310419_INSPECTIONS_20171231

2 V
NORTH CAROLINA
Department of Environmental Qual

F�11
Division of Water Resources
Facility Number-'--ct--i--' 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: UComwliance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: &Routine ❑ Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: y- Arrival Time: 7 Departure Time: v County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: t k 6 (q--�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Integrator:
Certification Number: W r G
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
H
Non-Layer
Pullets
Poults
Design Current
Discharees and Stream Impacts
L 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)
e, 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [] lq ❑ NA ❑ NE
❑ Yes ❑ No
[� Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NH
Page 1 of 3 21412015 Continued

Facility Number: - Ds ection: z i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3No ❑ NA ❑ NE
a. Ifyes, 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): 'Z
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 DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FNo ❑ NA [] NE
(not applicable to rooted pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2[-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ 'No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crap 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 E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
_�' ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
FNo❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C Na ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps D Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA D NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes Z�`No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Io ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili dumber: IDate of Inspection: t
24. Did (Re facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
❑ Nan -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
E5-lTo� ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No [loNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes f 90 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes [? o ❑NA ❑NE
❑ Yes �o [DNA ❑ NE
[:]Yes <No
❑ Yes No.
❑ Yes Il No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Corriinents.nswers�andl6n any additioaalrecommend4tions'nr;an ntlier'cnmments:� "' ° m::'
�:_av,rFF �•�,n•,.„r. ..h+'�4r�Yi'=F*,d:4:#f°�..:bs3:�^aga�c:,s�•'aC§ i:±¢Yt.r��F.:d� asi••y; 3i s�z�u�:si,�,���. ��$ � .. �
Use dritwings'of facilit ;tv,better;ex lain situativns:(use;additlonal: iies
C 0. C ere'4
t4, j r 17 G- 5e fvr—a ro0( A. n-C C. 4 s
7 f 1 11 -r
V. P� f r� 0 A C. ON ✓ - L 4►
Reviewer/Inspector Name: Q&V, i j Pp'_'( !/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 14 7
Date: 1'Z ?_/1
21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: J'Routine O Complaint ❑ Follow-up O Referral O Emereency O Other O Denied Access
Date of Visit: Arrival Time: ❑ Departure Time: County&A
Farm Name: Owner Email:
Owner Name: G� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Sack -up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oult
Ca acit
P,a
Non -Dairy
Farrow to Finish
L'a ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes dNo
❑ Yes ;2,No
❑ Yes �10
❑ Yes E No
❑ Yes ONo
❑ NA ❑ NE
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

11�acilityNumber: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo
❑ NA
❑ NE
' a. If yes, is waste level into the structural freeboard?
❑ Yes ;EfNo
❑ NA
❑ NE
Strucr 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 �a 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 Ej No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes �] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres detennination?
17, Does the facility lack adequate acreage for land application?
❑ Yes Ej No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reduired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
'Yes []No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [ZWaste 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 E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
[:]Yes j�rNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

lFuellity Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, cheek [] Yes dNo ❑ 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
ZNo
❑ NA
❑ NE
❑ Yes
CZNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [?I No ❑ NA ❑ NE
[] Yes
[Z No
❑ NA
❑ NE
❑ Yes
[ZNo
[DNA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes MeNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E No ❑ NA ❑ NE
Comments (refer to question. #):.E plaiin any YES answvers^and/or. any: dditiunai recommendations or, any..other . comments:..',
Use drawings of Tacilit to.laetter.ex lain situations (use.additliinai' ages asnecessar }. 4
o kIP le 0 7 culpe(s 0(A� 0i�:-
c'j C4_1 � Cn�I,-)5 a s cJ l Lj
0, �]
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ev
Phone: AJMK7�_
Date:
2/4 0I

Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0
Compliance Inspection 0
Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit:
iZRoutine Q Complaint
Q Follow-up n Referral Q Emergency
Q Other C) Denied Access
Date of Visit: Arrival Time: Lf7Departure Time: � County: A0h
Region: W,-R —
Farm Name: :: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title:
Onsite Representative: Vsn� R. g]rKilryn
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F 1Layer Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkev Poults
Dischartres 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?
h. 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?
Longitude:
Design Current
Cattle Capacity Pop.
Rairy Cow
Dairy Calf
Dai Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes•�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
[3 No
❑NA
❑NE
❑ Yes
10 No
NA
❑ NE
❑ Yes
PrNo
[] NA
❑ NE
Page 1 of 3 21412011 Continued

.. i
Facili Number: - Date of Inspection: j ■
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6NO ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
FfNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify OWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ 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 Fe�'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�` No
❑ NA
(] NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PffNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VrN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faclli Number: -L4 ICI 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 PNo ❑ NA ONE
the appropriate box(es) below.
n 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
2TNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes J-No ❑ NA ❑ NE
❑ Yes ;!rNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 4N❑ ❑ NA ❑ NE
33. Did the. Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ErNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency`? ❑ Yes 2No ❑ NA ❑ NE
Comments (refer to question #), Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 617 b
Date: —WH, -
2/4/2011

Type of Visit: P Compliance Inspection Q Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: LI Region:
Farm Name:
Owner Name:
Malling Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: r NN E_71t ►�?IV Integrator:
Certified Operator: .�C.- G �1� T iZCaL._]/V Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Eurccnt
Dry Cow
Farrow to Feeder
D • P,vuit
Ca adt
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
I 10ther
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 C] NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

. Facili"umher: _31 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LQ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
[] No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes XlNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes i No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Amplication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement? 10
11, Is there evidcnce of incorrect land application? if yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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): ���II li,
13. Soil Type(s):--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
#,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
[] WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [] NA ❑ NE
❑� Waste Application 0 Weekly Freeboard [ Waste Analysis ❑+ Soil Analysis ❑yte Tra fers Q Weather Code
'❑ Rainfall []Stocking Q Crop Yield 0 120 Minute Inspections E] Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

F'aclti " 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 to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
+�j
I �] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
VX
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments.(refer: to question'#): Explain any YES answers andlor.: any additional reconimendations.or:any other comments.=
wi facility t r ai
Use: drawings of cl ty o belts expl n.situatians: [use'additlbual pages. as "necessary)...
CA�kG 071UA/ b kAG 9Q)I y
A -
[�//w/a 1.00
A_VA L, �J & &C DALA�
At C vG IJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page. of 3
Ath 4& &E Phone: <%'
Date:
21412011

Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: JI((�t� . j & AC H & �A_F,4 (LM Owner Email:
Owner Name: ��uNE i'f'i �i- �)Q_0L.7JV Phone: 1:3 l�_ 300Y
Mailing Address: i� ] o C � aou_w Vim-' j -05 (P_ -A iLC /VC S F
Physical Address:
Facility Contact:
Title:
Onsite Representative: f &NIV f_-7-9 1J
Certified Operator:
Back-up Operator:
Location of Farm:
1 NNr7�r �L. &wLAN
Latitude:
Phone:
Integrator:
fbD I
Certification Number:
Certification Number:
Longitude:
1�11�4LO
Design Current n
Design
Current
Design Current
Swine Capacity Pop.
Wet poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
lfwpop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Co —
Turkeys
Other
Turke Poults
Other EL10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
4
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - L Date of Ins ection:
Waste Election & 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA-&W
Spillway?; q
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 �No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste_Anlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes j No ❑ NA ❑ NE
maintenance or improvement? 7k
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J�_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): ?�Iee SC
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 Re ords & 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.
0 WUP ❑Checklists Q Design E] Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes tNo
o ❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes No
[] Yes No
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes k N
0 Waste Application [] Weekly Freeboard ['� Waste Analysis Q Soil Analysis ❑ V 1ste Transfers
M Rainfall ❑ Stocking [] Crop Yield Q 120 Minute Inspections []' Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j N
No
❑ NA ❑ NE
❑ NA ❑ NE
o ❑ NA ❑ NE
0 Weather Code
El Sludge Survey
❑ ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: - 019. J jDate of Inspection: !
24. Did the�facility tail 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?
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond [] Other:
❑ Yes biNo NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments: - s.:<<. .
Use drawings of facility to better explain situations (use additional pages as necessary).
(-AE QQ
(A-) . A
q/obI y
boN 57
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��(o 's v+'7
Date:
2/4/1011

ADivision of Water Quality
Facility Number -��J��
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Acompilance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: {y` Ar[riivval 'Time: Departure Time: County: Region:
Farm Nome: CA{ iiE t-1 �.jgg M Owner Email:
Owner Name: Kex/ r tS 7H • ��t Phone: 910 -ate 3
Mailing Address: 64-3 1 �Q c- 96a awN M
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:.�l�[�7'► � - Integrat r:
Certified Operator: KC-H�F rµ Operator �Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I ❑" Longitude: = ° = i =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Other
❑ Other-
Dry Poultry
Ej Layers
❑ Non -Layers
Pullets
Turkeys
❑ Turkey Pouets
❑ 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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
Dairy Calf
Dairy Heifer
❑ Da Cow
El Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 0
d. Does discharge bypass the waste management system? (Ifyes, 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
El Yes
El No
El NA
El NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes N(No ❑ NA ❑ NE
❑ Yes PL ❑ NA ❑ NE
12128104 Continued

Facility Number: — U/y' Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo [I NA [I 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: C&S&Ln1
Spillway?:
Designed Freeboard (in); Iq S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) KNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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 JKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12.
Crop type(s) gcz� SC
13.
Soil type(s) JYeA
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
■■■�No ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement? ElYes
KNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
K No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
fi� No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
RN ❑ NA
❑ NE
e`•.k :.;' ...r lr` e.e.:.J:' kayo'ii1]�FiX.�is' :s.eic .:. s
Comments {refer taques�an�#}:i' xplain;any,:;Y>[rSnswers;ar►illorany recammends�tionsorg�ny nther�comments..
Use drawings offfacil�ty�to'betterFexp[am situations;{use additianalpages as necessary}� �I d
i
Reviewer/Inspector Name Phone: q I ___fl('
Reviewer/Inspector Signature: Date: I
Page 2 of 3 12128104 , Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tNo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists [] Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;(No ❑ NA [I NE
[] Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Haste Transfers ❑ltfinual Certification
0 Rainfall [] Stocking ❑► Crop Yield 3 120 Minute Inspections [] Monthly and l" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No
❑ NA
El NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ycs
4No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ 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
Cl NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certilication?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*No
❑ NA
❑ NE
A'ddltional Ctinrrnen#s'.aiidlnr Drawings: 1: t` ` r� :. 3 %` ='.
6ggFjaAJ QuP, 0010
1 k0 S C_uDCC 51ALUE
Puke 3 of 3 12128104

)PYDivislon of Water Quality
Facility Number ' 0 Division of Soil and Water Conservation
t', Other Agency
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: County: Region:
Farm Name: IV 12 '1�' , R[trf) Owner Email: ❑❑ r� j }
Owner Name: KLb(481IET� 1� , L ]�C �N Phone:
Mailing Address: I_i-__�� �� L]S i
Physical Address:
Facility Contact: �] Title: I Phone No:
Onsite Representative:-0--NIff70 1� t_� ��� Integrator:
Certified Operator: Y,GNN6 Tq h • -W - Operator Certification Number: jj
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = 4 0 « Longitude: = o = 0 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Layer
-7 I� _ Non -La er
— —
Dry Poultry
La
Other
❑ Other
Poults
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)
Design Current
Cattle Capacity Population
❑ DairY Cow
Dairy Calf
El Dairy Heifer
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
d. Does discharge bypass the waste management system? (If yes, notii'y 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
L,lp No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility umber: ] — LI1q Date of Inspection Q�
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes kNo
❑ 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: "Gtny
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ANo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes JNo
❑ 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 q. No
r
❑ 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
14. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ge< � in
�
-
13. Sail type(s) /Vd
14, Do the receiving crops differ from those designated in the CAWMP'?
❑ Yes P(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE.
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]yes No ❑ NA Cl NE
17. Does the facility lack adequate acreage for land application? '
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
�� . = �� � , .. �:� : � �. ., �� : � `. ; • :::,,: _ ;.;a_wr. r�:,s_2:==5;_;:.,�::�w��'���:�. � y�. P ... ....:, �.�_•.
Coiirme'nts {refer to question #}: Explain :any YCS answe'rs,aridlor anyrecatnrtiendations;oruhy
othcrcpmments�. ;.
.Use dra►vings of facility to.hetter exp ain.situations:.{use ad6iun:�iyages as necessary} 'ra $ W •.' g . _. .:
.yI r:
'�' •� iia iri�I.i.f
S-1 f L-L L-ZOU' 16 01V F I ELF
^-- , --- !6'
e��C]DfCAReviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 7�V6
12128104 Continued

ti
Facility Number: ] — G(j Date of Inspection
Required
Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
)� No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists [] Design G Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
19 No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ jaste Transfers
❑/tnual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections 0 Monthly and 1" Rain
Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
.j No
❑ NA
❑ NE
23,
If selected, did the: facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 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
XNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
] NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
M tiogqrtal Comments andlar Drawings:
`7 �l4/6
//I► /04t
I Zf2"4

Type of Visit X Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Vlsit A Routine Q Complaint Q Follow up ❑ Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Al Region:
Farm Name:
Owner Email:
Owner Name: \C NNETH_ _ ?Z_1RQL-_W Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative`: ��NIY F_wt
Certified Operator: l( F, AINISTM �— H
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f = f[ Longitude: = e =
Design Current
Swine Capacity Population
ilesign Current
Wet Poultr3 Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
[.aver
Dai Cow
❑ Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish 1 d
❑Dai Heifer
❑ Farrow to Wean
pry poultry
D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
Non -Layers
Feeder
❑ Boars
❑❑Beef
Pullets
❑ Beef Brood Co
Turke s
Other
❑ i urkey PouIts
❑ Other
10 Other I
Number of Structures:
❑ischarses & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? of yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
� o
❑ NA
❑ NE
other than from a discharge?
+++
Page 1 of 3
12128104
Continued

F'rcility umber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L sLno /V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll
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 A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA Cl 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. ❑ Yesio ❑ 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 ol'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
yV No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9� No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
jqNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ 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)•. .
LcloK [ ry r-c-> YG w c. sr�o� fv%�a"
�FA\C: (6) OF LI]VNG- C0k7-At^1G1) rnC.bA4rr7-
(-/Vc- (3" T- ix lAJC
Reviewer/Inspector Name l PA4N opr 6 6- [ Phone: 9�C�: 1 � = 3��
Reviewer/Inspector Signature: Date: 10 / ❑
Page 2 oj3 12128/D4 Continued

r4
. Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
9 No
❑ NA
❑ NE
20,
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
*No
❑ NA
❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
El NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
21 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
.j No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�N❑
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
o
❑ 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
Ro
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
& No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P�fNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 7Routine
piiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint Q Follow up Q Referral Q Emergency Q tither Cl Denied Access
�y bio Date of Visit: Arrival Time: 03� DepartureTime: County: DPfGz Region:
Farm Name: _......... Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: yy'' Title:
& Onsite Representative: AINd 9"LIW
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I E] " Longitude: = e 0 I = u
Design Current
Swine Capacity Population
Uesign Current
Wet Poultry Eapacity Population
Design Current
Cattle Gapa�ity Population
❑ Wean to Finish
❑ Laver
❑ DairyCow
❑ Wean to Feeder
Non -Layer
❑ DairyCalf
Feeder to Finish d
❑ Dai Heifer
❑ Farrow to Wean
pr y Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
La
f S
Beetocker
El Gilts
-
Non -Layers
❑ Beef Feeder
❑ Boars
Pullets
Beef Brood Cowl
El Turkeys
Other
❑Turke Poults
❑ Other
Other
Number .Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Dl
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Cl 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 Statc (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ef No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
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?
Structur/� I Structure 2 Structure 3 Structure 4
Identifier:A ��7N
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 Q/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ET No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ 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 14 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
❑ Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination 7 ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Y o
El NA
El NE
MIN
❑ NA
❑ NE
12( No
❑ NA
❑ NE
❑ NA
ElNE
�JNo
❑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)::
St= ND S4 096 0 ZPSM °VA L AW4S A Oeht,=W + Aoo2 f SS 0A1 Rrzr►x t •
* SAm,/ AS '3l - 6'4
Reviewer/Inspector Name 'Jr A 1 Phone:
Reviewer/Inspector Signature; Date: I D vd
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection V 119/WG 1
Renuired Records & Documents j
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
o
ElNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
dNo
❑ NA
Cl NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
2rYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
efYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M<o
❑ NN
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
tr I NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Rl"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
C! 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
N❑ ❑ 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
5 No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ()Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up O Referral Q Emergency ()Other ❑ Denied Access
Date of Visit: 1 r r $ Arrival 'Time: 13b Departure Time: County: N Region:
Farm Name:
Owner Name:
Availing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: Kt— _1_ WI'
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 01 Longitude: =° [� l
Design Current Design Current
Swine Capacity Population '1'V'et Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ILI Non -Layer
59 Feeder to Finish b
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ 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 Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (li'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 Lr No Cl NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
El NA
El NE
El NA
El NE
El Yes
El No
❑ Yes
2 No
❑ NA
❑ NE
❑Yes
G4
El NA
❑NE
1212&/04 Continued

Facility umber: 3 ] — q f Date of Inspection ►� $ o�
Waste Collection & Treatment
,/
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El2 Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA 60
Spillway?:
Designed Freeboard (in): H r .,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No ❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
J
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 environmenta7rcat, notify DWQ
7. Do any of the structures need maintenance or improvement? 2] Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes DNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part ol'the waste management system other than the waste structures require ❑ Yes EfN❑ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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) 136ttynVp r)4 J4 2 5 `0 (6-) ....,,,,.. _.
13. Soil type(s)
t1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'i❑ Yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
�E?'�ff
-CJ No
❑ NA
❑ NE
C.i.CA �3awsN
P4PFL-CA_r1tDrJ 5
ro
L7(0 3 s 0 __ z o b q
91026S
Reviewer/inspector Name
JAI Phone:
Reviewer/inspector Signature: Date: o
12128104 Continued

1~acllity Number: 3 — Ljjq I Date of Inspection A 1 US
Reauired 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes &1vo ❑ NA ❑ NE
❑ Yes LNo ❑ NA ❑ NE
2I . Does cord keeping need improvement? If yes, check the appropriate box below.
LEI Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections
❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�qo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
❑ NA
❑ NE
24. Did the facility fail to calibrate wastc application equipment as required by the permit?
❑ Yes
❑ No
A
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
rNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ON'. ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No Iti1A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes QNo ❑ 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 ffN❑ ❑ 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 l_• < ❑ 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 2<o ElNA ElNE
33. Does facility require a follow-up visit by same agency? ❑ Yes E No ❑ NA ❑ NE
Ad dltlom aii&ur Draw-
mnt
'
na:
K.
1 1 0 /04

Type of Visit D Co¢tpliance inspection Q Operation Review Q Lagoon Evaluatlon
Reason for Visit v/Routine p Complaint Q Follow up O Emergency Notification Q Other [3 Denied Access
Facility Number Date of Yisit: to ahl Time: 1430
10'NotOperational Q Below Threshold
Permitted Cert3fiied 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .....» .___._».
Farm Name: __ J
.� �fi 1�...,(j...j1LAc.Hg_� ...... County:.........IQ�P .»........».»».»..».»»._._ ....._._..........»,
Owner Name: » ».» .._.» ..._...» » ........_.._ ._ ._ .. • Phone No:...»....» _ ..__ .. __. __.._.._ _.»......»....
...
MailingAddress: _ . _ .. _.. _... . __ ._.__... ».».... ».».........._ _ ____ ____».... _....»..».......».»»... » ..... _ ._.»
I! acuity Contact: w»» »..»» ..» ».....» .»..».» ..». »» »...... Title:..___._._._.._......»»» .» ».»._ ._._ Phone No:
Onsite Representative:._ 14 ?2e�__ .....»».».»..»...» ......... In#egrator:
Certified Operator:.».»..».» .. ,.»..».»»..� »»..» » ,.. »»..» » ,....._ . __._.. ._ ...»_... Operator Certification Number:.. _ ...._w.» ...»..._ __..
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ■ ` " Longitude ' 4 44
_..:.., ., .,. Design
-,,ICU.7 ,',: �•,
rrent x � err
- N _.
; r, �r arrant ; :. � _.,{;,'; ' urrcnt . •;:
. .'
Swine : .Capacity
_ :�
-To", -:e�,".•Ft3- - ...�:::••, - ;.r` ea•,.
tion Porsltiy :.`.,, - Ca ciPo aiatidn `,' Cattle
Wean to Feeder
��
Layer
D
Feeder to Finish
M❑
Non -Layer I
Non-Dairy13
E
Farrow to Wean
❑ Farrow to Feeder
Other
-
Farrow to Finish
.: E •' ''
F-1 Gilts
El Boars
n'
RNlti�tbEr OLagDOI{IS
"iifin '.v4_ 7�2A '�FC�:.ir'pr Ai" r•..::.,.��^;q
Discharaes & S ImpaCiS
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 Coiiectinn &.1reatment
4. Is storage capacity [freeboard plus storm storage] less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 S tructure 4 Structure 5
Identifier• - ».I.
❑ Yes 21'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes io
❑ Yes 10
❑ Yes No
Structure 5
Freeboard (inches): 3 Z�».»�. .»w
12112A3 Continued

Facility Number: 31 — Date of Inspection v p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type P'(_Wu fi C 11) 5CV-0 ...._
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?
Ddor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [J/No
❑ Yes [2/No
0/yes ❑ No
❑ Yes N
❑ Yes No
❑ Yes ;7No
❑ Yes
❑ Yes [3'ko
❑ Yes �o
❑ Yes
❑ Yes
❑ Yes No
❑ Yes �No
❑ Yes 0,90
❑ Yes Q N
❑ Yes [�' 0
❑ Yes ;�/o
,___-_.a-.� .._..-.'�.-'�-.--•:..,... �;,,F;,:ra �,.r•..'s�r --.: � xv'- �r :�.z^..;«� '7�+:u �a+�.�u3;.�. ..., ,-�.w� ::ram--.:.-. .. _ .. _,.. _.., -... n:� -. �y:.e
�Cammants;(rder.W:.gnestina #):[�Eytplaim a�ty.'YES ariswrrs"aadloir^any,recnaamrndatio�# vraay8:ott>tsr,ca'`mmcgCs. "�"trI
� ..es�'�R$""9l,� 1�,Y s:4 k 2'i 'F°v.:'..•�.554 �)!iH `14h:�r. , . :..,. ... �4'�-' ']u.....,, - .. .. .y,,,y„�,Mq.e,.:.e..4.i'T
iUse �dcaWiiegs of fsicility�ta betteraxgl�ai sit�ttio �(tssc addit�oAa�i:pagea as ncs�sary Field Co Final Notes ��'� �{
' r' •�'�1ga�'•?s9?�=:. �t�: , � �,Q ''i:i�'1'�r�.: F ;: t'..- . � n .-?::x'N4, T,"��?.1 �F, �,:y
Ncw MAP F-GR- W UP +
iZc")c aid WAY l3AL't:;s �►4m �tcu),
WASr6 I°I►.t►4t..` TV t4=1L0S TQ 6C TA v-W tb Ca-11-+L- Pvw►93L+16,060T,
7�P - 'A LAd ac- 56C-t3 w.s-rtl S"l-P116"C Fa-QBUOV\S, N660 1W
S�F+L 1aE`1•W&Cd S6cw.
ReviewerAnspector Name
Reviewer/Inspector Signature:
Date: I b
12112103 Condnued

Fact ityNumber: — Date of Inspection 1 �
Re aired Records & entti ��
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, Checklists, design, maps, etc.) ❑ Yes El No
23. Does record keeping need improvement? gIfes,,,check the appropriate box below. �s ❑ No
❑ Waste Application ❑ Freeboard ate Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0110
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes wo,
o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes �To
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes ;WO"'
Nit DES Permitted Facilities
30. Is the facility covered under a NPDF.S Permit? (If no, skip questions 31-35) ❑ Yes No
31. If selected, did the facility fail to install and maintain rainbreak,ers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
f
13 No violations or deficiencies were noted during this fit. You vvili receive no further correspondence atwttt this visit.
I21IM3

,r
:t'"� '�:;�•�.; - tvisiori of Water QuaEity •
- "�:;.'' fi �°; . �.,•` s.-� Di isidei of Soil art&Water Canseriration'
io
xgC"iy
2�A 1 gip;.+'.�� Fx'{`'�'7 ��Y _ .i�;• + ..�. ,'�•"v.°'iT� � .�. ..+.�:.
Type of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine ❑ Complaint to Fallow up D Emergency Notification Q other ❑ Denied Access
Facility Number 17S M—FV/-7f I Data or visit: [
Permitted /d C rtified [] Condi to ally Certified E3 Registered
Farm Name: ...... ........t/.......ti .lt........ �� la6. � ....................................
Owner Name:.....1.,lv,l''.� .........Q..........................
Facility Contact:
Title:
Time:
Printed on: 7/2112000
IO Not Operational Q Below Threshold
Date Last Operated^ Above Threshold: ......................
County:........
G
Phone No:
Phone No:
MailingAddress:................................................................................. ......................................... ....................... ..................Q.......
...................
. ..........................
Onsite Representative:.... ! ' . . ��71.......... � 1......... Integrator: iC `. .fir .............................
Certified Operator:
Location of Farm:
Operator Certification Number:
a
�r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 64 Longitude ' 1 «
;. Designs Current
raru3a ' . Ponulatine
Feeder
FFinish
:,t; FWean
W.;
E
FFeeder
FFinish
Gilts
ks Boars
a<7..
Design Current Deslgn Current
Poultry Capacity Population Cattle Ca i ;°Po ulation
❑ Layer IDairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity.
Totvd.9kW -,
❑ Subsurface Drains Present Ci Lognon Area JE3 Spray Field Area
No Liquid Waste Management System
Discharges & Stream Imp_act�
f. 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 nian-made?
b. If discharge is observed, did it reach Water of [lie State? (if yes, notify ❑WQ)
c. It' discharge is observed. what is the estimated flow in galhnin?
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 R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes IKNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes No
❑ Yes No
❑ Yes 10'No
Structure 5
Identifier;....................................................................................... ...........
Freeboard (inches):
5/00
Continued on !rack

Fawility Number: — hate of Inspection
5. Are there any immediate threats to the integrity of any of the structures o?cr4=0(i el trees, severe erosion, ❑ Yes V(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes V(No
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 V(No
11. Is there evidence of over applicationI, ❑ Excessive Ponding ❑ PAN ❑ Hydra liicc]Overload ❑ Yes eNo
12. Crop type y (/Il
13. Do the receiving crops differ with t ose designated in the Certified Animal Waste Management Plan (CA P)? ❑ Yes ;d 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 ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes �dNo
Required Records & Documents
17.
Pail to have Certificate of Coverage & General Permit readily available?
❑ Yes7No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2f No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JSNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesXNo
g
comes oridence abatis #his visit:
rq) n4'e14'Fo 046r"i—t- /V
Fl
ReviewerAnspector Name r..��' ''tr ` ; .. �
Reviewer/Inspector Signature: k AS ,.- Date: / D$ Q5/90

Facility Number:,I 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? f
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (Le, residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the Iagoon? ❑ 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 X—/"o
31. Do the animals feed storage bins fail to have appropriatecover? ❑ Yes No
5/00

N
ivision of Water Quality
Division
of Soil and Water Conservation
0 Other Agency '
t �
(Type of Visit ❑ Compliance Inspection 0 Operation Review a Lagoon Evaluation
Reason far Visit Routine O Complaint Q Follow up ❑ Emergency Notification 0 Other ❑ Denied Access
Facility Number
jDalcorvisft: 21),'Time:t'rinteddin: 7/21/2000
Operational 0 Below Threshold
Permitter] [3 Certified © Conditionally
CeertiFcdf [3 Registered Date Last Operated orAbove'Threshold:
Farm Name: ............ ' ... '.?� .........1'l . ... ±....s.!�..... �t'..t' 1rA� County: ..........., t� �. !..t .............. .... .!...� .........
OwnerName . ............. ..4(rt:V.�Y\R .'.......��.i�.W...�.................................... Phone No:.......................................................................................
Facility Contact: .......�. ': ....... it Title :.......... .••................ Phone i4o:...................................................
FlailingAddress: ... . ..... .........................................
.............................................................................................
......... ...
Onsite Representative:....... ��� ....��.� L� .. Integrator., ........ .
Certified Operator; ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
1:-t�l
.MJ
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse I atitudeif �� ��� Longitude • ��«
Design Current
Swine Canacitv Population
❑ Wean to Feeder
Fceder to Finish
I Kg(�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑•Layer ❑ Dairy
❑ Non -Layer I I[] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I I ❑ Subsurface Drains Present ❑ Lag�mn Area JE1 Spray Field Area
Holding Ponds 1 Solid Traps ❑ Nu Liquid Waste Management System
Discharges & Strearn Im anti
1. Is any discharge observed from any part of the operation'? ❑ Yes `XNo
r
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑Yes XNO
h. If discharge is ohsern•ed. slid it reach Water of the State? (If yes, notify DWQ) ❑ Yes ANo
c. if discharge is observed. what is the estimated flow in gal/min? ' tq
d, Docs discharge bypass a lagoon system'? (If yes, notily DWQ) ❑ Yes �Io
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes J�(No
3. Were there any adverse impacts or pexential adverse impacts to the Waters of the State olhcr than from a discharge? ❑ Yes )?N0
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... ., . ��.............. ... .......... ............................... .................... ................................... ... ........... ............. ......... .......................... I ......
....
Freeboard (inches):
5100 Continued on back
v

Facility Number. — l Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes 0
(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 iEX -11"' o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes I0
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes � o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ P N ❑ Yes 10
12. Crop type c
13. Do the receiving crops differ with those designateMn the Certified Ani
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?
ante Management Plan (CAWMP)? ❑ Yes
❑ Yes
❑ Yes
Rettuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
I S. Does the facility tail 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? (iel 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 lteviewerflnspector 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'?
Yi#1PiQns:or d fcKn eN ► oo hoed. O(WI09 MsAsit; • Yoo Will-teeoi*e 00 fur ther .
car is' arider & abatif this visit. .
0
❑ Yes lyNo
❑ Yes [;I0
❑ Yes '<No
❑ Yes KNo
❑ Yes P11,10
�. cs ❑ No
❑ Yes P o
❑ Yes [ "
❑ Yes �No
❑ Yes �I0
e
❑ Yes P�No
❑ Yes _P�No
Comments r to # lain an YE a � e filar; un l i
C . is { eier question } , Explain y r , S,<.,nsw rs rerx y recotttimenila iiaris or any,otiter`cnrnmerifs �' :{i=� Y'�i ; }. ;" I'�'>
Use drawings of: facility;to' bettivexplain situations. {use:addk!nal pages as'nectssary} , F � , w f �1� ��r � ;�'"��
�. rvr.
Reviewer/Inspector Name
Reviewer/Inspector Signature: /jyFA_ Date: ]%)

FacilityNumber:
7:J-
�P !late 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 $(N o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes a
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 F"Q-
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan hlade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Ye�P/'N cc -01 No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes AO
Additional Comments and/orDrawings: �• .. i.-��.7�•IftY.� w� -.�.. ..q:. Fi:�t"I^!e '�.�:...:.�. s'� ..�M���j
AL
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U,��,{c Suds 3 3��U(�'
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Lci 1 v� -SC._ - 3C1 7V

13 Division of Soil and Water Conservation - Operation RcView
Cj Division of Soil and Water Conservation - Como iiartce Inspection'`"' � :, '..
,$Division of Water: Quality -.Compliance Inspection
© Other Agency OperaNdu Reiiiew
10'Routine 0 Complaint Q Follow-up of DWQ inspection 0 Follow -tip of DSWC review Q Other
Facility Number 3 Date of Inspection z
Time of lnspecliou c oa 24 hr. (hh:tnm}
Permitted ZrCertified 0 Conditionally Certified ❑ Registered JE3 Not O erational Date Last ❑ crated:
Farm Name: ...........€n�.... G1y........ ...... Counts:.., t3 ��
1�.........!f-v ......ric' ...... A.... :............. .. �......�.................'....................
OwnerName:........--•................................................................................................................ Phone No:................................................................ ...................
FacilityContact: ............... Title:................................................................ Phone No:..................................................
FlailingAddress: .................................... .............................................................................................
Onsite Representative:..., !��,:C1� � ....... ....................................... Integrator: ......... �.�.�..�� 5...........I....................
Certified Operator : ................................................... ............................................................. Operator Certification Number:.....!...............................
�Z
Location of Farm:
................................... I ....... .. ...........I ........ .... ........................................................ .
Latitude 0 �� �.4 Longitude 0 6 «
Design Current . Design Current Design Current
Swine Capacity PopulationPoultry Capacity Population.Cattle
Capacity Population
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish Iffi q JEI Non -Layer I 1 1[3 Non -Dairy I El
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other .
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ID Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps E ❑ No Liquid Waste Management System '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WoNo
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0No
h. If dischargc is ❑hserved, slid it reach Water of the State? (If yes, notify DWQ) ❑ Yes ;3"No
c. If dischargc is observed, what is the estimated flow in gai/min?
d. Docs discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ;'No
2. Is there evidence of past discharge from any part of the operation`! ❑ Yes ;2fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .........-2 5 rl........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures conserved? (iel trees, severe erosion, ❑ Yes P'No
seepage, etc.} . ///
3/23/99 Continued an back

Facility Number: 3 — 1 Date irt' inspection Z
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Cl Yes Na
(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 VNG
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes o
Waste Almlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes J�No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes VNo
12.
Crop type 4P1� Q13A 'F T:,3 Z $'M - G$-A ri
13.
Do the receiving crops differ with those designated in a Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 2No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes �No
b) Does the facility need a wettable acre determination?
0 Yes ❑ No
c}'['his facility is pended for a wettable acre determination?
❑ Yes J�allo
15.
Does the receiving crop need improvement?
❑ Yes V
16.
Is there a lack of adequate waste application equipment?
❑ Yes FfNo
Rcquirvd
_Records _&_ Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes VNo
18.
Does (lie facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, e(c.) /
❑ Yes Z No
19.
Does record keeping need improvement? (ie/ irri ion, frekoard, waste .ralysis & soil sdfiple reports)
❑ Yes ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the tirne of design?
❑ Yes &NO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes Dl�o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ic/ discharge, freeboard problems, over application)
❑ LYNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes ;3'No
24,
Does facility require a follow-up visit by same agency?
❑ Yes P No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes vo
�•yiaia(ioiis -of ftficiendbi § mere )nAteo• O(Wiog Ois' Visit. • Y00 .Wits eeoiye 00 ruttho ;
Torres or' de' ' e: about: this visit.
Comments (refer to question #}: Explain any YES answers and/or any recommendations o'r any'other, comments.
'
Use
drawings of facility to better explain situations. (use.addr<tivnal pages as necessary):
iJ� r i'orr N+sfl T% ps M P a..1 G' �Y� t]i] P� ( R -j-r J %A r i c. uT t lA y A► 0 t,r• i U_ Sr$ -A r rJa L, - A�
,Afb) )"P.4 AAOIe S4.W ;tir(, ►wopjiL Ta V<1-- a40 nAV-As uuk-� R fjAL (4 s+Aer- „
1S) C. s T0,0,4 1•oo1-__S 'F_ 1 ALU&7 D .
Womr. W AS E AnrgLy r'`S 1" .c�u I=�] w: r+1".S 6a Dhk S �3cFa � a� A�'r -� A+?e�. i c T� a ►,iS
Reviewer/Inspector Name
Reviewer/Inspector Signature: zff?�., E Date: B IZ.y 4 r
3123/99

Facility Number: 3 —q Daw uf' Inspection Z
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 Z N❑
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0"N0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, ctc.) ❑ Yes L2"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/ternporary cover'? ❑ Yes ZNu
Additional omments and/or Drawings.. ,
i
Pgov u GEt AP Vt sE;P T O A- r 1 �cVrENJ OZrj P i to. S + r+ rz� T R'V rr WkA i
'ri4�J S a �. P i 5 i ►-r �o -r4C L-A-6co.4 A R-T. 140 La 4 6 Eal�-
3/23/99

.. :: .. ..:.•...'..a!:..:",'.:
;.a. ^i:.::.:•:s. ii.:! �ir.:�;;i:
[� Division of Soil and Water Conservation p Other Agency
Division of Water Quality
lip Routine Q Complaint Q Follow -up -of DAV2 ins action D Follow-up cif DSWC review Q Other
Date of Inspection 11 q
Facility Number`� I Time of Inspection 4 :4k] 24 hr. (hh:mm)
D Registered 10 Certified 0 Applied for Permit © Permitted 113 Not O eratiunal Date Last Operated:
FaunName: ............... `#-•-- ...................................... County :........ .4-.......................... f........... .......................
Owner Name: ........ . ................. ............... ............................... Phone No: .... C11a }.. �A.-.'.........................................
Facility Contact:...............................................
.. I............................ Title:..f.......................................................... Phone No:...................................................
Mailing Address:.,.,..t'1 L1....,..., rr 4V�� 1.wh:j..........9j-....................................... ......... .A3�.f... t, ...t.f...a&!................................. .r- ........
Onsite Representative ..............4...Y I......Tali................................................. Integrator:......... 1htif i"5................................-.---.................
Certified Operator: ............ .f11[�le......(=n...... Operator Certification Number•... >Bta . .1................................ . [. 1�.........................
Location of Farm:
r►.f.....1U.. .......... sM........ 01 ......... ..... ai...1.i.... �....4....r�,�a.cs...... c .� .....�a. 1°15.5�............................................................
.................................................. .. ..
Latitude � " Longitude 1 i • h"L DO i'
Design Current:.:..::.. Design .y: Current D 'gn''''' .C:.urrent
5wiue '': Capacity Population Poultry .: F Capacity ,Population .,;:. Gattle' Capacity Populaf nn� 'Fj
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ElNon-Layer❑ Non -Dairy
❑ Farrow to Wean
Other
Farrow to Feeder ❑
.. ..
❑ ... .......
Farrow to Finish Total Desietvc 'paclty lip
Gilts
Boars
.:.. i'otal SSLW ': �S j , {pa
Ntimber'of Lagoons I Holding Ponds' ` ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
..F:•. ,,,, _ ... No Liquid Waste
❑ Management System
General
1. Are there any buffers that need maintenancelimprovement'? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes N1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ED No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flaw in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
10 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
EP No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(M No
7, Did the facility fail to have a certified operator in responsible charge?
❑ Yes
5P No
7/25197

„- .Facility -Number: 5\ —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes �Vo
Structures 1,a oons I ldin Ponds Flush Pits c.
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): ................................................................................................................................................................................................................
14.
is seepage observed from any of the structures'?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
1� Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..........6. x i> o..................+5 �.......q�:rc��......................................................---••---..................................................................---••-.......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
1P No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[� No
18.
Does the receiving crop need improvement?
❑ Yes
10 No
19.
Is there a lack of available waste application equipment?
❑ Yes
to 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?
V Yes
❑ No
For
Certified or ermi t d acilities Only
23.
Does the facility Fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JNo
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
No
C]: No.violitionsar defidehdis: were noted, during this' kit` Yau:rvill receive.no-f utter .:
:. coer6OWideke iihout this; visit:''
... 4 ... ... ...y ...:,:' :...: 1.. ..�...5 •....... :::....... ."':.................i..: s:...:ii:ii�-
m ents:(refeuto ueskian:#);. ,�... lai i'.ahy YES answers andJoranrreco: endgtlon or!an ) ercmmetti�
....... .a....... ..... ..'•'..,�''• .._ :i...::.. �..;ssEE:' �.......a....'.... :EsEj�F'FFFe, E' .•s:• :lEEfEi�Fj i�
)sat drraw of f cii�ty !v better cg lain situihans.' (use a. ditionai: a 'as;necessa ” _' ;; n 3`s i € 3 xw
e .t.s " �:" �� .. ; i,` a nt;�IiII I it'. ?E 15,rE • E .i :�d'd:._' �i„tfE; .
17— 0V w�olxkk Sk_4A e. t",Owa.Ac
'IA— L),kfU"—t - 'es S hov� C PW
. ]
0 OVA sw � .
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: iL �l - %„ Date: r l lto

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
is ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: i , 1995
Time:. , o 1'5-
Farm Name/Owner: k ��7?A *y
Mailing Address: T DQ(��v JA Z
County: 1►_�01� ►L . _ -,�,
•
Integrator: ' - c' C Phone���%�
On Site Representative: c- ►ed urn Phone.
Physical Address/Location: 0e tl I. S 4,'A-1- 1:E-7W f . &!C II
Type of Operation: Swine Poultry Cattle
Design Capacity: 4 ;D 4 �_ K%454, Number of Animals on Site: "" (:D
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: �'�' Elevatior : Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) e or No Actual Freeboard: 4—Ft. ) Inches
Was any seepage observed from theellagoon(s)? Yes or No' Was any erosion observed? a orgo
Is adequate land available for spray? 69dr No Is the cover crop adequate? Yes or o
Crop(s) being utilized: 6PI
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? 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 ofthe state by man-made ditch, flushing system, or other
similar man-made devices? Yes orC5 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: -,-V-U- A t1i VL.0 fL'VJ A -h (J)
...,�s�_�•�r�s�a�►�a�._s��,��w��:+�.i'i1/L�r.�.i��tic/��� �—'
'�K'i
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.