310246_INSPECTIONS_20171231

NUH I H CAROLINA
Department of Environmental Qua

2t.(1
for Visit:
Date of Visit: is
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Operation Review
0 Emergency 0 Other 0 Denied Access
Arrival Time: 0 D Departure Time: v County: Region:
Facility Contact: 1 Title:
OnsiteRepresentative:yoo^
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: / 7/ % T
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wen to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
5 7 O PO
Dr, P�oul
Layers
Design
Ca aci
Current
P,o ,
Dai Heifer
D Cow
Non -Da'
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Pullets
Turke s
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 Io Q NA ❑ NE
[—]Yes [:]No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�J- 5o[] NA ❑ NE
Pape I of ? 21412015 Continued

Facility Number: - y 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): (2 03
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
Structure 5
No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeotal t eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No -NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes 0A0_ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q NNoo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 o ❑ 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
ZrNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-No-0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D'1Vo__❑ 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
E] 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
2-N . ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Pane 2 of 3
21412015 Continued

Facili Number: 3 1 - 2 b jDate of Inspection: 3 Z 717
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
2; Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
No ❑ NA ❑ NE
Q'No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No FAA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
[(' Noo ❑ NA ❑ NE
01KO ❑ NA ❑ NE
Reviewer/Inspector Name: 06f ' C� (� oQ '� l� Phone: I ( o-7 T 6 7 3 o y
Reviewer/Inspector Signature: �` —�/ Date: 3 Z t ,-7
Page 3 of 3 21412015

for Visit:
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Arrival Time: Departure Time: County: Region:
Facility Contact: Title:
OnsiteRepresentative: 0r'L�,t
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 7�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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 [3-N-6_0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - -.2-(( jDate of inspection:
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
{�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ 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
E]-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
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
[J 5
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area _
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3<o
❑ NA
❑ NE
acres determination?
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
b
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No/
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
O
I o
777"""
❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesg�N�
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: I - jDate of inspection: 6
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 [ N- f ❑ 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 L/J rvo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No EINA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ICJ "" ❑ NA
❑ NE
❑ Yes
0_90_�[] NA
❑ NE
❑ Yes
ONo ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes d-NO ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (O - / !v % C7"'
Date: ( 16
21412014

Cj
(Type of Visit: (3'Com nce Inspection V Operation Review O Structure Evaluation (_) rFechnicat Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 f7 10 Departure Time: FT, I O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
ROAIt (4 Fz Z'rN
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1-7/ 9 1(
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
MUM
La er
!Mayer
Design
Capacity
Current
Pop.
Design C+urrent
eattle Capacity Pop.
DairyCow
Wean to Feeder
Dairy Calf
eeder to Finish
760
/YOO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r,+ P.oultq
Layers
Design
Ca acit +
Current
Pao .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 I o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[E'»-
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

FAcility Number: - 2_V jDate of inspection: C
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
l z- 3
Co nnecf-�d
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 ffNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ 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 Ef No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O-No
❑ NA
❑ NE.
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
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
F(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N
❑ 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 ❑Othe
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 l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fn No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Ficility NumberDate of Inspection $
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3' o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ETYes [:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ErNA ❑ NE
Other Issues
28..Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
E f No ❑ NA ❑ NE
do ❑ NA ❑ NE
VNNo ❑ NA ❑ NE
Reviewer/Inspector Signature: �'"�-y//,,.,/(_ Date: J 6 / 3S
Page 3 of 3 21412015

Type of Visit: ,QjCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J�®-� Arrival Time: Flo !i)Do-M Departure Time: �:Qp County: 9/1lDI�`yt Region:Y;R8
Farm Name: Aonry'a E� `' f'�nrvv� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:
Integrator:
Certified Operator:
f�TM�.18
�L
7, � y�\`
Certification Number:
n
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
07.9115B ltr. �
Layers
Ca aci_
Pop.
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPuults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2'No
❑ NA
❑ NE
❑ Yes
EIo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

r
Facili 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
�TNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L4 L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
XNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;2`No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6 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
,,,��Z{{{
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?,
❑ Yes
VT'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gj No ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WrNo
❑ NA
❑ NE
25. Is the facility out of compliance with pemut conditions related to sludge? If yes, check
[:]Yes
W17No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
;;�'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
4-No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
.5�No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond El Other:
!!C
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Vf No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �1 'h� "� �ae1\�
Phone: �5�- i LEWL51)
Reviewer/inspectorSignature:
Date: �—
.%fLf
Page 3 of 3
21412011

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: &Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time "; Departure Time: FM County: Region: /M
Farm Name: Ql9YVIA J��J-eJ I /d err 1 # 1 —1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Certified Operator: 4nmx, t• T
L ZM11
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number: p�Ij
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry - C>apacity Pop. -
I 11-ayer
Design Current
ty Pop.
C•attle Capaciall
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
P
Design Current
D�, P�oult , C•_a aci Po ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
L
Pullets
lBeef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2f No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[-]No
❑ NA
❑ NE
[:]Yes [:]No
[]Yes [%rNo
❑ Yes OrNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

•Facili ` Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes [ rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
J U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6No
❑ 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
D No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KrNo
❑ 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
Z[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2fNo
❑ 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
EJ�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CU No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ErNo
❑ 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 e-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes"Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facid Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and%or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 CAWW?
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 0-No
❑ Yes ENO
❑ Yes ONO
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[—]Yes P�`No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes W No
❑ Yes Y5 No
❑ Yes [ZNo
❑ Yes Vj No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
(Comments (refer to. question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oaees as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:��6: _
G
Date:
2/4, 2011

(Type of Visit: CaCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: t �yAtJC A Region:
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 'ZOYN16 Ez :z F U _-
Certified Operator: PjQ�I�}� T
Back-up Operator:
Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
CapacityC
urrent
Pop.
Design Current
Cattle CpacityaPop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
t p
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul_.. +
Layers
Design
Ca aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
❑ Yes � No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: Date of Inspection: I 1 I
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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: d
Spillway?:
.5 Ri 5
Designed Freeboard (in): 19.6 )9.5
Observed Freeboard (in): 9C Ll __T 3 O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 �r 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) yT��
9. Does any part of the waste management system other than the waste structures require ❑ Yes 11(I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Iy I No
. ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptablle''Crop Evidence of Wind Drift
❑ Application Outside of Approved
Area
/Window '❑
12. Crop Type(s): S c-, Cc ziy WH( r7 I J'l>
13. Soil Type(s):
1 (' Cn-JON ApepOl%�_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
i No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ElYes 17d 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.
Q WUP ❑Checklists o❑ Design 0 Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application❑ Weekly Freeboard Q Waste Analysis [D Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall [:]Stocking Q Crop Yield ❑' 120 Minute Inspections Q Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A�, No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ' 1 No ❑ NA ❑ NE
Pagel of 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. t
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 777❑��� No 19 NA ❑ NE
Other Issues H,
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 7t No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 70
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
0
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7T
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 CAWNIP?
❑ Yes
�{,
No
Tj7t
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.Ir/�il
t' No
Y'C
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
wf
14
Cpu� i � oN %ter �O1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I► Ya / t Arrival Time: Departure Time: ® County: b(n Pq At Region:
Farm Name: 'J_�14LF�> � Erb Owner Email:
Owner Name: ��jL� Ear E L_L_ Phone: 9 10 — 9qM 3'- CLCa
_ 6 C
Mailing Address: VL' 0939. —�-0
Physical Address:
Facility Contact:
Title:
Onsite Representative: ��J�©T/N! E I . F Int g�rato��r:,,
Certified Operator: Q)qA} LD i ��'�l✓LL. Certification
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Number: )DACI q
Certification Number:
Longitude:
Swine
Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -La er
DairyCalf
Finish
parrow
(per
Da' Heifer
Wean
Feeder
Finish
I) . P,oultr.
La ers
Design
C>a aci
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
TurkeyPuults
Other
Beef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 7(Y�j'7�'' "No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: - 4 (0 Date of inspection: 3(j
Waste Collection & Treatment
4'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,
1 /�{ No
TTT❑"`No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
q
Designed Freeboard (in): )9.5 %/• S
t-1
Observed Freeboard (in): U S SI-1 u 14
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
kNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes lyl No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �[
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ' ❑ Evidence of [Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5 v CQ(LA/ H641 S L]
13. Soil Type(s):
LC
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?
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other.
❑ Yes 14
No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes h No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jVNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - t-/ C971Date of Inspection: _ U
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo
o ❑ NA ❑ NE
2�. 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 PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�[
IXeeeel No
❑ NA
❑ NE
❑ Yes
\No
❑ NA
❑ NE
❑ Yes]{
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes to
❑ NA ❑ NE
!Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:,
Use drawin¢s of facility to better explain situations (use additional oaees as necessary).
l►Sli� (_0 i.co i.S
5up6C S(Av_uE!� EXCM�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -J.I6 -_J /Ip-J))-
Date: ` 10 / 1
21412011

Type of Visit Acompliance 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: %3 () Arrival Time: Departure Time: County: Ll N Region:
Farm Name: (NAt! � G'�C-L L F1}2 M * I-R- Owner Email:
Owner Name: Yt-O//N'' g Lb 1 ��� LL Phone:
Mailing Address: "1-4O S CARUtot_Ls V-3 �(�Q� ). ,A/C
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative� ALL integattto)r: p
Certified Operator: q.,coyacb T , Ce—acq-L —Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design Current
rent
�0.
Design Current
Swine Capacity Population
Wet Poultrylation
Cattle
Capacity Populatiou
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
airyCalf
to Feeder to Finish
100C>
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Pullets
❑ Turkeys
❑ Boars
❑ Beef Brood Co
Other
ElTurke Poults
Number of Structures:
❑ 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
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,&o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility I4umber:2.( 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: o�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y L4 (D
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any
of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes
)kNo
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes]
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
\
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
No
ElNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 4 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo []NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
+
12. Croptype(s) C`, wC` NQ'! Svi) WAN
13. Soil type(s) NAer—o (- r-O(ZesT-Q 11
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� (
j[J No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
INTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ty No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ 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 asinecessary) h ` �• '
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — (p 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. Q 0 Design El ❑Other WUP ❑ Checklists // ��
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ANo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑❑l /nnual Certification
El Rainfall ❑ Stocking 0 Crop Yield Cl 120 Minute Inspections 0 Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ 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?
❑ Y
,�ryjqNo
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
El NA
❑ NE
Other Issues
17T��t
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
���,,,Vqqq
�I 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
tz
p{,� No
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
\
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
I
❑ NA
❑ NE
Additional Comments and/or Drawings: `
w• A ► 2- 3
CC4aZaRj)CW T_NLkC �C) 1
Page 3 of 3 12128104

Type of Visit Q'Compliance Insp ion O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine complaint O Follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 6 a 6p Arrival Time: /'t_� Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: % Title:
Onsite Representative: ROO t1ilk ` Z71 t—L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: F--I00,0" Longitude: mom, o„
Design
Gurrent
Design Current Design Current
Swine
Gap, ecty
Popu� latioo
Wet Poultry C•apaity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer I ❑ Dairy Cow
10 Non -Layer I ❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
Farrow to Finish
ElElNon-
❑ Layers ❑Beef Stocker
Non -Layers ❑Beef Feeder
❑ Boars
El❑Gilts Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Turkev Poults
❑Other Number of Structures: El
❑ 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 ErNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
[I NA
[I NE
❑ Yes
❑]No
❑ Yes
0 NN/o
[I NA
[I NE
❑ Yes
2 o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 — Date of Inspection 16 d
�aste 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: LA&dIStJ LA �rcy- ✓L (,�,VTFi=i�JN,t�'tTl
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 53
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes d o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
�
6. Are there structures on -site which are not properly addressed and/or managed
�
ElYes ❑'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 dNo ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes CJ 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 El Yes CI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement? ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes CXo ❑ 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
E ❑ NA
[I NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[I Yes
IJ No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
VNo
❑ NE
18.
Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Co meats (iefer to question Explain any„YES answers and/or any recommendations or�any other comments «Y
UsedraHn#ngs of facdtty to better exPlam sgttuations (use addrtional,'pages as necessary), „w * 'h
(. 'V w. '�i,�. .,.f/^go.�`/
si�el� Rcrvl•V'C g/tn`n �fa.� �!, / onz�v ✓tt/f r;./.S 4kC/ wi / ✓erg'L
S
•t4 nCA-W-4.✓L"ih'J/ '/ d'/C./dJ. ✓`✓� ��wl/tZYO �t.i i /
�" 30 l4'
l'!.e kL i�•�ti,. J 1>, {-d-
.t.� ,: A
'
/
"a��l.'�t-!<s✓',1
/
l��od3:ArrN�r ��cttt7C •!/ �a+S4� �ar Bc�IQ/ til�olylaiA�rin S�/%l�M"
Reviewer/Inspector Name t n/ (�(;,' - .. Phonen/t 716
Reviewer/inspector Signature: Date: In
12128104 Continued

Facility Number: �j — a�f(� Date of Inspection is b
Et'guired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA UNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA GNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA CZNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
1_1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[:3NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[2111NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ No
❑ NA
EE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[I No
❑ NA
NE
Otherlssues
0
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
UeNE
30.
and report the mortality rates that were higher than normal?
At time the inspection did the facility
dNE
the of pose an odor or air quality concern?
❑ Yes
Ef/No
❑ NA
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
1
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E NNo
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
a<o
❑ NA
❑ NE
12128104

IType of Visit FY Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit .Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: yn/ � Arrival
'TTime: 4S f' —]Departure Time:
i� County: t) uN Region:
Farm Name: nVoAl cy{ , 1-,pz2F L L- 1-Ate M tr �— p Owner Email: m (?
Owner Name: VOVQC_SJ ) . E_2-?Ec.L Phone: 9�f(/p6�
Mailing Address: 4 i C' 3 • CACM t S �4 V—SAw t / • Z �' U J�o - -,Op S�
Physical Address:
Facility Contact: Title:
(%
Onsite Representative: 'ram Y1V1F_
Certified Operator: VQNQ -ice L•
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 1-4) l '-f
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish 1
❑ Layer I❑Dai Cow
❑ Wean to Feeder
ILI Non -Layer 1
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turke s
Other
❑ Turkey Pouets
❑ Other Number of SVudures:
❑ 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 I;U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes 0,No ❑ NA ❑ NE
12128104 Continued

i
i
Facility Number: I — (4701
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I GrL LS
Spillway?: Designed Freeboard (in): 19.5 19.
. ct:> 19.5
Observed Freeboard (in): 1-100 45 H q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes WNo
❑ Yes ❑ No
Structure 5
[I NA ❑NE
❑NA El NE
Structure 6
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes q 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 TC1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'tyl 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 JANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes TTTTTT111111�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ 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
El Application Outside of Area
12. Crop type(s) S G' 0'07 'y LA 1 EA I � 1 �
13. Soil type(s) COCA.(' STCYq
l / VO�ZFOL_t<'
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
D(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No
❑ NA
[I NE
Does the facility lack adequate acreage for land application?
[I17. Yes
No
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommenidatton r any other Comm n "sUP
Use dra ings of facility to better egplam situations.(use additionahpages as necessary) �.;?-?.: ,.. .. ..._
I. y 6.9-�-
91QL1 log I.
Reviewer/Inspector Name A l�tpiN s _ Phone:
qlQ-49(o-- 39
Reviewer/Inspector Signature: p_vY'.P) Date:
9%9il0 I
12128104 Continued

t
Facility Number: Z,—�l,01 Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�kNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
El NA
[I NE
the appropriate box. El WUP ❑ Checklists ❑ Design
g 0 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Waste Transfers
❑ /rnual
Certification
El Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes fi!�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tg No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/ `
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
( No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
] No
❑ NA
❑ NE
12128104

11
- M ✓
lOr Division of Water Quality
~1FaCltity Number 3_ al.J(p 0 Division of
Soil and Water Conservation
O Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6g Arrival Time:1 / - Departure Time: p� County: I/1/ Region:
Farm Name: PANAL\'�- 1 2 CLL `-A(W J- d Owner Email: 2
Owner Name: RCYJACN I ���Etnt, Phone:
Mailing Address: L4� S CActiLo lLS K G wFt+c �A(�J , /V e a $39 s - s s
Physical Address:
Facility Contact: Title:
Onsite Representative: \ZOA114 / E F_-1 Z E L L-
Certified Operator: 9,(51qL)1•-ri _F E'Z7L-G(-L
Back-up Operator:
Location of Farm:
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: `�4 iq1 Li
Back-up Certification Number:
Latitude: = U = . = Longitude:
Design Current Design Current Design-
'apacity.Populatiou: . Wet Poultry Capacity .Population Cattle Capacity- I
f l ❑ Layer I I ❑ Dairy Cow
❑ Non -Layer I_ _ _ ❑ Dairy Calf
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
=�M
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
Z No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Faeility Number:
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I a 3
Spillway?: Designed Freeboard (in): ) 9. s 1 1p . S 19.5
Observed Freeboard (in): L4 I 4` N C>
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes O�No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IoNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VrptLNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
ld No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P(No
❑ NA
❑ NE
'Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I V-1 CO r4 14 QA 'A NF— Phone: L110'4 j&-75e1-/
Reviewer/Inspector Signature: �. Date: j I / On Id a
Page 2 of 3 12128104 Continued

Facility NuDate of Inspection Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J6No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WIIP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;gNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U(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
JUNo
❑ 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
KNo
❑ 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
VfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
❑ NA
❑ NE
'Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality ,
Facility Number i { O Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 6�C(gt_npliance 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: ii ; Oti Arrival Time: LOO Departure Time: County: owl'Lo Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: !1 Title:
OnsiteRepresentative: IZ,dNN �'Zi.ELL
Certified Operator:
Back-up Operator:
Location of Farm:
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [�U = E Longitude: [ ---- ]o [ ---- ],
_ Design Current Design Current. :.
Capacity Population Wet Poultry Capacity Population
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
i
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 allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [--]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E NNo/o El NA ❑ NE
El Yes [ <V o ❑ NA ❑ NE
12128104 Continued

Facility Number: �'J( -a�� Date of Inspection t r I o(.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: (AFrv-d^J t C,Af-Aoi•l L CACr�j
Spillway?:
Designed Freeboard (in): 1 4. s-j 9-
Observed Freeboard (in): 4� 44 Z �Z
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 `i/ 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? El Yes D NN/o El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'Iqo- ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Dl o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ej4o ❑ 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) e(,),5
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNNo
[INA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ElE Yes
NNo
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,
INo
El NA"
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,L
� N
[I NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or: any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary): ;
(Art.mk#E - NAs APPLaD To $E ?-C-MaJEV Fn4yVV n1PDE5 r�Cann�i
IReviewer/Inspector Name J7 w d Phone) '146 - '1 W I
Reviewer/Inspector Signature: Date: (1 I13 I61,
Pane 2 of r 12128104 Continued

FacilityNumber: 3 j — %y6 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 ❑ Desi gn ❑ Maps ❑ Other
❑ Yes EYNNo ❑ NA ❑ NE
❑ Yes 1[J No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste App_li(c�tion El Weekly Freeboard [I Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
Elinf Rai I_/_I Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 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
,L_J,/Nf
l�l No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONNo
ElNA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
0<0
❑ NA
❑ NE
Other Issues
28. Were anv additional moblems noted which cause non-compliance of the mermit or CAWMP? ❑ Yes L9 No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
E31�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
Yes
[IL_
,�
YNo
❑ 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
P�Ko
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FKo
❑ NA
❑ NE
Comments and/or
Page 3 of 12128104

Type of Visit Ghcoo pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit td Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: D o$ Arrival Time: / / $' Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: �0nL- GZ2-jP—LA_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: = c = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
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
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: '=
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 L1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑j No
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: '� (— cY 1� Date of Inspection 6 2— p.(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (Aii-WJ I /A6,wW 2, cAGmrJ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): go U (4 Ci Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes rNNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IdNo ❑ 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 El o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,_,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,�o
L
qo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
�•Y
E o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[�,Kci
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L,d'No
❑ NA
❑ NE
'.I.) I�EP �� `� O F ANX)U A li CCIL�S HZCATSUJ w�i-► Ct-F. CoII.DS,
�AfLnn f�tsD ZE,Ce20S 7XA) Good S�IAPE.
Reviewer/inspectorName hJ, ' j Phone:C'4/Q)r/q(�— ]a6 $
Reviewer/Inspector Signature: Date: /o L;Lo /6J
72/28, Continued

Eacuity'Number: - a, Date of Inspection l o Ze o S
Required Records & Documents 7No
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Elryes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
D Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Elu Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,_/No
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[TNNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,ham//No
L7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
tNo
❑ 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
ftNo
❑ 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
`,"V
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑-1q'o
❑ NA
❑ NE
Additional Comments. and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Nate of Visit: /o y Time: Od
� 1 (,
Not erational Q Below Threshold
Permitted Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .._— Ro1Naw,._GZZEw (Aityn _��g____._ Coun Dvfyz
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title:._____._ Phone No:
Ousite Representative: �AkJQZti E t l �.. integrator. a it"u-;S
Certified Operator:—_ __.._,,,---_ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude =` =1 =11
Discharges & Stream Impacts //
1. Is any discharge observed from any part of the operation? ❑ Yes 0No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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 L--�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2fio
Waste Collection & Treatment ��
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes l,��lvo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ___ 1 _ — 7- . 3
Freeboard (inches): yd 90 3 Qf
12112103 Continued

FacilityNumber: 3 — a.y jq Date of Inspection
o, 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑TIo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes QU
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ff rNo
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes B/No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes n No
elevation markings?
Waste ADnliCation
10.
Are there any buffers that need maintenanceltmprovement?
❑ Yes
El-Wo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Brvo
❑ Excessive Ponding ❑ PAN 0/ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
v
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
<o
b) Does the facility need a wettable acre determination?
❑ Yes
,
c) This facility is pended for a wettable acre determination?
❑ Yes
--rvo
11No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[J'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes El"No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [}No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C; 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 pNo
Air Quality representative immediately.
SS, ) IcbS0 caP ; oT puNvAL a g.TSF rCA
❑ Field Copy ❑ Final Notes
tJSTIJ
CAR-E UL
Ott APPL'zcA-M6d WSND61-/ V&R_ S6g6fili45.
c4,,P_ EN-W PLAjj uS At,
E�o�tsC.
PATE K 9itS, WHEN
NEW WUP 661'AMIJ
4;6n, u%TNoisyj. f
t 6,, flDe9
-rw PVrAf ?AST OATS
&ro r mL-TM S+ W To
CI.IEM (oti. ��ISsetJ_
1FA LM ZL►') Vt_ tvi
Reviewer r Name /tuspecto U_.
(peso Suf+PE,
Reviewer/Inspector Signature:
Date: 16
12112103 _ Continued

Fgcility Number: 3 1 _ 24 1 Date of Inspection I b r& •
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Cn o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
_�o
[3/ o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
�/
(ie/ discharge, freeboard problems, over application)
❑ Yes
p No
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
❑ Yes
[3/No
28. Does facility require a follow-up visit by same agency?
❑ Yes
G3
29. Were any additional problems noted which cause noncompliance of the Certified AWMP.
[I Yes
LJ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
ore's
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
13'No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
WO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Ea'No
34. Did the facility fail to calibrate waste application equipment?
❑ YY
[� No
35. Does ord keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
Yie Form El Inspection
L7Yes
❑ No
Stocking Form []Crop ❑Rainfall After I"Rain
El120 Minute Inspections Anneal Certification Form
0 No violations or deficiencies were noted dm_ing this vmt. You will receive no further correspondence about this visit
::i ..•
@anmeai�aad/orDrawmgsP-? �-� �»• �• � -, �_ - 3 3tr- `. A
r,;...aZT.3Te2�TR �
12112103

)4Division of Water Quality ..
t Division of Soil and Water Conservation
�x
'4
O Other Agency-
c
Type of Visit Compliance Inspection
Reason for Visit � Routine O Complaint
O Operation Review O Lagoon Evaluation
O Follow up O Emergency Notification O Other
❑ Denied Access
IFacility Number Date of Visit: I _ Time: S Printed on: 7/21/2000
0 Not Operational Q Below Threshold
{p Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
/Farm Name: ..1..2.Q �L.Q......l .. 1. ...:L.....F•......�.0.................... Connty:............ 1,��...��..i�16/......._.............................
OwnerName: ...........491-✓A40....................................7��fr 1-................ Phone No:......................................:...............................................
Facility Contact:
Title:
Phone No:
Mailing Address: ...
ddress:....,,../../..y.......................................'..............................................................----.../..'J..........................�................. ..........................
Onsite Representative :.---.. 4f./yr7�_._._.-_----......../-:..ZZ,L-,-..-.- Integrator: _.(,/�OLL.-,$
Certified Operator:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Curr
C'�narity Pnm.I.t
Operator Certification Number:
Latitude Ono` 0.. Longitude =• 0` 0..
-W Wean to Feeder
i Feeder to Finish
Farrow to Wean.
Farrow to Feeder
Farrow to Finish
Gilts
:,,:y Boars
Design Current
Poultry Capacity Po ulation Cattle
❑ Layer ❑ Dairy . -..
❑ Non -Layer ❑ Non -Dais
❑ Other I i
Total Design Capacity
Naml of Lagoons' -:{ 2 j ❑ Subsurface Drains Present LagmwSpray
Area ❑ Field Area
" _--`
oldtng;PondS/SoLdTraps OW
No Li uid Waste Mana ementS stem
v
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated Bow in gal/min?
it. 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 PrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ['No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I • Structure 2 Structure 3 Structure.4 —Structure 5
Identifier. ......... ........�l}r.._.._.........._..........................
Freeboard (inches): �J 3'7
5/00
[]Yes ;jNo
Structure 6
Continued on back

Facility Number: — Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) -
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [�No
(If any of questions 4-6 was answered yes, and the situation poses an /
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 777 (No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 1i71
elevation markings? ❑ Yes �INo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence f over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P�No
b) Does the facility need a wettable acre determination? ❑ Yes XNo
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes � No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
jg(No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ANo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
((No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
['No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
/VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
INo
tVti •yioCa(it}njs:eF dgf�c�enc#e •wgre ngted d(tt ih tbis: VWjt; • Y;ojt will-recgiye qti fu4 thQr. -: • :
cotiesnoudence:about.thisvisit:.........•.........................'.'..
/q) 0,F> 6z«y ©c�STo/✓ D�PGZ� S 'rJJ T C��✓Q ,eS;--
i�E�A� foR e�%1F�ir yr l � �rZ�•
are jPR�%FzF�/�S AV'9 �oD//D
Reviewer/Inspector Name
Date: 111T i'2 5/00

Facility Number: — Date of Inspection /��f� printed
on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�l
wit No
liquid level of lagoon or storage pond with no agitation?
TTT
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
/� No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
/[�
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
Additional,.. tnmenfsan or D
lrawknp:.
A,,
OU
5/00

13Division of Soil andWaterConservation Operation Review _ , T.± y; __
✓ � Division of Soil and Water'Coaservation CompBance Inspechon -
r
'Division of Water Quality � -om lumce Inspection "
_ r _ Qu tY-. p _
-=.0 Other Agency-::OperatiomReView
Routine Q Complaint O Follow-up
of DWQ inspection
Q Follow-up of DSWC review O Other
e
Facility Number
Date of InspectionTime
of Inspection .�p" 24 hr. (hh:mm)
Permitted E3 Certified [3 Conditionally Certified E3 Registered Not O erational Date Last Operated: ........................
Farm Name: ........... Qr!.....................................
County: ...... .....���..il�J!/..�1./._.............. ....`- _t......
OwnerName:......... OK�L......................
/L..!......................................
zZC4.........................................
Phone No:.........................Y..............................................................
Facility Contact: .....r/.:../�li...........z.l ill........ Title:.........{iX
.................................... Phone No: ...................................................
Mailing Address:........../.................................................................................................
Onsite Representative:........
/
......................................... ......................:.
........................................ ..
Integrator:.............
..............U,u.;�G/................................
......Ql/5....................................
CertifiedOperator: ...................................................
.............................................................
Operator Certification Number:..........................................
Location of Farm:
...........................................................................................................................................................................................................................................................................
=
Latitude =• =' ="
Longitude
=• =' ="
Design Current._
..- Design Current ,;, ,, _ .. Design . , Current -
Capacity Population
- Poultry' ' " Capacity Population Cattle Capacity Po iulation
' `: ❑ Wean to Feeder:.
❑ Layer ❑Dairy
- Feeder to Finish 1j;Z,*
❑ Non -Layer - ❑Non -Dairy
Farrow to Wean
- - -- - _-
�_: ❑ Farrow to Feeder
❑ Other - - •. -
❑ Farrow to Finish
Total Design Capacity
-s❑Gilts,
-:.:: -. --..
❑Boars
-TotaFSSLW
== Number of Lagoons -
;` ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area -
-HoldirigPonds / Solid Traps
.. ' _' ❑ No Liquid Waste Management System, .-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LayOM10/ GL a'3
Freeboard(inches): ................ .d......... �(�.......�Ch.n[............. ............................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
.j No
❑ Yes
,����///No
❑ Yes
pq No
Structure
6 \
[]Yes p9 No
Continued on back
3/23/99
1\

FacilityNumber: — d/,l Date of Inspection (,
6. Are thdie structures on -site which are not properly addressed and/or managed through a waste management or �- ������//////
closure plan? ❑ Yes I No
(If any of questions 4-6 was answered yes, and the situation poses an // ``
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes DK'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 5tNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[A No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
VLNo
11.
Is there evidence of over ap lication? ❑ Excessive Ponding ❑ PAN
❑ Yes
KNo
12.
Crop type li((/4
13.
Do the receiving crops differ ith those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
5LNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ YesINo
c) This facility is pended for a wettable acre determination?
❑ Yes
t% No
15.
Does the receiving crop need improvement?
❑ Yes
09.No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
04 No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes (<No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes k`No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ discharge, freeboard problems, over application) ❑ Yes RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes P�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Q<N0
C. . •Yiolatio ........n... mere doted..... this:v..........e.... do f.....: :
comes orideitce: about this .vtstt.::....::.. .
_, _... _ ..
Comments (refer to� nestiodJ#):` Explain'ait YES answers and/or any, recommendationors an ;,.,other,comments _
�Use.drawings of fi cility:to better explain situations. (use additional pages.astnecessary)c-_
�S �JuS� '6PTk_ havt'tskpL a',SpyG,ray, S �'t irL .
c azell s 24 l�v�/s L} re bAe-i_ dowvi_
l 1 Ace . eGi. 7 ✓� ca �Lt _ -7idt3i
6[a a,r A li cor l(� Z,kG /cptie4. zt`. c -{�i l j ✓ c(S art �O
I V 1:Y- t� vz-e l) hn w K+ n to ?Y. /m-IYA,✓l Y c 144,
Reviewer/Inspector Name - �ht°�/, :✓Y'E //-/.L',��L-;- ,.., _
Reviewer/Inspector Signature: `/���/_t ?E „ �� Date: G /3-fivll V

Facility Number: — Date of Inspection II (01
Oder lasuls
`�' W
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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �9No
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 [ (N0
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 [KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes (9rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (KNo
Additional Comments and/.or prawings: _ -
6�
w(`I�t�
�'IMS
ra/vrvv looks Y � to i c t �X e �2 e� C �i,
3/23199

`• 0 Drvisfon of Soil and Water Conservation Operation Review_ 3
• Division of Soil and Water Conservation Compliance Inspection _
77
ivision of Water Quality _Compliance Inspection _
Op 13 Other -Agency -eration Review r -
WrRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other 1
Facility Number f 2 Date of inspection q
Time of Inspection 24 he (hh:mm)
Permitted j2riffertified E3 Conditionally Certified 0 Registered 0 Not O era[ional Date Last Operated: „- ...............•......
.........Fa�Vi�.:....E7—T-&" _ Count ✓Pt', ................................................
Farm Name:.................................................................................... Y ...........,A.............r
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... .........................,
Onsite Representrtive:...... .t�,J/fir_e' %� 1�LL........................................ Integrator: ......... C.A..Q0-;i_1.�L'S.............................
.............
Certified Operator: ................................................... ................. ........................................... Operator Certification Number:..........................................
Location of Farm:
Latitude =• =' =-1 Longitude =• =' =14
- _ -- Design Current
--
-- Design' Current ,fie -. --_ Design Current-
...
_`_
"-Swine:-" -- ,' Capacity Population
_
-.PoultryCa acitg Po p ulation _. Cattle - Capacity Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer `` ❑ Non -Dairy -
.;
❑ Other
Total Design Capacity
- Total SSLWai
Number of Lagoons ®
_- ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
- HoldiiigiPoods / Solid -Traps
-:. ❑ No Liquid Waste Management System -
[]Wean to Feeder
❑ Feeder to Finish
�6 �
❑ Farrow [o Wean
❑ Farrow to Feeder
❑ Farrow [o Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? - []Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes FrNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) []Yes �No
c. If discharge is observed• what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N o
Waste Collection & Treatment TTT
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2�aStructure 3 Structure 4 Structure 5 Structure 6
Identifier: s� C' r`leGI' tG
Freeboard(inches): ............ nq.............. .........36...........................................................................................................................................................f
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes K No
seepage, etc.) -
3/23/99 Continued on back

f
Facilit Number: .�1 —2
Y �'� Date of Inspection
q t
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
-
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Yes
7.
Do any of the structures need maintenance/improvement?
❑
,�No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
YNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
�/ No
elevation markings?
Y5
Waste Application
1
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
yNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
1J
I� No
12.
Crop type cibR^j �LA34c�+!ESZF T .
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
(KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
XIn
15.
Does the receiving crop need improvement?
❑ Yes
Z/No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
QJ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
plflo
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[�'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;3'!90
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
;2'&o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ discharge, freeboard problems, over application) ❑ Yes ET'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes.bNo /
24. Does facility require a follow-up visit by same agency? ❑ Yes 0<0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes WrNo
dVti violafiotis;o� deficiencies wer8 it6fed-during this;visit.'- You' withrepeiye nti furthgr • ; • ;
cories otideii& abii if this visit:
- _
Comments (refer to -question #); Explain anyYES answers and/or anyrecoriimendationss;o[ any other comments: Use drawings of facility..to tietter_eaplain situations: (use additional pages as neces-
sary):`=
I qq? 'W Is ... ? { C.
t/<,dAj 14 6fF 'Z.',JC- / # SQJc S
P"VF Ous C'AMPI-ES O•r-
Reviewer/Inspector Name f--v
nroe-01KAt_ aQ. eatu— 3397I
Sa- lei; at/ ET- S044f i- Z'931 3 -3c87 7-S/G9
DD 4s_r Mc.r-aL_ 8cr-r--r'_--.
14RO TM) 27S
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Num Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ;3iY0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes e6No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;�J 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 2�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 ZNo
31. Do the animals feed storage bins fail to have appropriate cover? El Yes ZfNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ;dyes ❑ No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency.
Division of Water Quality
1A Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number
Date of Inspection
,31
Time of Inspection ML124 hr. (hh:mm)
U Registered 13 Certified 13 Applied for Permit a Permitted ILI Not Operational Date Last Operated:
Farm Name: ........Yi.aw�.t7 ........ .ZZ Lk ...... L'rn:,....._kL.)..� 5....................... County:.....!.tJ41ji.P.l...............................................................
. `
OwnerName:......!. Q...... FiY. IL ........................................................................ Phone No: ... �- ............................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ...q.-..jtt....c ...:`.......t^a�r m1.LS....U.<.......................................... ....� tea isa c 1....t.N �........................................... . IM..........
Onsite Representative: .... N'.0 l).................................................................... Integrator:.....! `.rx.>`.1.5..........................................................
Certified Operator;.. awl ....... Z ij................................................... Operator Certification Number;.....IZ.( q`..................
Location of Farm:
Latitude =* =, =" Longitude =• =' =[I
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ,MV,
a. If discharge is observed, was the conveyance man-made? El Yes Ltl No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flow in gel/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require M Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes rp No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes i" No
7/25/97 Continued on back

Laciiity Number: 31 — 2yte
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Laeoons,11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ �...........................L..`.{::.....................................................................:.............. -......................................................................
Freeboard(ft): Z-3 2.L.......................................... ...............................................................................................................................................................I.............
10. Is seepage observed from any of the structures'? ❑ Yes ® No
I I. 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.
t
Do any of the structures lack adequate minimum or maximum liquid level markers'?
❑ Yes
® No
Waste Application "
14.
Is there physical evidence of over application?
❑ Yes
91 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..... be;r.Mlo.....................50(!N................................ ... ati.......... .................. ..........................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
®No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
1� No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
N 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
O No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[9 Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
>` Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further
...... . ...... . ...... ...... . . ...... . ...... . ...
correspondence about this visit:: .
Comments (refer to question 1i): Explain any YES answers and/or any recommendalions-or any'other comrirents
Use drawings offrcilitq to better explain situations. (use additionalpages as nccessarv)c
r' ,.
S, Mr. ezzcll has Y=L ' ly cr.5iC.1 Vp:�e. vier 'Ff„r Qoacl•
2 - I • 1�ct�n ,, \1q sheulJ be ry aWcJ _
Ig�j.JConkiAs a � 'in1�\r.rzi (DeYmv�a_ t
7- ` zk U� ���Fi-,Q1� SrW�j/ C0.15iSM+-'� Tit- VW'nn11+ ( Ft tf.\,�Ot� il'Aln. �Ycr PA�1: J*
5n vvt avv- fad r�t�r] * 0 L 2S)�t/qL • ` I 1
S.� 40M",;Mi O) i33- 5v83
7c �� 7/25/97
Reviewer/Inspector Name Drtai- .( Il.�rc.l cix
Reviewer/InspectorSignature: �,�,�_�- Date:
�T�

`;❑ DSWC Animal Feedlot Operation Review u4
® DWQ Animal Feedlot Operation Site Inspection .m.
191 Routine V Complaint V Follow-on of D%VO inspection O Follow-on of DSWC review O Other 1
Facility Number Date of Inspection e z
31
Time of Inspection � 24 hr (hh:mm)
Megistered PCertified D Applied for Permit pPermitted JE3Not Operational Date Last Operated:
FarmName: ........ ?V.WkA... ..... Fktbn........IOng.............................................. County: ..... 1D. u�.Iili.......................................... .......................
OwnerName: .....S,0naA.-... Fr.Z.7.t)!............................................................................... Phone No: .... Clip �............................................
Facility Contact: ..... gopals..... Lzzel.................................... Title:
Phone No: �tilo) Z�-7L8L
1' L 1
Mailing Address: ... !i.7R0...SoU.ttir.....�Au�Cn.I1.st............................................................ JtuAY.SaW..;./V4................................................. ..7.-.n.91 ..........
Onsite Representative: ... 13.
P ' 1Q.J..... �� 2L#.�.1............................... :............................. Integrator: ........ �..rCu.�(S.........................................................
_? Certified Operator: ........a)-'..._6Zz,9................................................................ Operator Certification Number :...... 11114 11114 ..................
Location of Farm:
Latitude 0.=1=1 Longitude =00`="
Design
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedt
Farrow to Finisl
Gilts
Boars
ropmanon
Poultry Capacity Population Cattle Capacity Populati
❑ Layer I ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity .�
Total SSLW �—
Number of Lagoons / Holding Ponds, I Z JU Subsurface Drains Present �JU Lagoon Area I❑ Spray
I —I NJ . t ;-...A ckl—f . Ar.... n..n........ C.•�tr....
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
EgNo
2. Is any discharge observed from any part of the operation?
❑ Yes
fO No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance. man-made?
❑ Yes
VNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
M No
c. If discharge is observed, what is the estimated flow in ,ah min?
—❑
—
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Yes
(A No
3. Is there evidence of past discharge from any part of the operation?
❑.Yes
14 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EA No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
;4 No
mai menance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
54 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
PNo
7/25/97 Continued on back

Facility Number: 31 — 2t((o
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.tioldini! Ponds. Flush Pits. etc.t
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: � 1. *2_+ k3....................................................................
Freeboard(fty............j...................................4:..................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Aonlication
❑ Yes
A No
❑ Yes
'® No
Structure 5 Structure 6
................................................................
.................................................................
❑Yes
f$No
❑ Yes
No
Yes
❑ No
(•W,
_14 M.
14. Is there physical evidence of over application? ❑ Yes ID9 No
(If in excess of WMP, or runoff entering waters of tthe State,
1n_o t�ify DWQ)
15. Crop type .........SOl�ega,.S.....1..Got Ya........U�.hIA ................... (.YYtUja..................._ I..Irin.............. .......... ......................... ...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes XNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Nwviolatioins or deftciencies.were noted during this visit. You'Will receive no further
I'll. about this visit:-:
❑ Yes JgNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
❑ Yes JO No
[],Yes RNo
Z•Jbx<- 't'"„ or, tncan # I Should be nWf, Jj N6-s pr. ihnJ-r r.fw�l o� �n�catis *2_+-4t3 410do be,
�';�ltJ wCid c,4,j wtici rtMeedd, Inrtar wG1kz o� In'om,s kl Lf #3 SkoA) be rrmlUed,
>� �u c_VOps _A�' 6� gild, Sti«i3 be- It%NW N ccrFtl4W PP(a,..
coryxk acvr & in sptw� rt/nz sheulJ 4 usd in W6-oge, cw�IWlGhovtS. (%�o�
'CO tL* slavlb 6e p6.
za. ShoW L- er xifC-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: