310231_INSPECTIONS_20171231

NORTH CAROLIN
Department of Environmental Qual
W)

FJ
(Type of Visit: (0 Co ance Inspection U Operation Review U Structure Evaluation U'I'echnical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 2 ( r Arrival Time: n c 1 r Departure Time: F County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ff-"r 5 r" I l' k + I, I' S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Z 9- 714
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Mayer
Dai Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
-.1 tko
k69D
Dr.+ P,oult , +
La ers
Design
C•_a aci
Current
P,o .
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ " ElNA ❑ NE
❑ Yes _ ❑ NA ❑ NE
❑ Yes CNo ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number. '3- 2--31 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 �_
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
❑No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes [D-14�o ❑ NA ❑ NE
❑ Yes ❑"�O ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment -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 a No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3"No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EtNo ❑ 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 ff Z ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 N
❑ NA
❑ NE
Required Records & Documents
'No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[I
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fNo
❑ 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 [fNo ❑ 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? ❑ Yeses ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes P�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ' Number: jDate of Inspection: 'Z
/7
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
NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NANE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No
B❑
O- A ❑ 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 agency9
ies of facility to better
❑ Yes E"1Io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes G3'No ❑ NA ❑ NE
❑ Yes E!rNo ❑ NA ❑ NE
❑ Yes
ENo
❑ Yes
E�.
❑ Yes
[-]No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
� as nnunaaarvl ., 'sue-v.
2�I o�^^�� 1�. Z
Pv1Z
-j�
Gw
C l L L h o n f L i f A,-fn ',_w . 4,
Reviewer/Inspector Name:
_'e 4
Phone: .`(,- 06 7-3Oy
Reviewer/Inspector Signature:
Page 3 of 3
(i
Date: Z /7 /
21412015

� ivision of Water Resources
iiiiii
Facility Number I ' t—J - Z_3 / 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: Compli a Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: tl 'L/ 9 // r—Irrival Time: i 4 S Departure Time: 2 '3/J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M �' 54 ( P f /1r / 3
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2�
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
7.. 7.
I) , P,oultr,
Layers
Design
Ca pacit
Current
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
I I
Turkeys
TurkeyPoults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'
El NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili , Number: - Ii Date of Inspection: 1 T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: may—
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Z7No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P>Ngo'�[[:]
❑ 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 No ❑ 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?
ZNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[-]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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?
fo
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Eacili .Number: -51 1 Date of inspection \ h f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Vo
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes ][� ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
Comments,(refer,to question #): Explain any YES answers.and/or any additional recommendations or any other comments.
Use,df'a'wines;of facility to better explain situations (use additional pages as necessary).
Ce, c14t_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
f
(o o /7 _'9'
5C90 Plon�-Ct(
Phone: (n 79 6 2 30Y
Date:
OIL-
21412015

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time:
County: 1/tJll1�
Farm Name: —Mae
�,ry►-�
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 114ahal t`1'►dp
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: V�91
Integrator:
Certification Number: Lfa�4
Certification Number:
Longitude:
Design Current
Swine CapacityWet
Wean to Finish
Poultry
[Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity H.
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Design
Ca aci m
Current
P,o ,
Dairy Heifer
Dry Cow
Non-Daiiy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
Other
OtherI
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes XNo
❑ Yes 2No
❑ Yes o
❑ Yes o
❑ Yes WNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET?4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ENo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1� 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 FrNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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? AK
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et#'No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 77No
❑ Yes VTNo
❑ Yes PNo
[:]Yes [4'No
❑ Yes PTNo
[-]Yes
VrNo
❑ Yes
PNo
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faeili Number: Date of Inspection: �-'j-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;�'flo
D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
PrNo
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
ZrNo
D NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
D Yes
VfNo
DNA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
Yes ZNo
Ej Yes gNo
❑ Yes YNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? D 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
NA ONE
❑ NA NE
❑ NA ❑ NE
ENo
❑ NA
❑ NE
jNo
D NA
NE
o
NA
D NE
No
NA
❑ NE
Continents (refer to question f: Explain any YES answers and/or any, additional=reconameudations or any otber,comments.•, ,: • : _k
Use drawings of facility to better explain Ataations`(use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Date:
Page 3 of 3 121412014

G
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 2Toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : QU M Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: JVo_rS m,��
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region: Wtk
Integrator• �
Certification Number: Qg" t—t
114
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
[Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D�. P,oulti.
La ers
Design
C•_a aci
Current
Pao .
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
lBeefBroodCow
Other
01 Other
Turke s
Torke 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 A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ Yes
VTNo
❑ Yes
PTNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Pagel of 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 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ 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 .0 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 environmeen�tal threat, notify DWQ
V I 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 VrNo ❑ 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 V(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..))777"'
❑ 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
r�r1 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
[3 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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 r 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
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ y i Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f (6 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

. --ii.
Facili Number: - a Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ONo ❑ 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
Wf. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Vr 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
VfNo ❑ 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
XNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�No
V I No ❑ NA ❑ NE
Reviewer/InspectorName: �wS Phone: CfJ�'Jl�� cbt�l�
Reviewer/Inspector Signature: L,J�(IyW�� Date:
Page 3 of 3 21412011

Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: IBLRoutine O Complaint 0 Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region:
Farm Name: I f l� 1� �j '�-AcLoA LLC- Owner Email: f�
Owner Name: It 4 A (�1'�rH'ILL,12S LL� (� � 'Phone: 916 _Qg0_Gl �1c p,p
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: M4-(L5H(Ql.0 \)HI cu e S Integrator:
Certified Operator: l ► l,q(LS#f4t-L ". YH J L,C 1 PS Certification Number: 016� LI
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Wean [o Finish
Design Current
Capacity Pop.
Wet Poultry
La er
1
Design
Capacity
Current
Pop.
Desigtt
Cattle Capacity
Da Cow
Wean to Feeder
on a er
DairyCalf
Feeder [o Finish
Farrow to can
�!
14co
D . P,oult .
La ers
Design
Ca aci
Current
P,o
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
IN
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 2.1412011 Continued

FairNumber: `; 1 - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
MO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes J6 No ❑ NA ❑ NE
❑ Yes ,h! I 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 structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) L
9. Does any part of the waste management system other than the waste structures require ❑ Yes TNo ❑ NA ❑ NE
maintenance or improvement? IV�—
Waste Application ,{ ,
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q/� I No ❑ NA ❑ NE
maintenance or improvement? �C
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): V�E.(�— Sc
13. Soil Type(s): I Y � QQLV A061 Vy-4 TTCL 3 (,—K
Ij
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 t ' No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
❑ Yes I No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Q WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
Q Waste Application ❑ ,,W,,,IIleekly Freeboard Q Waste Analysis Q Soil Analysis ❑ �ste Transfers Q Weather Code
0 Rainfall ❑ Stocking ❑ yrop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

io
Fac07ty Number: "-31 Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ""o 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. TC
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �� No ❑( NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No 'ly l 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? 10
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
p(i 1 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 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
to
t7� 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
WNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any;other comments >3 25
Use drawings of facility to better explain situations (use additional pages as necessary).+
uwnw p(nP go `a
w•4
15,19111 1.3
OpIll 9w A . �c� �1�5r Aga—o� 9011 w-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9c)
Date: oL L L
Page 3 of V412011

Type of Visit A Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:/ Departure Time: County: 1 N Region:
Farm Name: I I/yIAP is RM &LC_ Owner Email:
Owner Name: M �' �2 1P N!%..(..1 S LLC g 1 . \ .Phone: q j - a`q& f4� I tpI
Mailing Address:_� C� %Q'IG>E I`J ICtS�3 /vC. �JaO _
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentativeI"/'t"S�tTL�- �'l��Z-�-IPS Integrator:
Certified Operator: u r ry�A05 6t)ILC • �f%1 L l2 S Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: M o F-71 , M Longitude: [� c
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver I
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
1
❑ Dairy Calf
12 Feeder to Finish AN140
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
El Beef Stocker
El Gilts
ElNon-Layers
❑Bee f Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
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 �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑Yes 40
❑ Yes �j��No
12128104
El NA ❑NE
❑ NA ❑ NE
El NA El NE
Continued

Facility Number, / — Date of Inspection 9WZY]
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 JTTTT❑`"`No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
j1'
Identifier:
Spillway?:
Q
Designed Freeboard (in): ' . 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ANo
❑ NA
[I NE
(ie/ large trees, severe erosion, seepage, etc.)
//��..,.(
6. Are there structures on -site which are not properly addressed and/or managed
El Yes LYJ No
❑ NA
[I NE
through a waste management or closure plan?
VV��
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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
WON
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?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/oi any, recommendations or any other comments ---
Use drawings of facility to better explain situations. (use additional pages as necessary): w
IReviewer/Inspector Name 31 Phone: 1 C�-�`ib -4 R) -I I
Reviewer/Inspector Signature: Date: %
Page 2 of 3 12128104 Continued

fteiMy Ntint r: — 31 Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
No
X
ElNA
❑NE
"��ElYes
ElWaste Application ElWeekly Freeboard 0 Waste Analysis 0SoilAnalysis ❑ vyaste Transfers ❑ Almual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections E]Monthly and I"
Rain Inspections []
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ 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
,�(
Q(J No
El 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
33.
Does facility require a follow-up visit by same agency?
❑ Yes
! No
❑ NA
❑ NE
Additional Comments and/or Drawings:
w CAU 13LkE o2O I0L,
•
11Nlii �. S
Page 3 of 3 12128104

Type of Visit rOCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
16 Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: M" Arrival Time: 0 Departure Time: County: �� Region:
Farm Name: I 1 I AP §2�w) LL _ Owner Email:
Owner Name: Mq-P IIPM)LLI p&
(s LCt Phone: 9�Ci'
Mailing Address: ` 66 t/�� A�`[iS V 721 t J� E Y- A LJ- �'�h.' A I• /\J c
Physical Address:
Facility Contact: (� Title: Phone No:
(� _
Onsite Representative: 1 ' I f(l _5'q 4 .L_ Integra�t-o�r,:
Certified Operator: �� ��— '�y11LL! 1" n`S Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [o = [� Longitude:
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer El Dairy Cow
❑ Wean to Feeder I
ILI Non -Layer I ❑ Dairy Calf
Feeder to Finish titer 19 1550
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Nn-
oLa ers ❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets ❑ Beef Brood Co
❑ Turkeys
her❑
Fia
Turke Pouets
❑ Other Numberof Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes � No []NA ❑ NE
[:]Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
I
[I NA
El NE
12128104 Continued

• Facility Number: _, -- a3 Date of Inspection S p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: m A P
Spillway?:
Designed Freeboard (in): S
�/9T
Observed Freeboard (in): bl.'1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P�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 �fNo
❑ 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 MNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [4Io ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes KNo ❑ NA ❑ NE
maintenance or Improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El 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 types) (G� ^ A _ -_ _
13. Soil type(s) f FU (L�(�I l L� , l r 4aLAAW `!, t)T(�L� �eVJ e/J A- LL- Hct�Lf—_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,RTNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes KNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any iecommendatton'sgr any other°comments =y
Use drawings of facitity,to better explain situations. (use additional pages aslnecessary) ?,
Reviewer/Inspector Name �(r�7 1 S " I Phone: y%!Ut 5a) -7
1t Reviewer/Inspector Signature: yti _ Date: /QSj/n
12128104

Facility Number: "j —�3) Date of Inspection 5 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes] No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists El Design Q Maps El Other �,�,
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes I No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑ /nnual Certification
[EI Rainfall ❑ Stocking E]Crop Yield Q 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Ye
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4No
❑ 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
ONo
❑ 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
RfNo
❑ 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
b��y No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings
(tiy 6P
12128104

j Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ?V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �/��/��,j/� (Arrival Time: OS� /� Departure Time: County: ��AT Region:
Farm Name: ►Mr I Yl 1f'� 1:7mn i �U2 ' / Owner Email: (y��
Owner Name: 1 t C1�`� i"1 I� l`a) i-1-) Rg L t�-(��—� ('� ' Phone: q n_ Q0A3_C
Mailing Address: !0S wA�'OS I V=��. �C7 l.l�--��12-SAI.t_� . NC aR39e
Physical Address:
Facility Contact: Title:
M
Onsite Representative: 1 r A(L5-#, 1 (� 14ju-I RS
Certified Operator: MAa,5ltil ' . T µlamps
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: K b -4 1 L/
Back-up Certification Number:
Latitude: = n = , Longitude: = o = ,
- -, "- Design "Curre'nt I)e'stgn ' Cu-re
Swine;:; -... '�Ca act P,p ulation• WetPoul -� '" `+" + -1 -" -
ne;: P , ry., p tr.y-R. actty Population Cattleu
Destgp - Cbrcent
-
Capacity Population
;`
❑ Wean to Finish
I
!" ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I.- ❑ Non -Layer I
❑ Dairy Calf
;;.:
'�:�
Feeder to Finish
90
i'> ":
N.
- Dry,Poultry w
❑ Layers
El Dairy Heifer
❑ Farrow to Wean
❑ D Cow
❑ Farrow to Feeder
❑Non -Dairy
El Farrow to Finish
❑ Gilts
'. El Stocker
'
El Non -Layers ers
El
- El Beef Feeder
❑Pulle
❑ Boars
❑ Beef Brood Co
❑ Turkeys
_
Other
-- .. -.. .. „:-..;.
Pw.
Numbe%of Strucfures: ED
❑ Turkey Poults
❑
Other
❑ 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
[�,No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection J O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes lNo ❑ 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: 61KO015I
Spillway?:
Designed Freeboard (in): . 5
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.) YYY ��`
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ElNE
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 Jthreat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes Lxl No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes i� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes OI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [I Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence off WindDriftEl Application Outside of Area
IL
12. Croptype(s) IAC Cogw J2 SG e2(P�')
13.
Soiltype(s) bh6.1V_u�)UC- ry!Q(ZU—T 176613 C_ENTENX-Lk
J9t-GZEtMLE
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M 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
A 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
IV No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or, any recommendahonsto�r-�anyiother°Tcomments0-�-
�� � ':Use drawingsof facility to better explain situations. (use additional.pages as necessary) � ?*' n^sµ�',
Q.s=main s�3S ��zom p���e water
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: I I JsIaC%
I

Facility Number. 3 ) — 3 Date of Inspection 1 09
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )ANo ❑ NA ❑ NE
the appropriate box. 0 WUP 0 Checklists 0 Desig
n 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ �aste Transfers ❑/mual Certification
0 Rainfall ❑ Stocking [I Crop Yield 0 120 Minute Inspections G] Monthly and V Rain Inspections 0 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
V No
❑ NA
❑ NE
❑ Yes
t4 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
!A No
❑ NA
❑ NE
❑ Yes
J�NNo
❑ NA
❑ NE
❑ Yes
�tNo
❑ NA
❑ NE
❑ Yes
(4No
❑ NA
❑ NE
❑ Yes UjNo ❑ NA ❑ NE
12128104

y n Division. of Water Quality
Facility Number 3 a 3 � 0 Division of Soil and Water Conservation
-- O Other Agency "
Type of Visit ACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
�
Reason for Visit W Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:EVQ Arrival Time:07" Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: 1► 1 A (-S #j4 L L f} 1 LL l C Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative::(y�1 t AX39AL--
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: Q R-11 (t
Back-up Certification Number:
Latitude: = U a ' = « Longitude: = o = 1 =
"Design " Current "^' Design'' Current
Design Current
Swine
Capacity Population Wet Poultry CapacityPopulation
Cattle Capacity Population ..
;,-„
❑ Wean to Finish
❑ Layer
- ❑ Dairy Cow
❑ Wean to Feeder
Ii
[E]Non-Layer
❑ Dairy Calf
Feeder to Finish
' D go
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
' ❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
ElBeef Stocker
- ❑ Gilts
Non-LayersEl
. ElBeef Feeder
ElBoars
�- El Pulletsts
El Beef Brood Co
f
--
-
-- - --- — -' El Turkeys
- —�.
Other - El Turkey Poults
❑ Other I I Other
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 1 of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
12128104 Continued

Facilityl umber: — Date of Inspection TJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA FINE
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: M A-P
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes y 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 o ❑ 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 ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesIo El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1
9. Does any part of the waste management system other than the waste structures require ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IfNo ❑ 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 gNo ❑ 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 acre determination ? ❑ Yes 11 ! No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 2rNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �RNo ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName 1140ANOR — I Phone: 410'1960'15od I
Reviewer/Inspector Signature: ti) , Date: q13LOR
Page 2 of 3 12128104 Continued

-Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box. ❑ WIIP ❑ Checklists ❑ Design ❑ Maps ❑ Other
'
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ 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
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
/rV1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ly No
,\
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El 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
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J� No
❑ NA
❑ NE
Page 3 of 3 12128104

_ AD Division of Water Quality I
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
x
Type of Visit Fcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit dRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Idi
Farm Name:
Owner Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: t) 00 Departure Time: County: LJPL.XKI Region:
Title:
Owner Email:
Phone:
Onsite Representative: M AFI;RA LJ,— P L4_t L tf5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: Q o = ' = Longitude: = o = , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non -Layer
Dry Poultry
❑ La ers
❑ 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?
Design Current
Cattle Capacity Population:;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: '3j -- j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t-A btDf,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
L1J 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
notify DWQ
threat,
7. Do any of the structures need maintenance or improvement? ❑ Yes
ILI No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
9 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
//
LI No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ON(
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
eNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ef
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
�EKNA
El Yes L�_,I/Np
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes L1 No
❑ 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):
6Ef oa="IgCEp atc. (uwt., Li:cu-ja
&0L)P(OATC- W UP Fan- NbW dNI46f-,
IReviewer/Inspector Name o fAAA1(-LL Phone: NwG 3$ I
Reviewer/Inspector Signature: Date: d
12128104 Continued

'[Facility Number: —aj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have 11 components of the CAWMP readily available? If yes, check
the appropiate box. WUP []Checklists []Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Y , l o El NA ❑NE
Yes 11J No ❑ NA ❑ NE
❑ Yes WI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes � ❑ NA ❑ NE
❑ Yes FNjo
❑ NA ❑NE
❑ Yes �,/❑ NA ❑ NE
❑ Yes L7 N ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes CJ Nf ❑ NA El NE
❑ Yes ,(NO El NA El NE
M ❑ Yes No ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
CJ No
❑ NA
❑ NE
12128104

,. Division of Water Quality ,
jAke ity Number 3 i I O Division of Soil and Water Conservation
' - - -- -- O Other Agency _
Type of Visit VCom Hance 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: Arrival Time: J o Departure Time: County: 'DtAXA) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J cnF QI.�SoAi
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o Longitude: o
Design Current Design Current Design ,Current
Swine, Capacity Population Wet Poultry Capacity Population Cattle, CapacttyP�opulahon
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
j.J14 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
`.- ❑ Dairy Cow
❑ Non -Layer
I
I
"❑ Dairy Calf
I>8"
❑ Dairy Heifer
Dry Poultry JE1 DEZ Cow
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 L/J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
[I NA
❑ NE
NNo
/ El Yes
—❑
�N
El NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Date of Inspection-=a-+-f-�
FacilityNum
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: tA660AI /
Spillway?:
Designed Freeboard (in): / °I
Observed Freeboard (in): )
o
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
Ej 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
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
EKNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�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 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI+ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C J S ce) S G o
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
{! I No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ErYes
❑ No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
d No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
ElNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
1S,) �JEEf) LQ1i2ol. tlE4DE0, IARbC AMcxJrJT da)R WSAI ytAoVES(a/6�A1. �tS>
3A(.E S o E 11A� OFF SIDE 0C VRA1`S' fa'cl-D,
Reviewer/Inspector Name I J o H 01 O'L, Phon 4W / 116- /j Y D
Reviewer/Inspector Signature: 0 Date: p Jy o
P.' 2 of 4 1212RI04 Condnued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes 6 Now❑ NA ❑ NE
El Yes (_eIo ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
3 No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,Ea<q
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
N [I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
El 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
ul o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 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
,❑ N
❑ 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
EfNo
❑ 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
LJ No
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit lv Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access' /
Date of Visit: 20 Q Arrival Time: ;00 Departure Time: ' 00 County: C1 Region: a)'Wo
Farm Name: 6
�T/✓ZC� 0j4�_�.�M Email:
Emai
Owner Name: "71'—O w Phone:
Mailing Address:
Physical Address:
Facility Contact: ���� Title:
Onsite Representative:-c)O,tld ��%F/Z,p^i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = . = « Longitude: = o = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non -Layer
Other
❑ Other
Discharges & Stream Facts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes EI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 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.
Spillway?:
p
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E� 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 FZ(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 FzfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes OrNo ❑ 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 ElNA ❑ NE
maintenance/improvement? ZZ
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �& ❑ NA [INE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground [IHeavy 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 N
12. Crop
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
XNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
C�rNo
❑ NA
❑ NE
15) S�i�/ns C %fsr �% m,'7Sl_l 060
Pq
Reviewer/Inspector Name r ` '. < : Phone:�°/!l7)
Reviewer/Inspector Signature: / Date: /O�ZVA, i
12128104 Continued

Facility Number: Z Date of Inspection
Required Records & Documents ,,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElyJ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropirate box. ElWUP ❑ Checklists ElDesign ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,_V(No
J(J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ko
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
JVNo
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,,���(((
ICJ No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�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
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
)2TNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�) ` ✓�Ctfr�_f fF / DG� �jL�C�2V �GlJO
/��F>iL �.✓ Lxooitl , lf,E L"�G /%%rF� Gr/ou�o /�e� /��s��'k
Tv /P�Ao ,,, 645�vo.4) lfs' 4
Irv- rdw,
At- /I-� �or�� ��,�� Ii ECoeo s ��,/ t%Q�, �id�✓�2
12128104

Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation
OI
Reason for Visit �ioutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of visit: { IO dq Time:
Q Not Operational Q Below Threshold
Permitted [3/Certifiedd, /Conditionally Certified ❑ Registered Date �t Operated or Above Threshold: _
Farm Name: _ �_.4!` ! �Ecp% ` QQh1 ��� County:
Owner Name:
blazing Address:
Facility Contact:
Onsite Representative: , J o / { Ad e
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No: --- —.,
Integrator.
Operator Certification Number-
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• 0` 0" Longitude =• =, =�
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _-- I. ---
Freeboard (inches): .3 o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El
El YesYN'q
ElYes [�jo
❑ Yes ff No
Structure 6
12112103 Condruted

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
G!(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
2fNo
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 maintenanceltmprovement?
❑ Yes
2<0
8. Does any part of the waste management system other than waste structures require maintenanrelimprovement?
❑ Yes
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
�B
LYNo
elevation markings?
Waste Application
10. Are there any buffer that need main[emtancelimprovement?
❑YesIN
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop ripe L$W SEo"vOA L i%) SGD
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
[IYes
G�4�0
b) Does the facility need a wettable acre determination?
[I Yes
C� No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
��
0No
16. Is there a lack of adequate waste application equipment?
❑ Yes
2 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
[I Yes
E No
Er
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
3'f4o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
r--I No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
2''No
Air Quality representative immediately.
Feld Copy ❑ Final Notes
.,) I,) Oa-MrtJ Ce C AND PER-I"tsr -fis 4r. P I�S srN 4k U Rap s,
3g,) 1:1`F9 CoP`e oG ANA)A)A(- GEat_.T mfxCATZ;�P\J A50-f. rvtl-- QCca"-pa
�pR2iEc::7r. ?t�rwP C7 EJE.PJT 6r a, * aN S" 7a SCA-KtUDA. ;Zr- mQ►g3Cft
W 4rz r-), < C 41 C-R P VtI A Y 8-6 P(- F o o d,
FO6tyy\ SN Goag SWAM
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112/03
Continued

Facility Number: _ Z Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain tainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocldng Form ❑ Crop Yiel orm ❑ Rainfall ❑ Inspection After I" Rain
El120 Minute Inspections Annual Certification Form
Yes ❑ No
❑ Yes GNIO
❑ Yes ENo
❑ Yes M-O
❑ Yes L�g oo
[IYes L r oo
❑Yes oN//o
❑ Yes 2
❑ Yes L7 No
D'Yes
❑ Yes
❑ Yes 20
❑ Yes Q
❑ Ves �No
Yes ❑ No
0 No violations or deficiencies were noted daring this visit You will receive no further correspondence about this visit
ECo aad/utD�wmgs:
:�sr s a.Y.S.a:.:vMi9C''S1e^zY"_ ..,E _ •:._ �. .. ve-
12112103

Type of Visit
P(Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit 2r Routine
O Complaint O Follow up
t] Emergency Notification O Other ❑ Denied Access
I
Date of Visit: Time:
Faciliri Number
10 Not Operational Below Threshold
,,t'
y Permitted
0 Certified
0'/Connditionally Certified'
❑ Reegisteredd Date SLast O erated/or�Above Threshold:
A
/`J_,941
Farm Name:
B`-WA1.7!'E
44 1,7dXi17KF0_s /ARn,
' �-7f�'Co� (/y0�/✓
Owner Name:
—) 0,4d
1 A),
Phone No:
Mailing Address:
Facility Contact: %% Title: Phone No:
Onsite Representative: :31
©if'i Nf 7/Gi?SiJn1 Integrator: �!?F%rii('y-
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0. 0- Longitude �' 0• ��
DesignCurrent - - , ""; `'Design.:., -Current r ,_ Design ;Carrel
Swine: -Ca aciri_ Po ulation :Poultry_ _ .Ca aciri =Populs6on Cattle Cs aciri Po tilati
❑ Wean to Feeder F-1 Laver L 171 nairy
U Farrow to Wean I I_ -
".` ❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Design Cspacity _
.' ❑ Gilts
❑ Boats Total SSLW
.Number of Lagoons i ❑Subsurface Drains Preseat ❑ Lagoon Ares ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste 'Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 59 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;ZNo
❑Yes ZNo
❑ Yes PTNo
Structure 6
Continued

Facility Number: 3/
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive liot
12. Crop type `12/-' K/rtt/OA d
13. Do the receiving crops differ with those designated in the erti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, traps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes V1No
❑ Yes ZNo
❑ Yes m No
❑ Yes No
❑ Yes [ZNo
El Yes ONo
❑ Yes 0 No
❑ Yes VNo
El Yes [ZNo
❑ Yes 14 No
❑ Yes 21 No
❑ Yes ONo
❑ Yes ZNo
❑ Yes ZNo
❑ Yes VNo
❑ Yes ONo
❑ Yes ZNo
❑ Yes )zNo
❑ Yes 0 No
❑ Yes [�No
❑ Yes ONo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer -to question #): Eitphdn any YES ansn eis and/or any recommendations or. -any other 'comments:
fuse drawings of faeilityto better explain simatfops. (rise additional pages as ueeessary) r `�� Field Copv [I Final Notes i
-� ield.._...__.�....___._._._______._...
641E2>/7_1 *�L/✓G OP64? 5 o B` D,eAE,e, SPR�y�z��c]Qs
�El'DQp_:i eOz71Pctr7-6-/Ti✓O
<r✓ �RD�R.
Hy
Reviewer/Inspector Name _ -
.
Reviewer/Inspector Signature: Date: /2 // O
05103101 Continued

Facility Number: -2 Date of Inspection a 0
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 anv dead animals not disposed of properly within 24 hours?
❑Yes
No
28.
Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
❑ Yes
PrNo
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
O 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
01 No
31.
Do the animals feed storage bins fail to have appropriate cover? -
❑ Yes
A No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/tempormy cover?
❑ Yes
❑ No
Additional Comments. and/or Drawings:
O5103101

Division of Water Quiliry-- _ .
- O Division of Soil and Water Conservation' -. - -
-..) Other Agency;
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit IWAoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 2 3 t Date of Visit: mTime: ® Printed on: 7/21/2000
0 Not Operational O Below Threshold
Permitted E3 Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
FarmName: ............._!7!................................................................................................... County:.............................................
Owner Name.. ...............0. oo . .......r e e,rSOr� .............................. Phone No:---------------
..............................................
Facility Contact:
Mailing Address: ........................
Onsite Representative:......
Certified Operator:
Location of Farm:
Title:
Phone No:
��2rs.v�............................................. Integrator: Pre5l
........................
............................................................................ Operator Certification Number:....................
xfl'svirine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =, 0..
Design Current Design Current Design Current
Capacity -Population PoultCapacity PopulationCattle Ca ici _, Po iilation
Wean to Feeder ❑Layer ❑ Dairy
'.,:.; Feeder to Finish 10 Non -Layer 10 Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capad
`= Gilts
Boars Total SSLW
Present JJ❑ Laga Area
No
Discharges tic Stream lmpacts -
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/mid?
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: .....
.......... /.................. ...........................................................................................................
Freeboard (inches): 32,
5100
❑ Yes )2fNo
❑ Yes ,4:I1No
❑ Yes �No
❑ Yes ff No
[]Yes ONO
❑ Yes lErNo
❑ Yes 'Erf to
Structure 6
Continued on back

Facility Number: 3 1 —2 31 Date of Inspection $ 25 Printed on: 7/21/2000
S..Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes �'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �Io
(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 _13'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes _0`No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes,0No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes J] No
11. Is there evidence of over application? ❑ Excessive Pondii�ng ❑ PAN ❑ Hydraulic" Overload ❑ Yes XNo
12. Crop type �e r��tv�6l C�� r0 la/'A ZQ t J "'W t'J�q , h , ee n ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Platt (CAWMP)? ❑ Yes J1 No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc-)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
LJ' N •yiptatigtis oi' BQliciencies -were h6fed diwifidI.4bis:visit; - Y:oit :will-i ebeiye tio: fui•tlter -: - -
. coriestw deli& abotif this :visit.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes �No
[]Yes EfNo
❑ Yes ONo
❑ Yes yr No
[]Yes gNo
❑ Yes 1P'N0
❑ Yes XNo
❑ Yes ,�No
❑ Yes 1'No
❑ Yes 0190
❑ Yes�No
TC\ere is Oavt ¢xcell'zvj SaaVADl of Fieldf-
11et",•}ct; t back leu A•Feldf- rfrA oit i%
r1eCes Sq* . �
/<
Reviewer/Inspector Name
11 - i'1-'7 11,s
Reviewer/Inspector Signature: �.f��, Date: S/00

I Facility,Number. 3/ -Z? 1 I Date of Inspection 25 0 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 ❑ 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 Ja'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4!TNo
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 UNo
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 IRNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Ji No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

'Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation '
for Visit Q Routine O Complaint O Follow up O Emergency Notification O Other/ ] ❑ Denied Access
Facility Number
Date or Visit:
Z 3 1
Permitted Certified E3 Conditionally Certified0 Registered
Farm Name: ............ YSdI— .....'......
Owner Name:.......... iU��._ '' _................. .... .....p{-�SOYJ........................
Facility Contact: ... ..lJ..e..k..!^....... P%.AIe7 - ......... Title: ........ ...........
Printed on: 7/21/2000
IOINot Operational O Below Threshold
Date Last Operated or Above Threshold: ......_............._..
County:...... %_L..../!...........-..................-........................
Phone No:......[.. �/��.....-.._1.0... .......
Phone No:
Mailing Address- ..... ............_............
Onsite Representative: ,,,,_"L�, a_ �,e(/✓5�,,,.,,,,,.._..,.._,,, Integrator. _t'r'a
.✓..�.................... t..........................................................................................
Certified Operator:...` .............................._..............
Location of Farm:
Operator Certification Number:
(Swine ❑ Poultry []Cattle []Horse Latitude =•=° 0` Longitude 0• =° =I.
Swine
Q rj L/U
Design Current Design Current
Capacity Population Poultry Capacity Population
❑ Layer
❑Non -Layer
❑ Wean to Feeder
Feeder to Finish
❑
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons JU Subsurface Drains Present JU Lag,�on .Area JLJ Spray Field Area�
❑ I
Holding Ponds / Solid Traps No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [I Yes f�1Vo
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other y�
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, nolify DWQ) ❑yes ❑ No
c. II discharge is observed. what is the estimated flow in gal/hnin'. i41/4 —
• 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 KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes `N0
Waste Collection & Treatment /I
4. Is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway ElYes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. .............. _..................................................................... ..... _........
Freeboard (inches):
5100 Continued on back

Printed on: 7/21/2000
Facility N"mber: Dalc of Inspection OUs,
5.
sev
Are there any immediate threats to the integrity of any of the structures obser d'? (ic/ treeere erosion,
❑ Yes
M No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
s
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P�[.No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[(No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
NiNO
12.
Crop type B 4 � 6, w 4-
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[j{No
b) Does the facility need a wettable acre determination? ❑ Yes [gNo
c) This facility is pended for a wettable acre determination'? ❑ Yes [�No
15. Does the receiving crop need improvement? ❑ Yes KNo
16. Is there a lack of adequate waste application equipment? ❑ Yes D(No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
qNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
����ffff
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ej�,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[E(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [(No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'? ❑ Yes Wo
24. Does facility require a follow-up visit by same agency'? ❑ Yes QKNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes INo
K,6 yibl'atioris:ordeticienciBS were h6fed during fhis:visit: Yoit will teceiye ti6 further
cori es oridence: about his 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):
►�Arr Pe 4vy5e,� 5 e-w-I- O r G d- C k\4 , e- d��-
i d--k- dors s+w t p
0 T L 1.0. s-ram
_:r_ V,,k. ffior. O r L �o Cr✓� _ , A
O-r 16Witro�aL — N'i t^ C,Ou"v'a,...�c-►- s� Skow
Reviewer/Inspector Name E. h v e r, r W l t
Reviewer/Inspector Signature:
l J
Date:
5100

s
1.11
Facility Mumber. —Z 3 / Date of Inspection 10 2 ooC� 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-(] 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 a5tvo J
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes 0140
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 621No
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 9110
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes "RWo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
3:Y-es ❑ No
M^y . Vc 4wst� s
Cto
v� yoo J
INN'
I- ov�
UJO
CV� lawQ
� lam— ci
5100

o Division of Soil and:Water Conservation - Operation Review _
O Division of Soil and Water Conservation Compliance Inspection
' 11 Division of Waier,Qualrty -,Compliance Inspection
r
Other -Agency -;Operation Review-
Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Facility Number Z 1
I Date of Inspection 1 1 3 5
Time of Inspection 12.50 24 hr. (hh:mm)
Permitted 0 Certified [3 Conditionally Certified E3 Registered Not O eration�all Date Last Operated: ..............
Farm Name: 6e�^'�...._N....C�tiin�e✓J > 4P�................ County: .Iid�iir.
.................................. I.'........�.t....................................................................................
Owner Name: ......................_./_&rr) t.e H. C,1'la�'t�
............................................... trJ.......................... Phone No:...........................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: .........................++ ............................... Integrator: .....•. .e.Fn G................................................... ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =• =' =" Longitude =• =' ="
Design Current Design'. Current.." _
Swine, Ca achy Po ulation Poultry_ Ca acity Po ulation Cattle
❑ Wean to Feeder
Feeder to Finish
Z ej 4o
2 Qd
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-Dair}
❑ Other
Total Design Capacity
Total SSLW
Current I
Number of Lagoons _ .. - _ - ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Hold"x;
ing Ponds / Solid Traps E� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/mid?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes X No
❑ Yes ® No
❑ Yes 'M No
V1A
❑ Yes allo
❑ Yes IN No
❑ Yes 29 No
❑ Yes X[ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
2 (m
Freeboard(inches): ...................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X No
seepage, etc.)
3/23/99 Continued on back

Facility Number: v — 23/ Date of Inspection
6. •Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )5No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ®,No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes X No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes jd No
Waste ADolication
10.
11.
12.
Are there any buffers that need maintenance/improvement?
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ,t
Crop type i3 grin ULlrl Hti t�l �inall ii�A%^1 w.,4ty- ffiln uad
❑ Yes
❑ Yes
®No
19 No
13.
J
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
X1 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
bg No
b) Does the facility need a wettable acre determination?
❑ Yes
CKNo
c) This facility is pended for a wettable acre determination?
❑ Yes
IN No
15.
Does the receiving crop need improvement?
EVYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
H No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
fR 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
M No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
A Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
24 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Uff No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
Od
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
jig No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
►lJ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JO No
..
.. yi.... t... deficiencies were potted• it ... this;v........ e.... in .further
.
.........
corresootidehce:about:this.vtsttti-::...:-:•:::..•::....:........... .
.......... r. w.y..w nr_ ... p .r a.q_ a.v mu.. ma.00r: = acw.... c auauvau m may uauca wuuucuu.
se drawings of facility to better explain situations. (use additional-pagesas necessary)i-_
15. SOVne�" 04ttetr C..(� rcSSGf 61U+ 5tass) pre-<C4 ih $er^tua(A-f,cddS,
Lder;c, +o OS+AjPtjs-j, cogs_( 6,,,,e6t;, _`feld .
(q, F'q�-Mar stwatel 6e';.t keerin) (Veek►� Frt¢bogr'd rC601AS in iv6let•
Reviewer/Inspector Name ( 'J a'p:ZCVyq{%�% ¢- �d� .�_J;S :�./.�.r% Q ` I
Reviewer/Inspector Signature: ']Y ili..�, /v ^ �� Date: % 11"3 %-(r
3/23/99

Date of Inspection // 3
Facility.Number. 3� — Z31
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
:0 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
Pq No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
M 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
M 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
DR No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
K No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ,® Yes ❑ No
3/23/99

0 Division of Soil and Water Conservation [3 Other Agency
19 Division of Water Quality
1QRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review p Other
Date of Inspection
1 Facility Number
Time of Inspection Y,-`'LS 24 hr. (hh:mm)
13 Registered
E3 Certified
E3 Applied for Permit F Permitted
[3 Not Operational
Date Last Operated: ..........................
FarmName: ......
Owner Name:
j _..................................
........ `-.y cR...... ._...e!....S..................................
County:.......
Phone No:.....
L.X1......q...................................................
`d — 1C� a�`�y
FacilityContact: .............................................................................. Title:....�Q......((.................�................................... Phone No:...................................................
Mailing Address:.r.o..3. -_ ..._W�`-�z.._%,.�. .....Id.............t,....�3............ ........ ..................
f� t........
OnsiteRepresentative:0.W. Rl%../.....'..W ._.1�A.-E .................... ......_.......... Integrator:... ,y :_ .............................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Latitude =• =, 0" Longitude =• =` ="
Design��Current 0 z-Desigii Current Design" Current
Capacity.Population-- Poultry Capacity Population Cattle. r Capacity Population
„, +, ❑ Wean to Feeder 10 Layer I ❑ Dairy
`�-„ ❑ Feeder to Finish ._. ❑ Non -Layer I ILI Non-Dairyl I-
re E
❑ Farrow to Wean - t�
❑ Farrow to Feeder ❑ Other
�H$lq .,
`- ❑ Farrow to Finish =Total Design Capacity'
❑ Gilts
,0Boars Total SSLw-.'
.--
=Number of Lagoons J Holding Ponds , ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
z
AM
�� ;�, u € . ^; ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
,a.J
IQ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
1XNo
c. If discharge is observed, what is the estimated flow in gal/min?
N ly
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
O No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
N No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
y/
&No
7. Did the facility fail to have a -certified operator in responsible charge?
❑ Yes
IXNo
7/25/97

aatity Number: —a3 ,
' 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes VNo
S
Structures (Laeoons.HoldinL Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:..................................
...................................
Freeboard(ft):.......... .........................................................................................................................................................................
.....................
10.
Is seepage observed from any of the structures?
❑ Yes
�No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
O No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
Nf 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
(VNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
allo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
r�.!^°\...........................................................
15.
Crop type ....{.. ...j..... ................ _......................... _...................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
ONo
18.
Does the receiving crop need improvement?
OYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
t4No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
tWNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
14 No
22.
Does record keeping need improvement?
Wes
❑ 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
Z 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
Q No
0-No.vitiNtioitior
de£iciencies:were noted during this:visiC You:will receive-661tirtlieir
correspoudehee about this:visit:
ARglit
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:�o j(_ �� Date:

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
n
5_
tee.
"w
IWRoutine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Bate of Inspection
Facility Number
Time of InspeKaion 24 he
0 Registered 13Certified [3 Applied for Permit 0 Permitted 113NotOperationall Date Last Operated: ..........................
Farm Name:... .i�Y ..f.SJ�.... .r... - ^..0..r..-.!a-e�.vi.... !!..a!1^..................... County:.. ...ld.,_Vs.n..................................WK..L!.1...
Owner Name:...-�i4M.ri.t..r £..... .r......�. �n.a,wa.la_Sri .............................. Phone No:..�.a.ln)... Q6..�..O.Q.�..I ..........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Moiling Address: _ ..d..3...... c. ,.......V,1..a . rt1 i.......10
-t� .. j.,d........... ... os:;n.S..K..;..L.� C..r.....klc ................
OnsiteRepresentative: ... j .. .-5 �....._ 4 :...G ............. Integrator:...pr. .S..A............................. a...................
Certified Operator;...10y, l..ls..n.,n+...... L.r....... a..... ....................... Operator Certification Number, ..... f.7J..1..7�. ............
Location of Farm:
Latitude ©•�{D_5]<l
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
29 LiO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I Holding Ponc
Longitude ©• E�T' $t -
Poultry Capacity Population Cattle
❑ Layer I ❑ Dairy
❑ Non -Layer I❑Non-Dair
❑ Other
Total Design Capacity
General
1. Are there any buffers that need maintenance/improvement'?
Total SSLW L
Subsurface Drains Present ❑ Laenon Area
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made'
b. If discharge is observed, did it reach Surface W:ncr? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galhni0
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
J Spray Field Area
❑Yes 19No
❑ Yes lK No
1��>i�
❑ Yes Q No
❑ Yes ® No
❑ Yes IN No
❑ Yes [9 No
❑ Yes ® No
❑ Yes CgNo
❑ Yes V1 No
Continued on back

Facility Number. L — z
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
N No
Structures (Lagoons tloldin!Ponds, Flush Pits, etc.1
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: 3....5........... .
Freeboard(ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
®'No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
MNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[KNo
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..Sal..v�n:: ai r.................................uv
a_� �....
.va e
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yesz,
0
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
1R No
18.
Does the receiving crop need improvement?
N Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R 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
:RNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
® Noviolations or deficiencies were noted during this.visit. You.will receive no further
correspondence about this'visit: "
I4. W O .! � O» Cp v ""-�4 ' `Zt W-2Rdi t H ,Sp � � e%d-i � W �.2 •w-e.+�eA - +-�/�
2.2.. !wa V.R. S V ,rt o V 'r-e Os , ia+L e.o rl.-z c'F N t-aol— a l l*w u'^-es3 t4. eitW '' S P
"Ll i.. t o Y j x"'s at C " a [ kv-"O
also a f P x o rt t v�ar { , , v1n tJ ; vmr q�?iv. ✓v`a i
h .✓v v klxwvs, e I l 1 e �a {-i e l d 4 3. co r e --Axd-3
tin..t 'jo-v j e-v r b „ bt-t-s ,
otvsz'% Lz t-v" s "I F_ 0a-a d. Q c x j c r, i �. t �y Juba ,•.. we. l ( c..e-,r�r a-.�d d-ee,d- 4+5-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: per, ��_ _ - Q �� „ Date: 9 2-3 % q i

j Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVII2ONMENTAL MANAGEMENT
• Al
ANIMAL FEEDLOT OPERATIONS SITE vISr'ATION RECORD
DATE: �i-L, 1995
Time: 0IO
Farm Name/Owns
Mailing Address:
PL7
County:
Integrator. �e1%J714 679— Phone: /" S0 "J !�06 % SZ �X 2m
On Site Representative: 4r--b to IW6 Phone: '/
Physical Address/Location: SiQ /3U0 02 • j Ali • � 0— S'R ld®Y^
Type of Operation: Swine V/ Poultry Cattle
Design Capacity: IrOP Number of Animals on Site:
DEM Certification Number: A& DEM Certification Number: ACNEW
Latitude: _K._' Longitude: 77 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 inche es r No Actual Freeboard: Ft. Inches
• Was any seepage observed from tt ee lagoon(s)? Yes Q Was any erosion observed? Yes r N
Is adequate land available for spraa�y? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: X 3,Ac""�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings�r No
100 Feet from Wells? es r 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 r N 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)? Yes or No � //
Additional Comm ents: 5xe=LJe /•i!g 21dop-LL 'Op/N&
1/G���%.t Y✓i �r//�%Z Gl ��i
fe�v�a�
1
cc: Facility Assessment Unit
Use Attachments if Needed.