Q)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the -Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure,2 Structure 3 Structure 4 Structure 5
Identifier: N
............7�.0.............................. S..............................................................................................._.................
Freeboard(inches):yT,,, �ei.Qi{L
S/00
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
A -
❑ Yes ❑ No
❑ Yes �No
❑ Yes No
❑ Yes No
Structure 6
Continued on back

Facility Number: Date of Inspection 1 ;// / %ZP Printed on: 1/9/2001
5. Are there�any immediate thr ats to the integrity of any of the structures obse ed??'(Tie// 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 J6No
(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
'V) No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
'
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
r�
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
11.
12.
Is there evidence o over application? ❑ Excessive Ponding ❑ Hydraulic O load
Crop type (hA. r)
❑ Yes
No
13. Do the receiving crops differ'with those designated in the Certified An�raal-Waste Managemeflft Plan (CAWMP)?
❑ Yes
tANo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
))j No
15. Does the receiving crop need improvement?
❑ Yes
o
16. Is there a lack of adequate waste application equipment?
❑ Yes
X:o
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Viyes
❑ 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
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?
❑ YesINO
21.
Did the facility fail to have a actively certified operator in charge?
❑ YesNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit? .
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
tXNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
((No
/�
'
' �'Vo-yiola�ipttls;ocdgfciencies wgre pofe�- djx`ing thjs:visit; • I':op witi•Sec$iye tjo [utj•titer •; • ; -
ctiriespotideitce:aboutthisvisit.:.:•:•:•:•:-:•:•:•:•:•:-:
i
Reviewer/Inspector Name
Reviewer/Inspector Signature: 4 4��r7 _ �J�,/,�� Date: '4 11W d l 5/00

Facility Number: — Date of Inspection '}.� Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�Wo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
J6NO
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
P(hlo
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
[gNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
VNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
;dNo
5/00

Division of Soil and Water Conservation Operation Review:
;r 0 Division of Soil and Water Conservation Compliance Inspection
Division of Water Quality Compliance Inspection
-- 0 Other Agency = Operation Review a -.�.
Routine OComplaint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection T4; pl% 24 hr. (hh:mm)
Q Permitted Certified 0 Conditional v Certified [3 Registered 0 Not O erational D• to Last Operated: ...........
Farm Name: ...... ..:.............. ! ... .............. County:............J...J` ...
OwnerName:........ .......GL.................... Phone No:.......................................................................................
.......... �,� J}, �
Facility Contact. ...... ... .. .............r�l itle:......1 .✓...! ........................ Phone No:..........................
Mailing Address* ........... ...................
........ .. ................................................ ............... .......................... ..........................
..................
Onsite Representativ :......... Q .....:...........%`�L.L........1_l[egrator................Z�..............................
Certified Operator:,,,.,..,, .................. . .................. Operator Certification Number:..........................................
.....
Location of Farm:
Latitude =• 0' =•° Longitude =• O' ="
Design Current.'
Swine, Caoacity Population 1
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
4Number'of Lagoons
HoldingPonds'/Solid Traps
-z- Design- Current
':Capacity„Population:. " Cattle_
-.. ❑ Other
Total Design Capacity
- TotalSSLW
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ 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?
h. 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 Slructur 2 Structure 3 Structure 4 Structure 5
Identifier:���
Freeboard(inches): .........1.1.213........... ............._./................................................ ..... .............................. ................................... ......,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes gNo
seepage, etc.)
3/23/99 Continued on back
❑ Yes �(No
❑ Yes No
❑ Yes ❑ No
❑Y ❑No
❑ Yes KNo
❑ Yes pl' o
❑ Yes gNo
Structure 6

Facility Number: — Date of Inspection
-6. Are there structures on -site w ich are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of
12. Crop type
[]Excessive Ponding ❑ PAN
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
❑ Yes IoNo
❑ Yes ONo
❑ Yes $ No
❑ Yes :IN
No
❑ Yeso
Waste Management !Stan (CAWMP)? ❑ Yes No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
ONO
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(§JN0
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JINo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
94 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
)JZ(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ANo
I.
.C. . . . . . . .S. . (igt. ..i. . . . .`. . . (i. O&iI}g �bis,vislt.• YQIt Will-fecd*O 06. fut t f
...
, coriesuorideike: about: this'tstt. • : .:...: .:............................ .
16) _ �
1-14
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection 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 4No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes tNo
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
5�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Wo
Additional Comments and/orDrawings:
5/00

e
f

C] Division of Soil and Water Conservation Operation Review
[ Division of Soil and Water Conservation - Compliance Inspection ':
Division of Water Quality -_Compliance Inspection
f EOther Agency- Operation Review '
Routine O Complaint O Follow -tip of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
'finic of Inspection 24 hr. (hh:m o0
Q Permitted Certified Q Condittionally Certified ❑ Registered 0 NM O erationl a�111 D'',�a,,1te Last Operated:
Farm Name: s.? ��^.!�G`.. ....._y_`.!-`!!.... .............._ Cormty:.._.1......... 1)..�\............................
......... ......... ... ............................... 1
Owner Name: ...._`5..4`lSSiti.......................................................... Phone No:........................................................
Facility Contact: .............................................................................. Title:................................................................ Phone No:.....................
Mailing Address: ..................................................................................................................... ...................................
.............. .........................,
Onsite Representative:... ............................................................................. Integrator:. ...
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =•=' 0" Longitude =• 01 ="
,�wme t.apacrry ropmanon
Wean to Feeder Oo
Feeder to Finish
❑ Farrow to Wean
CC] Farrow to Feeder
❑ Farrow to Finish
Poultry Capacity Population Cattle Capacity Population
❑ Laycr _ _ ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
❑ Boars i i 1 Total SSLW
I Number of Lagoons J❑ Subsurface Drains Present JJ0 Lagoon Area Ip Spray Field Area I
Holding Ponds / Solid Traps == ❑ No Liquid Waste Management Svstem
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 -Structure 2 Structure 3 Structure 4 Structure 5
Identifier:/{2
Freeboard (inches): .......................... .35 `t /
...............................
❑ Yes
IG,No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
j No
❑ Yes
No
Structure 6
1 /6/99
Continued on back

Facility umber: 3 Date of Inspection
5. Arit there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes VNo
seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [YNo
(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 [VNo
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [YNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes �WNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes W No
12. Crop type ..... t... s.6i..4'r4
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[)I No
14_
Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
WNo
15.
Does the receiving crop need improvement'?
❑ Yes
19No
16.
Is there a lack of adequate waste application equipment'?
❑ Yes
WNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9NO
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
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
'MYes
❑ 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 certified operator in responsible charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
NrNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
n No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
5kNo
No.violations-or. deficiencies.were noted dtiring xliis visit:. Yoti will.reeei've nb Ttirther..'.
edrrespotideitce:tibbtit:this visit ...:::•:•:•:•;•;•:•:•:•::•;•:•;•:•:•:•:•:•;•:•:•:•'
Comments (refer to question #): Explain any YES answers and/or any recommendations:or any other comments
Use drawings of facility to better.explain situations. (use additional pages as necessary): fr
Reviewer/InspectorName V-Q� Htt._�.'
Reviewer/Inspector Signature: Date: d , �� 11/6/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
1$ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DS W C review V Other
Facility Number
Date of Inspection
�
Time of Inspection 130 14 hr. (hh:mm)
0 Registered ] Certified MAppliedforPertnit U Permitted JE3NotOperational Date Last Operated:
FarmName:..__` �.._`�`�........................................................... Countv:..... .1^1'.!Cl......................................................
��''`
Owner Name:... \. . �ti sc..Phone No:..... iA,C_I�ZSoZ " l "( M
...............................................................
FacilityContact: ...... ....................................................................... Title:................................. .. Phone No:...................................................
�AG-3 Kor- k�w G[o 3 r�� f� �................4` �� 2 8S
MailingAddress: .............................................................................................A.......�..........l'S........../................... ��.?..... ..........................
Onsite Representative:... .1^i^ .........................................................................._ integrator:....1 ��......... �✓e_ .....................
Certified Operator................................................................................................................ Operator Certification Number.
Latitude 0'='='1 Longitude =•=°=11
Designs Current
Design Current Design Current `-• `
Swme," = * `CCapacity` �Popula6ori `Poultry'
Capacity,:,Population , Catttg _ .«Capacity. Population
®,Wean to Feeder
4L4 OG
=.
❑ Layer
` `
❑ Dairy
;` •: ❑ Feeder to Finish
`:
❑ Non -Layer
.'
❑ Non -Dairy
`' ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
El Farrow to Finish
Total Design Capacity
El Gilts
,
Total SSLWe
❑Boars
;.Number of Lagoons / Holding
on ®" Subsurface Drains Present
❑Lagoon Area ID Spray Feld Area
l,� , '- ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
jgNo
2. Is any discharge observed from any pan of the operation?
❑ Yes
ffNo
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 Surface Water? (If yes, notify DWQ)
❑ Yes�
No
c. If discharge is observed, what is the estimated flow in gallmin?
N N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
El No
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
[0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
O No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
ElYes
M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
W No
7/25/97

h
�1
1
�•
i\
{

Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[9N0
Structures (Lagoons.IIoldine Ponds. Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
CQ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 1 �
...................................................................................................................................................................................................................
Freeboard(ft): :� ..................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
O No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
'UNo
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
O(No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
RNo
(If in excess o1lf, WMP, or runoff entering wlateq of the State, notify DWQ)
15.
Crop type v(..S.o}...f.... C�'!.�.`.�.1./..Ll! .
......r:............................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
jrA&No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
i$ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[X No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[)�No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
R9 No
0 No.violkions or deficiencies: were n6ted during this:visit.:You:wilt receive no further
correspotideitce about this:visit:::::::::::::::::::
1d-1 L� ti� hv.; b�_ 0 �e 1a �i 1 -to ve�2cei� t �Scc� r+a t,qs h-�%A<� k
t„ �
ice'\c�j(t
3''i
1� "' C`"�1' 'iS "7�`Q�• rei.-ate �.vi s2._ d`�' t'�CrS -F- 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: .\[ _ ��� Date:

FV
❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
10 Routine O Complaint O Follow-on of DW'O inspection O Follow-up of DSWC review O Other 1
Date of Inspection 7 l
Facility Number ZI
Time of Inspection 3:00 24 hr. (hh:mm)
0 Registered la Certified 0 Applied for Permit [3 Permitted 113 Not Operational Date Last Operated: ...... ........
,.........
�r
Farm Name; ........S�fifRYt._5.......N1X.IGr.......Ft..1.Z............................._ County:......SJ1L�Q,......................................... .......................
p1 ..... .........
Owner Name:.........f`Appx-�ad ... jaw.!`.............................:................................... Phone No:...CR/.qY6..(cT(.c...q6Y.........................................
Facility Contact: ......... . .. ... . .%A .A............................ Title: ..... CA)L tt.......................................... Phone No:.Cg1.4.�S7a.$.-. 1.4 ...........
Mailing Address: ...... 3Z%.3....... N. GCII...y.... aj.f.qo..... 1.1!ar4..................... ........... A.W. fht1n'....1�A............................... ...0.25 ......
Onsite Representative: .... ?WJ.Y......
faA#keS.Vx..._...................................................... Integrator:...�jO1.Iz.SY'i(n.:._��Qy..�..........._..........................
Certified Operator; ........... ?-AtlhI...... 4,...... P4.c.4r.............................................. Operator Certification Number: ........ 1-74a k...........
Location of Farm:
Latitude E-R�-• ERT ®« Longitude -71• ®' ©"
- Swine - Capacity Population Poultry Capacity Population Cattle ' Capacity Population
Wean to Feeder 64W ID Layer ❑ Dairy
El Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity _ 32 og 7
❑ Gilts
❑ soars Total SSLW G�
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lag<wn Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [RI No
2. Is any discharge observed from any part of the operation"? ❑ Yes 09 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? _ ❑ Yes W No
b. If discharge: is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flow in gaVmin? NIA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 5qYes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (IU.No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Ud No
7/25/97 Continued on back

Facility Number: 31 — Z l
C
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
U'No
Structures (Laizoons 11oldine Ponds. Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
(PQ No
Structure l Structure 2 Structure 3 Structure 4
Structure .5 Structure
6
Identifier: __....._#A................. ........... {.Z
Freeboard(fty........Z:rY................. .......... -.v................................................................................................................................................................
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?
P Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters ofthe State, notify DWQ)
15.
Crop type (of1SYdt�.... fMLdC...................._.......41LOXGQ......................._COf. 1.............................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
gYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
U No
18.
Does the receiving crop need improvement?
Dq Yes
Wo
19.
Is there a lack of available waste application equipment?
❑ Yes
®1No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
® Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
El Yes
ryt
Ja No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
R Yes
❑ No
ere any additional problems noted which cause noncompliance of the Permit?
❑ Yes
IONo
0 No violatitins'or deficiencies*en notM duffing this.visit..Y.ou,will receive no further
....... ........ . ...... . ...... . ...... . ...... . ..
correspondence about this visit.
and/or
;. &rt. ame, I,, svl �-t' eIJ s6uld be, reseerlej. 11 pp 1 lI ( 1 r
i1112. EvYmior\ o-n&-s Or\ cv� r W:Lu OT (a9r'o:. u-I Sho AJ 6e (00 W41 cl A art^�t/ e't5e.eded
gam- aP -s 564 be� ((re��seeded.
I(,. Corn OJJ 4'li5uu,0 AIQwpttO Ill N16%OLLJ "ej c^'44� 't
am vso� I,%W :t. C,er{i find 64 . W e,-o`ss +o br, p(W,•�-nQ�
z2. S01� cLclo� !; shOUJ� rlws�e _ C(, {' 13,1 ruv\\ ftVAf'r�apnd tre
5 Mu ucoJds. skajid be, c,�on9ls Wr4%1 uus�co✓iilizc!(�on p1a
t-Q, Wbt. 00. pta�2d. se cx�a
skovO 6 (1M fh eer4ieJ
indertru
, L W whicj l� oor` wc�slti
I be ir. eer}i Et'rc� ��uh. !'�rc(b noMbenin
1. 7/25/97
Reviewer/Inspector Name rtR� `�WrtnA
Reviewer/Inspector Signature: A( / / /ofl _ _ _ _ _ Date:

•
Site Requires Immediate Attention:
Facility No. %_-_ 1,4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: `1' 1995
Time:
Farm Name/Own(
Mailing Address:
County: _
Integrator.
On Site Representative: -D t ­ t 4 I: c 1. Phone: '
Physical Address/Location: NC S 2 _/ l j !1 kW 141 VoCe 4.,.w
Nl C 1Z I Sq L i—<Fri w �r 1 f
Type of Operation: Swine . Poultry _ Cattle
Design Capacity: -Z,2 00 4/wl2 Number of Animals on Site: - & vU
DEM Certification Number: ACE I DEM Certification Number: ACNEW
Latitude: _° 0 S` ' _ 1- " Longitude: 7 i ° N Y ' s_" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. �_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _ :
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)6s or No
�. GPi&,�
Inspector Name
libP
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.