310261_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: c nipli 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: Z 2 Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �l < < F4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: I r 6 f � -7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wearff to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
4 0 i
D . P,oul +
Layers
Design
Ca aci_ r
Current
P,o ,
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
—TurkeyPouets
Turkeys
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 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 6 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No
El Ye No
[—]Yes E No
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facili Number: Date of Inspection: z l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ 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 E2<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 environments reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VN
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes d/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
N�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes � N� ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes L_d <o ❑ NA ❑ NE
❑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 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3 - 2 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
No ❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Kj No ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ LJ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ErNo ❑ 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 PNo ❑ 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 LJJ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes N�/(�j NA ❑ NE
—❑
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No NA ❑ NE
Comments (refer to question'#): ExplaidanyYES 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
'N! d r% 1-(
-zp / 7
Phone: T' ° 73°Y
Date: Z 72 f 7
21412015

Type of Visit: Cf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: k,LLfa S /= �1��IS
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
to Feeder
Non -La er
Dai Calf
Mn
er to Finish
Farrow to Wean
(�'g0
D , P,oultr,
La ers
Design
Ca aci_
I
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
ers
Beef Feeder
INon-La
Boars
Pullets
Beef Brood Cow
Other
Other
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E No
❑ Yes do
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facili Number: 2 Date of Inspection:
Waste Cdllection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q� 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
6o
❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E: o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 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
ETNo
❑ 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
ETNo
❑ 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
]f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
r No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 fTo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:J�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ON—o
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [I -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ffNo ❑ 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 ['rN _ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 2 Cr Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ED No
the appropriate box(es) below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �NA' ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ,jNo ❑ 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?
Reviewer/Inspector Signature:
❑ Yes _[:j No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA E:jNE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes Aff No ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
Date: �6
21412015
Page 3 of 3

/ i
�� Division of Water Quality
Facility Number �„ I - 2 4 ( Division of Soil and Water Conservation
type of Visit: om iance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: p O Departure Time: of 39 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: N� �O'K S �-�✓ J1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 1 - V 5 & 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Ct
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
qlr 0 L
�,
D�. P,oult .+
Layers
Design
Ca aci_ +
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCOEW
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 EJ'No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
[-]Yes [-]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes
Ef
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 21412011 Continued

Facili 'Number: n- It jDate of Inspection: (� 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ N ❑ 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 ErNo ❑ 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 u ' V 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 E�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �fNo ❑ 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 MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,(
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L_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 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
ONO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6S O
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Noo
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LJ ❑ NA ❑ NE
❑ 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili •Number: 1 - 2 L Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[J No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ j No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
CTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O io ❑ 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
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
n, �No 0 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).:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 io-7167DoL
Date: VA_h�_
21412014

Date of Visit: �/�Arrival Time: : 4 Departure Time: .' County: Y/t,!)[}1 , Region: kzd
Farm Name: Q_A �je4aQdr—q4atn Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Certified Operator: { (( V Z�ttdz o. E�V"s
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
C>apacity
Current
Pop.
Design Current
C>attle Capacity Pop.
DairyCow
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Di. P�oultt,
Layers
Design
Ga acit
Current
P,o P.
Cow
Non -Dairy
Beef Stocker
Gilts
'
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El 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 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 XNo ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes E] No
❑ Yes y I No
❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page of 21412017 Continued

t
Facili 'Number: Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,rNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
VfNo
❑ 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
12 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
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 9No ❑ 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 VNo
❑ 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
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate Coverage & Permit
of readily available?
❑ Yes
V1 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VI No
❑ NA
❑ NE
the appropriate box.
-
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V j No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
,4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fatility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ZNo
❑ Yes r�_el No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Z No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes 4 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 71 No ❑ NA ❑ NE
Reviewer/InspectorName: yyj K� �.A7�1%1� Phone:61
,J a5
Reviewer/Inspector Signature: �_ �, �Af�y..,.� Date: 5 -3 D'1 1
Page 3of3 —� 2/4/2011

r ype or visit: iU s..ompnance inspection LJ uperarion Keview lJ arrucwre e.vamation kJ recnmca1 rnssIsaance
Reason for Visit: 011outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: a. D County: YH,ILJ/ M
Farm Name: -ytt� 1, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: LAIRD
Onsite Representative: Integrator:
Certified Operator: Ar-SE1a1. ID. IF�wa._ra Certification Number: D13
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Curtrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. , Pcoaltr, ,
Layers
Design
Ca aci
Current
Pao .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I I
—TurkeyPouets
Turke s
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes Z No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes 6No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
;!!['No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
ETNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
5TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E!J�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
IC16
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes X5No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
OdNo
❑ 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
9'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
r�t
U No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
6 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
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ 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
;]'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z'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
,21 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
ZJ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
CaONo
❑ NA
❑ NE
Page 2 of
21412011 Continued

,!;°, Facili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vj 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:
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
�ffNo
❑ NA
❑ NE
❑ Yes 71 No ❑ NA ❑ NE
❑ Yes ;n No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;a No
33. Did the Reviewer/Inspector fail to discuss review/inspection witli an on-site'representative? ❑ Yes VrNo
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: SAA4. WN CW;�� Phone:
Reviewer/Inspector Signature:Date:
Page 3 of 3 Q 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:` (4 Region:
Farm Name:'bEy TC-_CL Rf�pS rrR4l M Owner Email:
n (` c11O-93s--301 CXH
Owner Name: j('fEf` EOwA6Zf�S P�1Z hone:: qO l- 99(o-3�(a4CW
Mailing Address: ��� WI LLa�� {—� J�a�S 1Za 6 t.L(A U)L(_F,/VC o�C1 Slp
Physical Address:
Facility Contact:
Title:
Onsite Representative: )Z',1GX16iL &bW4aDs
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�(i0
I) . + P,ouI
Layers
Design
Ca aci
Current
P,o .
DairyHeifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef 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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page I of 21412011 Continued

Vacility Number: (- ( Date of Inspection: (p /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes TTTTTT❑"````"''''No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 061)(_
Spillway?:
Designed Freeboard (in): I Q•S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes , a No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) p�'
9. Does any part of the waste management system other than the waste structures require ❑ Yes 17J No ❑ NA ❑ NE
maintenance or improvement? V-"
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
*o
❑ 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
CO
12. Crop Type(s): (S� t,'
13. Soil Type(s):
!
co—rwfC TQ UlL(,e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U 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
We
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V 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
El Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists EDDesign ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. —] Yes '"'� No ❑ NA ❑ NE
❑ Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ yvaste Transfers ❑ Weather Code
0 Rainfall ❑ Stocking ❑ CAp Yield Q 120 Minute Inspections 0 Monthly and V 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IrAcility Number: - & Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes '% No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
!A No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
'#No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
l�/I 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes jo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yeso ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yeso ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orr comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ajp. N(3 (b161 dIL G�� Puf Go Pt1 w� (t�cc�fuis t3µt 1 ri aflGttu6T �cicf)
�j1MS t�IC�AcaruF✓
W.A.
�Ilsltt I.S
�.o
Soo/b fZRilo — /4AS STR�-'C"
L,gC�6oN Su,�OG� r OF LA��� S I �% Tti�
M� uI;D
wAp6E w
L µA,6L f3C �Gt�
f(cG&Ss o(r lLE%UICD/4CN TwaHIa4s6-s iNroor/C
Reviewer/Inspector Name: M.41V t✓17 GA I N E S Phone:R%%�G'/b�-�3
Reviewer/Inspector Signature: _ Date: II/�od
Page 3 of 3 21412011

Division o
FaciliyMir"erater y ConeramWilQWa ,
i
Q Other Agency' `"
(Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit i Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 Departure Time: County: IA1 Region:
Farm Name: 'i�)eX / &. L Qty Q6i.4JS r�A(t.M Owner Email:
�EaC7C-�t EDwpGn
�ro-R�-sue H
Owner Name: (� Phone: t-
Mailing Address: � �� C�A4ZV� 1 N� 12DS C3.1 � CL'(L- OIC_CIF'w of0 S %O
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: �i�n�-� ��(ilr���Integrator:
\
Certified Operator: ��X I C \`' L'�`'''�S Operator'Certification Number: J_SiG.LI�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� U = [� Longitude: Q o =' = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes t
o El NA ❑ NE
❑ Yes o❑ NA ❑ NE
Page I of 11/18104 Continued

jFacilityNumber: - -1 —
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 l Structure 2 Structure 3 Structure 4
Identifier: ZA lW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VVVVVV�No El NA ❑ NE
❑ Yes El ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes q 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 tJ reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �r(J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) I_ -
9. Does any part of the waste management system other than the waste structures require ❑ yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No ❑ NA [INE
ElYes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Igra No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No [I NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ElYes ❑ NA ❑ NE
Comments (refer to question #): Explain any -YES answers and/oryany recommendaiions-or any
Use'driwiugs of facility to better explain situations '(use additional pages as necessary).
Reviewer/Inspector Name j(/' S `� Phone: `/iU- tip"t3d�
Reviewer/Inspector Signature: Date: 02V%-%/

Facility Number: ( — / Date of Inspection
Required Records & Documents `
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes rANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. _ / ❑ Yes No El NA El NE
0 Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis ❑ ) aste Transfers ❑,inual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Q Weather Code
22. Did the facility fail to install and maintain a min gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
_kNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
t(No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�,No
❑ NA
❑ NE
❑ Yes
No
El NA
❑ NE
❑ Yes
No
El NA
❑ NE
❑ Yes
j�(,
I� No
❑ NA
❑ NE
❑ Yes
fi"''o
❑ NA
❑ NE
❑ Yes
�LNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
W '
11/nhc) 1' Ll
0Vly ► )
CA 04
C1J�o F� UOuP i U
Page 3 of 3 12128104

,Division of Water Quality /
Facility NLLtnb¢r I) I n oc t,y � � "0Division of Soil and Water Conservation
' Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O Arrival Time: /0 Departure Time: County: L N Region:
Farm Name: lax 1 E(Z D�6i+�rt%S �%�Q�Y) Owner Email:
�E C )tom �DwA4�OS Ph910-�8-3ola[►�
Owner Name: one: 9rn-'d4fo-'/S�IaC.. QB�w�
Mailing Address: -�` Aa ll O g L7E(�ll A V,y l LcC , /&
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: �c(=--i(Tez Ew"),go)S
Certified Operator: Yacf- -�z_ E O' aa_r\5
Back-up Operator:
Location of Farm:
Phone No:
Integratoopnr: o I QQ /^
Operator CCerh'fication Number: "'� (0 Ll
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o a
Design CGurrent
CapacityPopulation
Finish
Design Current
Wet Poultry Capacity Population
❑ La er
Design C•unrent
Cattle Capacity Populatio
Dai Cow
o Feeder
❑ Non -La er
❑ Dai Calf
to Finish
7Bo
DrPoultry
❑La ers❑
❑ Dai Heifer
D Cow
❑ Non -Dairy
Beef Stocker
to Wean
to Feeder
to Finish
Non -La ers❑Beef
Feeder
El Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Brood Co
Number. of Structures: F
I
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 No [INA [INE
❑ Yes ''❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No
❑ Yes J�No
❑ Yes LZ 0
12128104
❑ NA ❑ NE
❑NA ❑NE
El NA ❑NE
Continued

Facility Number. —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA OOX/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Ll0 No El NA ❑ NE
El Yes 7❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L�Q No ❑ NA ❑ NE
❑ Yes ✓XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �iNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 19
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
V(No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
% No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
'A No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
§�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
)d.No
❑ NA
❑ NE
'," arm
Comments (refer to question #): Explain any YES answers and/or any recommendahons.,og any other comments
Use drawings of facI U3�` to better explain situations. (use addthonal pages as necessary) "'
Reviewer/Inspector Name I i(iIANOA ES' Phone: i(0— $�
Reviewer/Inspector Signature: Date:
ttitaiva uonunuea

I
Facility Number: — Date of Inspection t- /O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes X No
❑ Yes )kNo
❑ NA ❑ NE
❑NA ❑NE
❑ Yes , No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑/aste Transfers ❑/nnual Certification
0 Rainfall ❑ Stocking ❑ 4op Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and
maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
w•4-
miw/o / . -(
1 I /as/o01 l • Co
❑ Yes gNo
❑ Yes t� No
❑ Yes VA No
❑ Yes �Jo
❑ Yes No
❑ Yes •�\ No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
KN.
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
[I NA
❑ NE
❑ Yes
tKNo
tdl No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
12128104

(Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1 QN Region:
Farm Name: ��XT��-- Y_nWA�-�� Owner Email:
I l♦�XI E� ��W(�a-�S Cts�-a4&-`30 a[h� OwnerName:. Phone: r/'�
MailingAddrem:._ot J W1LLQ¢� t-^ gfbwn � G}�I Ru)LL♦"t 1,A/C 085W
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: \,iEXTEt2 Y':�w�S
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: ) (P3%i`7
Back-up Certification Number:
Latitude: M o f ---- 1,
M Longitude: [----j ° M , M
Design
Current
Design Current
Design Curre111111 nt
Swine
Capacity
Popul��tion
Wet Poultry Capacity Population
Cattle
Capacity Populanua
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
D'y Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ers
El Beef Stocker
❑ Gilts
❑ Pullets
❑Bee f Feeder
❑ Boars
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Turke Points
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 �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
1ANo
❑ NA
❑ NE
❑ Yes
't2�AIo
❑ NA
❑ NE
Page I of 3 12128104 Continued

1
Fdhility Number: Date of Inspection % O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes •❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ��1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FNo ❑ 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
❑NA
❑NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes;No
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 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 Area
12. Crop type(s) Y> (_L S (:]�
13. Soil type(s)
14.
v
Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
_J� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
R� No
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
N9_Lvo
❑ NA
❑ NE
Reviewer/Inspector Name (� t4 G Phone: //�U ` i'1(o - 9 1 .1
pc I
Reviewer/Inspector Signature: Date: // oq
Page 2 of 3 I2128104 Continued

1
Facility Number: 5 1 —a61Date of Inspection loll-21u �J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )qNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes U No ❑ NA ❑ NE
the appropirate box. 0 WUP ❑ Checklists 0 Design ❑ Maps
p ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes
Yes � No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ �aste Transfers ❑ edttnual Certification
0 Rainfall ❑ Stocking ❑/lrop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'�_"'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
qNo
❑ 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
E�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
qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
.4No
❑ NA
❑ NE
Page 3 of 3 12128104

G Division of Water Quality -
Facitity Number ( a(p ( 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit QrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / ° Departure Time: County:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1 r Title:
Q(�ll
Onsite Representative: _ I LLB I' 0y5 1 oN
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: =o=, [�"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
x_.
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(�rNo
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
12128104 Continued

14racility-Number: 3 1 —,0& 1 I Date of Inspection I Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z? 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: (�FFGOO/t/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1R 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
RNo
❑ 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
yJ No
❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ 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
[K�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes
,FR No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
FVrNo
❑ NA ❑ NE
❑ Excessive Ponding [:1 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 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
M No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[.'�lNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a(p. CET �.ot?�df
dIC. �IKEE� w( 2.ECo(tAS SEraF� co�yTO �k1C�
Reviewer/Inspector Name
q ,4 GA/A'E} ONN FA2KE L Phone:1%-ry�
Reviewer/InspectorSignature:
4t. Date: o9//�d6
12128104 Continued

Facility Number: 3 1 -a(p J Date of Inspection 1 61
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes o No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [91 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
[INA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EO No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IV No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
® Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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 concem?
❑ Yes
Z 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
FKT 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
5P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments and/or
12128104

6,
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - _ --- Q Other Agency
Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency WOther ❑ Denied Access
Date of Visit: / ' Arrival Time: ' q Departure Time: County:
!
Farm Name: �F,1"f_/IGcJDS Owner Email:
Owner Name: 42s �— Phone: _
Mailing Address:
Physical Address:
Facility Contact: %� Title:
X 1 Onsite Representative: 411—a% L2&24W 5-
Certified Operator:
Back-up Operator:
Location of Farm:
ie
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: & Ay
Latitude: [o = [� Longitude: '[�U [�,
Current' Design Current Design Cal
Population. '. Wet Poultry 'Capacity. Population Cattle :Capacity, Popu
Dry Poultry
❑ La ers
❑ 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?
❑ 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?
Page I of
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
El Yes
/
YNo
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes X�'No
❑ Yes ❑ No
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):r
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 ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA PNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA gNE
(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
[I Yes
El No
r
[Iw NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[:]No
❑ NA [ENE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA /OrNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
r�
[Iy� NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA�9NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA;NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA XNE
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):,
�(/O1I�, ,j,�R�I�fzEcpS 4' 1'4w
�.✓� T�fjt> lff� acTu2F .S��F.o.
Reviewerflnspector Name r Phone:
Reviewer/Inspector Signature: ilnn .. Date:
Continued

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

Division of Water Quality F
Facility Number %61� O Division of Soil and Water Conservation
0 Other Agency
ITypeofVisit'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )( Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: parture Time: County: C< Region:
Farm Name: 25�GJas Owner Email:
Owner Name: I6F 1 F!( 5O)UmRDS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: tOE� 'sir li/%Cc/ I)Ao .5
Certified Operator: L/�YiF_Q� i 9 "/dd,0 i
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No: /� —
Integrator: _z9/% zw '� �`�el�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Longitude: = o = , = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev 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?
Cattle
Design Current
Capacity Population
I
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
ef Brood Co rO Be
J
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes , No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
[INE
❑ Yes
)ZNo
❑ NA
❑ NE
12128104 Continued

I
i
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�(
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 9.4—
Spillway?: /)r'
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
es
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) &e, Cl,, C�a44,) r _• (D/��>
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
I���JJ/// No
El NA
El NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
/lQ No
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ii): 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):
e -;,- So` & i/'r-s-r /<e4Ooe> 1
W/��-e 9�a $ YS�S :/l-7/o 1.9�
ek
3.0/ NI/N/a(-mi l-S, g1-fly q'
c.ec-
Reviewer/Inspector Name I (/ I Phone: (9/O) W/ — f37,2'r
/�
Reviewer/Inspector Signature: , �ji O Date: 5131o7—
Page 2 of 3 12128104 Continued

Facility Number: , j� —,�{.` Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P(No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PfNo ❑ NA ElNE
❑ Waste Application ❑ Weekly Freeboard ElWaste Analysis ❑ Soil Analysis ElWaste Transfers❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code '
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes I[f No El NA ❑ NE
El Yes rrrrlV rNo El NA El NE
j/ I ❑ Yes No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
—ttt
VJ No
❑ NA
❑ NE
❑ Yes
No
[INA
❑ NE
❑ Yes
/V1No
❑ NA
❑ NE
' ✓�,e� � J �r�Fic y /✓ , e lf✓
12128104

Division of. Water Quality
Facility Number (p Q Division of Soil and Water Conservation
©y
O Other Agency
Type of Visit Wcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A5 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other . ❑ Denied Access
Date of Visit: /` (p96 Arrival Time: D; /'�j Departure Time: fy� County: 4/pGL� Region:11
Farm Name: `t✓EYTf.P flu)Aan =� Owner Email:
Owner Name: J JEIfTf R r i i) D!S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: /�
Onsite Representative: T"f — �%A�OS Integrator: �%%�il.P,oes/tf _— 4 �ceD'k i i
Certified Operator: fx7f2 Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Other
Back-up Certification Number:
Latitude: o = I = N Longitude: = ° = ,
Design Current Design Current Design
Capacity Population Wet Poultry Capacity Population CattleCapacity"
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ;1 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes z No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 7
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
St ctu e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 45
Observed Freeboard (in): 40��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V(No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I/J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IVNo ❑ 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) �f�QjylGlp/} llfi�LF JI ff, l©dS�6��
13. Soil type(s) Aa, AD.
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/No ElNA ElNE
No ❑ NA ❑ NE
X11
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
�dNo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I /
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
ElNA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
ElNA
ElNE
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
JVNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
El NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,�{
(LI No
El NA
[I NE
and report the mortality rates that were higher than normal?
/rrryyri��
30.
At the time of the inspection did the facility pose an odor or air quality concem?
❑ Yes
No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / O S Arrival Time: Departure Time:ld'tiunty:
Farm Name: F,V�/�FtU /�l� �/�ji2A'L Owner Email:
Owner Name: Y/�i1�TfiQ GOLIJ�fi1�5 Phone: _
Mailing Address:
Physical Address:
Facility Contact: /� F Title:
Onsite Representative: y! /6.t�TGrIL `iQkW&5
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �/9gQOCL/
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [� o = = Longitude: =o =,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

iv I.
Facility Number: — Date of Inspection b 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?
Stn,rhve I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
ElNE
through a waste management or closure plan?
10
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
P�No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
El Yes
rr��l
I� No
El NA
El 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. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsidepf Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes
J0
PNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
W
'e e'&
f5 �o ZOE,
Reviewer/Inspector Name Lik7 ;'.gj Phone:
Reviewer/Inspector Signature: Date: 510 A9S

. '•
Facility Number: — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
f No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,,,------///
Lq No
❑ NA
El NE
❑ Waste Application ❑ Weekly Freeboard [I Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9(No
❑ NA
❑ NE
D.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
! No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
yyyyyy++++++
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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?
ElVJ Yes
�f
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
/5) ®w,✓��e ��/ �au.�o Z✓ a`R/i�i�U�S��'s G-✓�SP��4��y�,o.
a�vN�2 � L0�2•t�u�c/ Gliv� ran/. d.✓ �zs /�,o�S,
8rP S•9fiPGE �FSr��7s &7rs0 ,�31675.��r�nE
- �l/O7F_ ! ,Q�,coeo� /��i¢7- �s✓d A,060:�
12/28/04

of visit 0Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit Poutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number hate of Visit: if Time:
Q Not Operational Q Below Threshold
ermitted Certified 13 Conditionally Certified 13Registered Date Last Operated or Above Threshold
FarmName: ....... ............ __—................... County: _._. ou�N._......... _._.__..._ .._._._
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: ....... .e !_...4_S[�!!!5+ 2..__...... _....................... _.....
Certified Operator: .__................................ __..
Location of Farm:
Phone No:
Phone No:
Integrator:...—CX"V..._..................... _.......... _........
Operator Certification Number: ..... ........ ............ _......
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' =11
_ .. De51gn Current a : Destgp CUmnt a Destgn Current
Swrce ,, r =Ca an , Po'idation Podltry: _ ,Ca aci ,:Po`alation `.Cattle _ Capacity2papiflatio,n.'.
Wean to Feeder = ❑ Layer _ ❑Dairy
Feeder to Finish - _ ❑ Non -Layer ❑ Non-Dairy
Farrow to Wean
El Farrow to Feeder ❑ Other ,
Farrow to Finish
❑ Gibs _ Total Dtst�t;Capactty i `
❑ Boars 'Total SSLW`
� Number of Lagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ....... _/...... _........... .......... ..__._.._...---.....__.... _____.
Freeboard (inches):
12112103
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑No
❑ Yes 13No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: — Date of inspection
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ONo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
Cf No.
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Noo
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
2VIO
elevation markings?
Waste Application
10,
Are there any buffers that need maintenance/improvement?
❑ Yes
eNyo,
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Frozen Ground ❑ Copper and/or Zinc
12.
Crop type gwwupA W 'fg o
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
NNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑��'N��o
b) Does the facility need a wettable acre determination?
❑ Yes
Yes
NO
C�3o
No
c) This facility is pended for a wettable acre determination?
❑
[j
15.
Does the receiving crop need improvement?
❑ Yes
Now
16.
Is there a lack of adequate waste application equipment?
❑ Yes
2<0
Odor Issues /
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below El Yes L2<0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Zr-No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes Bi o
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 0 No
Air Quality representative immediately.
Comments (refer to question #) Explain any YES aas veil iii to any rernmmo�ahoas or any�other rnmments
Use:drawmgs;of facthty to better exphtm sttuatiom (ase addrhonal:pages as nei�sary) ;Field COPY ❑Final Notes
"
_x
AK6A J!J T10,0 WLTA �"At.. W 7-KU AA-60S Mh1AJ VA^1(-E,
LOW IWA VJ BACK rXdD f't WOZ MpVV16A)A1VCC WOO,
SoN6V ANA C09LZ62AT�0F) aAt 0 L✓FaAO) O FLAc6 (ZE(O
5wD6c
►c.ECo2�,s .�tl/ 6-� fJ OJ�Gt.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: O
12112103 1 Continued

Facility Number. '' _ Date of Inspection
fienuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes pNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WI1P, checklists, design, maps, etc.) ❑ Yes 040
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'Ido
❑ 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 /o
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit? ru,(/
(ie/ discharge, freeboard problems, over application) ❑ Yes N
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes [a NV
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
a4es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[� N
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
P40
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditronalComments andfdr Drawings
i..'Nk.tFM'N�_YP.v.....-ai:6='...r-..., r.. t -• y..
12112103

Type of Visit P Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit j6Roufine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility_ Number date of Visit: / O Time:®
10 Not Operational 0 Below Threshold
0 Permitted O CCertified 0 Coonnditionally Certified O Registered Date Last Operated/,e/� Above Threshold:
Farm Name: DrXT«L GjiLO%ED5 E IY County: �//WYPZX/-)
Owner Name: 1)F)(Zee C&�)A ,0.5 Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ��X�F2 �� U)R(l0 5 Integrator•. a�
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' =, =- Longitude =' 0` =
- - --Design'
a Current ' X Destgn . ;Current :. ;.: Design Cnr�ent '
_-
Swine - _Ca'- aeity -Population "Poukrv�._ - Ca acm 'Po ulation --' Cattle Ca achy ;rPo ulatioa -=�
❑ Wean to Feeder
❑ Layer
❑ Da
--
Feeder to Finish
x,
❑Non -Laver
❑ Non -Dairy
"
Farrow to Wean
v '
_
❑ Other �.+--
❑ Farrow to Feeder
Y
Total Destgti CBpacity
❑Farrow to Finish
❑ Gilts
r - x==
qr g Total SSLW
Q Boars
u nber� Lagoons ,:
%
f _ ❑Subsurface Drains Present ❑ Lagoon Ares ❑ S rav Field Area r
...w
HoldtnmPonds Sobd Tra s _
.�r.,.,Management..
_ ❑ No Li uid Waste Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): -qt'
05103101
❑ Yes VrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
PfNo
❑ Yes
ONo
El Yes
I/INo
Structure 6
Continued

Facility Number: —Z (Q I I 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?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
O No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
elevation markings?
❑ Yes
ONO
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
O, No
11.
is there evidence of over application?/t ❑ Ex essive Ponding El ❑ Hydmuli verload
El Yes
yJ No
12.
Crop type `L L� — LC � RS F
13.
�(�
Do the receiving crops differ with those designated 14 the Certified Animal Waste Management lan (CAWMP)?
❑ Yes
W No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
V.No
V.
b) Does the facility need a wettable acre determination?
El Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
(0 No
15.
Does the receiving crop need improvement?
❑ Yes
('No
16.
Is there a lack of adequate waste application equipment?
El Yes
/PNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V1 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design? _
❑ Yes
0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
jn No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
VNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 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
ONo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments (refer to question,#):.Eiplain any YES answers and/or nay rernmmendabons�or an* other' comments._ =`_
Use drawings of tacilityto better eiplsra sitaarioas (ttse addWonal"pages as necessary) - F ❑ Fteld Copv —❑ Final NotJ
1DQjFR KCmf)VF_
/MAV 200Z,
�) C SuRe 0 �(a'jC 2002 So<^c- �lis ` RGPa-1-F
�C0ROS,
-- -
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: O
05103101 V '-
Caphaued

I
� V
Facility Number: % — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ 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
0 No
28.
Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
❑ Yes
r
y� No
roads, building structure, andfor public property)
/
1
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
ElYes
0 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
O No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
;21 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
-.aamtmnart.omments anaforurawtngs:
Z��s
a7 � r�
APP�A�
G P h-�?.ice (��rQS
O510310I
Aare J iO,P F�
SMAP'E. S

(Type of Visit Acompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit. )� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or Visit: Time: Printed on: 10/26/2000
Facility Number
Q Not Operational Q Below Threshold
Permitted 0 Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name:.......lA�.�c:..:..F-3..............................................:............ County:...... .......`1_c'1.................................................
...
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ..................................................................................................................... .
OnsiteRepresentative<:. ... '.4f................................................................................. Integrator:..C�-ed\.F............................................. I......
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number._ ................................. .......
[]Swine ❑ Poultry []Cattle []Horse Latitude =• =, =" Longitude =• 01 =6
3wme
to Feeder
to Finish
o to Wean
to Feedei
to Finish
Design Current
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Po uI tion Cattle Capacity Po ntlation
❑ Layer ❑Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Waste
Total SSLW
Area J❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes I`No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes kNo
Structure 5 Structure 6
Identi ficr: ......................
Freeboard (inches): 3 `
5100
Continued on back

Facility Number: I Date of Inspection Printed on: 7/21/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
N(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
J4 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?
KYes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
e)ONo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
rQ*es
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
[]Yes
KNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
WNo
12. Crop type 172_t t^—t o� cr —Zjz . Ste.\\ 0i- [ ti Q�Q �3QeQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
,� No
15.
Does the receiving crop need improvement?
❑ Yes
Wo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
',No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
[]Yes
,K No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
14No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
fZNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
J'No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
IfVq•4iolatigtis:o
d¢fici6.ndie9 were itgte#. during 4bis:visit; Yoit will i ebeiye titi further.: ;
.,.,corresnotiden&abouEthis
visit:�::�::�:�:�:::•:.:.:.:.:.::::::::::::::::::::.:.:
Comments (refer to question #i) Explain any YES answers and/or any recommendations oc any.otler comments
+ C.KoSl ve5
1,,�,���; �er (..sR.. � cal t�ee�S��r-�� i�r�e�. �►� `��.�.,e�— k-esaea��.
J, � +
Reviewer/Inspector Name l) pay � k��V z\jz .
Reviewer/Inspector Signature: `��_ Date:
N

Facility Number:3 Date of Inspection Printed on: 7/21/2000
Odor Issues
,1
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
3�I 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
X No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
P 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
Yes
No
or broken fan blade(s), inoperable shutters, etc.)
❑
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
WNo
Additional'Comments and/or Drawings - -
Yet��\� wi� ��Vet- g�e��( ►t l�+�e�-c S�'�olK1�� �`� �`'•� `T
�2s\� c✓ CF-.� � r�^^ � ��U- �c��'1-, sil�.1� 2�ev�o'. w.cv
1� accit�-- �- a o�-f-t,e. 3 ��� �� s � �►�-�e,
SQ.�f .�iL .5� ,5s"4t' ,�-
5100

Facility Number 31 2ti1
Date of Visit 2/lsn000 Printed on: 3232000
O Not Operational O Below Threshold
® Permitted ® Certified U Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: Dexter.Edxvards............................................................................................ County: D.uplk ............................................... Yk'!RO.........
OwnerName: DeZter..................................... EtLteartla..................................................... Phone No: 29.3.-.J.QI2 ...................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 323..H! ard.EdwArds.Roud............................................................ BAUIRY&C-11C ...................................................... 2 .11.............
Onsite Representative: RudyKcnuedy........................................................................... Integrator. CArrnU.'A.F mda.Luc..............................................
Certified Operator:JLeater..................................... EdwArds.......................................... Operator Certification Number: .16364 .............................
Location of Farm:
®Swine ❑ Poultry ❑ Cattle Latitude 34 • 39 - Longitude 77 • ®1 23
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(inches): ............... 2.Z ............... .................................... ................................... .................................... .................................... ....................................

FacilitjOymber. 31-261 Date of Inspection 2/18/2000 Printed on: 3/23/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maimenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancrrimprovement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/hrspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
A -N&violaiionatir:&-trEiericiei'vvere:noted:duiing Oii'viiii:: Y'oti �vff receive nier 6 hift :' :'
.........................................................
Freeboard Check. Farm Manager (Rudy Kennedy) was on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[J Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/InspectorName GrrMaYtctier

Routine
of
Facility Number
I I Date of Inspection TZG, M
Time of Inspection l aS 24 hr. (hh:mm)
Permitted 0 Certified [3 Conditionally Certified 0 Registered Not O erational Date Last Operated: ..............
Farm Name: .......sD,,,/1SCounty:'.......................................
.............. .a................................................................. v..
OwnerName: .........._.��....¢:.iC-I.C_?'........._O� W q s.................................. Phone No: .......................................... -................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..........................................................................................................................................................t.................................................. ..........................
Onsite Representative: zCa r...E.G�.�/. a j^d'f......................................... Integrator:.... L,1 ��0 �) 'J
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
Latitude O• =° =" Longitude =• 0` ="
Design ` Current'_ ' Design Current Design 3Cmiieht
Swine 7Capactty.'Poiulation Poultry Cif act -Po ulation .._Cattle y.3Ca aci :Po`ulalion.
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish z R&A 2660 '. ❑ Non -Layer 1 10 Non -Dairy
❑Farrow to Wean
-_' ❑ Farrow to Feeder, ❑ Other ?
Farrow to Finish _Total Design Capacity=
❑ Gilts _
❑Boars =:Total SSLW,
Number of„Lagoons Subsurface Drains Present ❑Lagoon Area Spray Field Area
Aoldtng:Ponds-[,Solid Traps ..� ❑ No Liquid Waste Management System 5--
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes i5 No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes allo
c. If discharge is observed, what is the estimated Flow in gal/min? %t /1
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 ;ffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2- Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches)............1..._�.................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J21No
seepage, etc.)
3/23/99 Continued on back

Facility Number. ,�/ — abj Date of Inspection
r
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes RNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 5 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 7P No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Yes ONo
12. Crop type 6 e y' Nt u d Ct 6 r^u 'Z 2) f ret, i h.
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 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes J9 No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' dVo yibl'atioris:or def ciencies •were itgte0. during this:visit; - Y:ou witl-tebeiyt lie fut•th. & -: -
coriesoorideitce:about:this' isit: :•:
❑ Yes ® No
❑ Yes J� No
❑ Yes 0 No
❑ Yes. OrNo
Yes ❑ No
❑ Yes XNo
❑ Yes RfNo
❑ Yes VNo
❑ Yes VNo
❑ Yes KNo
❑ Yes RNo
/. G)'k'tmell O;q /OL5,00h Glee W-111 (esf',1401�
Cs�� 61; sl, grass vc),,4ol}ivc Go✓ev oh 6Gt/e nVeA5 OP 1,q jeor) d k e. %
hlocJ VcSe�gi;cvt on aw4s'ide
19. Ec SOre 4K-i ' co,re--4 s4 4in PAN 6�IA�tGeF ern tUasFo P�a>,
;s used on T�Q - 2's- ire sLre 4,,4 PAN b91c,t�ce '-r c.A)ov)A-Fee(
F7 -err er l y ors
Reviewer/Inspector NameS.�o `Jl GW p e %n C{,.-�`� .> • - r"� �> .?
Reviewer/Inspector Signature. Date: Z Q/ y
3/23/99

Facility Number: Date of Inspection 2 Q
-Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
jWYes
❑ 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
ONo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
WNo
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?
YIYes
❑ No
0 3/23/99

Divrstonof Soil and WaterGonservation -Operation Review
_ - E3 Dion of Soil and Water Conservation -Compliance Inspection
Division of WaterQuality` Compliance Inspection
� Other Agency -;Operation Revew-
Facility Number 1 Date of inspection 2qq
�t Time of Inspection 1 =rX) 24 hr. (hh:mm)
Permitted E3 Certified Q Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
Farm Name: ........... .✓.4),�i:Y`..... E(6.mvk......5--r'n:..................................................... County: ........ Qv�11[`_............................................................
Owner Name: ..............6-eutt.r.........................L�.PIr...G.Yh......................................... Phone No: _ °.IA�_Z9..'.. 1�.:..............................................
Facility Contact:
Title:
Phone No:
Mailing Address: ...... .32.,3.......
ti.i.�L
... u#7�rr�.S.......N, ...................................
�.4.t1.�P.t/zj�e t...................................................
N �i1�:
.......... .......
Onsite Representative:..........S
n.......
u
:%idpja.J�s ...................................................
Integrator: ..........
C.Ak..Y.t IS.....................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =' =' 0" Longitude =• =' =..
Design Current.
Swine ,. - .. Capacity Ponulationr P
U Wean to Feeder
- Feeder to Finish 10 P
❑ Farrow to Wean
❑ Farrow to Feeder ❑ t
❑ Farrow to Finish
a ❑ Gilts,
❑ Boars
'Number of Lagoons
Holding -Ponds % Solid Traps �.
Design
Total Design Capacity_ 21(p0
Total SSLW "
] Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area I_
] No Liquid Waste Management System '
Discharges At 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
h. 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 yo No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ( No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches)............35...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Z(DI Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or-=+�f��
closure plan?
❑ Yes
® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
(Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
allo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
1P No
12.
Crop type - YCTMUlo p�Y,t t Strulk
13.
NikK
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
PNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
`P No
b) Does the facility need a wettable acre determination?
❑ Yes
Qi No
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15.
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
®No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
®No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
® Yes
IN No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
19 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
(TNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1p No
24.
Does facility require a follow-up visit by same agency? -
❑ Yes
[XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E?No
iV0 V1OiafiQtis,OT, dCtIcle,DCif`S N�fCC IIOICd' A. &' i , i. ii5, visit. * YOi} Wiii,l-eCQ.iVC i10, illl'tl[gl' • , ,
.'.'
corresDODfYeDCe.tbiliiif this visit.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.
Comments (refer to question #) -Explain any YES answers and/or any recommendations oc any other comments:
Use drawings of facility to better ex lain situat_ions.((use additional pag6s,as necessar-
y)
- —
-7_ ., d: K.c wells sh,Nld bo vowed, (y Vt QzQLs info (olco� skvvM 43 . e,)elu ded.
tSwejs in 1S�t'0.,{ t� h # - II 1t3 #t( s�ot�t} IUe, eovt Q��t (�� \ �Inil* boa � `1
18. (`ffl?Anov\ dell S�QI C� � : t� �arp rCCO�. �t � 54 ocid {aG Y �tlW kv \1
l9. Acx l %r o�` so,% 'o-, 5il'ZIJJ 6e- Tv\4tV3 o cww
aPP�`ca%o. tecavt(s (lei rActera;n�ly {L� wwsi (iry. Fij WO slMvlt) be v:A
�,vt.L2S-
1 Jvi
Reviewer/Inspector Name F
Reviewer/Inspector Signature:
Date:
3/23/99

'Facility Number: �, L6 I Date of Inspection
Odor Issues �T
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below P4 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 P No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes [INo
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 J�PNo
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 PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Wo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes PNo
3/23/99

U
Division of Soil and Water Conservation Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 1 ro =
Facility Number ! -���
Time of Inspection Ot 24 hr. (hh:mm)
13 Registered 0 Certtified/ E3 Applied for Permit ,Permitted E3 Not Operational Date Last Operated:
Farm Name: ............... .L 'is c.(......��f Yf�S....... 1ftH........................................... County: .....
b4k ....................................... .......................
. i�i..0
Owner Name: ......... ................................11k...i........................................ Phone No:.... �:�1Q� 4 .:.. 30�r........................................ _.
FacilityContact: ..............................`................................................. Title: ................................................................ Phone No:...................................................
Mailing Address: ......313.......IN-.r�kIrtS�..........GF.UWA.........J-9....................................APil.lAVi1.(}.....J.'..............................W...........
Onsite Representative: .............jJekr.....U.". �.............................................. ... Integrator: ............ .C.NL Y..!?.jj.5.................................................
Certified Operator:............................................................................................................... Operator Certification Number:
Location of Farm:
Latitude 0• =, 0" Longitude =• 0' ="
Design -_-,_Current Design, ,Corrent Design ;Current
fi
?,Swine F `;Capacity -Population . �l'oultry Capacity Population _ Cattle ;'Capacity `Population
❑ Wean E
❑Layer = ❑Dairy ,
Feeder j� p 24 0 ❑Non -Layer ❑Non -Dairy
�� . ❑ FarroOtherFarrow
❑Farrow to Finish '` Total Design Capacity'
❑ Gilts
❑Boars Total SSLVV
Number o Lagootts / Holditlg,Pond-Subsurface Drains Present_ _ ❑ Lagoon Area Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
Ep No
2. Is any discharge observed from any part of the operation?
❑ Yes
�O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
6 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
W No
c. If discharge is observed, what is the estimated flow in gaUmin?
A
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
I'
0 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
P] No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
1A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(A No
7/25/97

Fac`rLty Number: 3 —Z-6 t
8. Are there lagoons or storage ponds on site which need to he properly closed?
Structures (LaEoons.Holdine Ponds. Flush Pits. etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):.............1.%z.........................................
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?
❑ Yes
® No
❑ Yes
No
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
P No
❑ Yes
® No
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 Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............> �mnydg ............. s:..... 5p.,..\........................................ ...............................................
..............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
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 Reviewer/Inspector 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?
E. No.violatioitsor deficiencieswere noted during this;visit. You.will receive -no furfhei-.
corresporidence m0out this:visit.
® Yes ❑ No
❑ Yes 1,Z No
❑ Yes Pl No
❑ Yes to No
❑ Yes ® No
❑ Yes ® No
❑ Yes ;@ No
❑ Yes No
❑ Yes [� No
Yes ❑ No
❑ Yes M No
4A Yes ❑ No
l;9 Yes ❑ No
IZ. �IySI� Pl pl_ iv, IILayoti 56ovlt) 1be eX'Wei. �p nJt t T1'Or" iG yy t k c'` 'L r'.
\
L2„ L:'prhC C KAJ 4-R.K S 6 Jd iu IAi7 d in '% rc (Ovdg T- L GQ-7 �,, W -w ?— `)kovtd
6e t`e w ov.J -ov, - (W 0 } . L6 [ ui, -F a{ k a� ; fF�tdn r�. kS 0 1k� -H'uk, '%J .. 4dJFI .
m' A-�C�v e� Ti oif At-rvt— oti_ 0.- put) 301 ZG.S/
7/25/97

❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
[IgRoutine V Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
[ Facility Number Date of Inspection
[ Time of Inspection I '.oU 24 hr. (hh:mm)
Megistered %Certified E3 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated: ..........................
FarmName:...... .4.Xi'.... �W..txdS.._T.�'rha............................ County: ..... Lqkm......................................... .......................
Owner Name: ....... NIL ......edk&ds...
........ Phone No:..k(a.�..2q.�, 3012
.........................................................
Facility Contact: ...... Q. Air......rvux ra.............................
pTitle: ........ Qk1u�....................................... Phone No:Cti(.d�1.`Ig—.SU..L�.............
Mailing Address: _3Z3.._.`WSJ.....................................GV.vi.�.�t .r..L...................2$F�.B........ ...................
_, 1 �
Onsite Representative:__.t�es<t< ...
tom" tr......(AW........................................................... Integrator: ...... l�G,Cf.O�...;;...........................................................
Certified Operator: ..................... 1 3�
.......................................................................................... Operator Certification Number:.......c ..
Location of Farm:
Latitude •���'1 Longitude �•�'�'
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish 440
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds L
General
Poultry Capacity Population Cattle
❑ Layer I ❑ Din
❑ Non -Layer I ❑Not
❑.Other - - -
Total Design Capacity —7 o
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Total SSLW
Subsurface Drains Present JJ❑ Lagoon Area J❑ Spray Field Area
No Liquid Waste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in pl/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of desien?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
0 No
❑ Yes
m No
❑ Yes
® No
❑ Y,,e11s[�
No
M
❑ Yes
P No
❑ Yes
® No
❑ Yes
No
iQ Yes
❑ No
❑ Yes
[4 No
❑ Yes
M No
Continued on back

Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
W No
Structures f LaEoons,Holdin2 Ponds, Flush Pits, etc.I
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:...................................................................................................................................................................................................................
Freeboard (ft): .......... Z-Z.
.........................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
1B No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
R No
12.
Do any of the structures need maintenance/improvement?
[AYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15.
Crop type ........ cmaal...... 6g,..*.AX...............................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
R) 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
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement'?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
EA No
®
No violations or deficiencies were noted during this.visit..You.will receive no further
.
correspondence about this.visit.-'
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments;
5. Qe r careful` aF Gkks tul,,... uaty� (&rm1wr. pipe,. r
IL. `hLv kcal ociW uJFO� ,o{ Jayoom !6kovld be ^0weJ, %ws an inN.t��oukt �a9oer� wkll rIWA 6e
(vinwod- co k,i- J-s'(ric{ so;I o d bL)4cy: g, % /,*� s6vQ be: rrseet)d. Rt,y & ptaes
slloula he coverd. ir\Lf QIpeS sladlJ eao4eadCd 1vr`�(u„ iv.4o (c.ycdrt.
z2- (�`ya4ta tccwda Slnoult] be N� ti'Ur.bv- O.d �1\dj ntm.lxr Erntx�evcy rc{ton {�W1 hd
bR a1 s F k.
7/25/97
Reviewer/Inspector Name ," -
Reviewer/Inspector Signature: Date:/tf �q

Site Requires Immediate Attention: v3a
Facility No. Pn. I - )L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 a$ , 1995
Time: —
FarmName/Owner: D XTec 2D-S
Mailing Address: 3 D 3 W XL,% '_ A-.fZ-J D w O S ar j (Sec ` lA �2' 2QSI
County: 1� U V t_ I 'j
Integrator. ,e [ Phone:
On Site Representative: C f' ./ UtS Phone:
Physical Address/Location: y4cS Il._ 1 63 5y , S Y- . t} W I'
Type of Operation:
Design Capacity:
Swine
Z v C+ 0
Poultry _ Cattle
Number of Animals on Site:
DEM Certification Number: ACE DEM�C/elrtification Number: ACNEW
Latitude: `� _" Longitude: �1 ° 44 ' Elevation: Feet
Circle Yes or No
Does the Animal WasteLagoon have sufficient freeboard of 1 Foot + 25 year. 24 hour storm event
• (approximately 1 Foot + 7 inches Yes r No Actual Freeboard: _3�._Ft. - Inches
Was any seepage observed from the lagoon(s)? Yes o OVas any erosion observed. Ye or No
Is adequate land available for spray? es rNo Is the cover crop adequate? Qor No
0'
Crop(s) being utilized:
AL
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No ' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments: C—(Lk il-v u s 41 D s
Yl �tC5
Inspector Name
\ cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

f Site Requires Immediate Attentio (�S
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: 1995
Time:
.T/�.\T,'�,��,T'�,�\
Farm Name/Owner: �eX7<-ri�iP �v4 UGC S 7 1
Mailing Address:
County: ��c�
Integrator. L �i r o Phone: �!� n� lr� 36 Z 2-
On Site Representative: _U C h Phone:
Physical Address/Location: G end P u tiv Ile rq
Type of Operation: Swine L-1 Poultry _ Cattle
Design Capacity:'x5�� Number of Animals on Site:
DEM Certific lion Number: ACE DEM Certification Number: ACNEW
v Latitude: j Longitude:�' �' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
1
(approximately 1 Foot + 7 inches) " or No Actual Freeboard: /Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or T� Was any erosion observed? os or No
Is adequate land available for spray?/ Yes or No Is thee crop adequate? Yes or No
Crop(s) being utilized:1��yi�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? _&e or No
100 Feet from Wells? es rrN�No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(No)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters offtthe state by man-made ditch, flushing system, or other
Similar man-made devices? Yes or/N0J If Yes, Please Explain.
Does the facility maintain adequate waste management reco ds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Ad "'Don�alCComments- 0.-1
r
Inspector Name S' atnre
cc: Facility Assessment Unit v Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:919-715-•(5048 Rug 1 '95 10:31 P.10/13
SLt K--qlardsa:acc �w vu
,--ac!ii 'Number.
•. SITE VlS1Th'riON R2 ICORD
DATr:� 7 4 I 1 t9;5
O�vne.�_lE4T_i� _�a4 Far:r�'aca=
10
AeA^r Visiting Site: _tjrz,, ��_. — -
I7C:atOL: p
On She- 2cps:senttivc: - i
—
Physical ?:ddrws:
Nlaung h(id;Ess:
Type of Ope.adon:^ Swine ?C koultry - Cac1e
Numhex of Animals on Site: "
Des, _;n Cap-rclt
Type of irspzc.don: Gcouud X :trial _
�b
• $ Citde Yes or No
m Does the A,L--ral Was= Lagoon have sufncienc fre=z)oatu of I Feot - �S y 2 ..cu s.vra c
U Fen:'
L�chcs
z (aoprorirn�eIv 1 root r 7 tnet:-s) Yes or!Nn Actual �—
y c
aFof facilities with more tl= one la_oon, ple:� aid:ess the c,hcf a;oons' freefiozrd ut der L e
ocon�nents section.
Was any ;eexage obse^:ed frera tfla lagcoa�s)? yes or No Was t� etz erosion of thz d tc?; Yas ox?Qo
Is adequate land available :or land app!lcadon? yes Of No Is the co-:er crop--af!eaua a? Yes of No
c
Add;,-;cnal Cotameats:
rJ
Fax to (919) 7 559