310458_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qud

(Type of Visit: Q C pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine ❑ Com Taint o Follow-up D Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ,3❑ �I County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Gapaclty Pop.
Wet Poultry
Capacity
Pop.
Gattle Capacity Pop.
Wean to Finish
La er
DairyCaw
W n to Feeder
Non -La er
Dairy Calf
ceder to Finish 14qo
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P.oultr.
Ea aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
Other
Turke Points
Other
[Other
Discha�es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑Application Field ❑ ether: _
' 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 E24 ❑ NA ❑ NE
❑ Yes
a;
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: 71 - Date of Inspection: 2 7
1471
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 120
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 Va ❑ 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 t reat, 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 ❑ N` O ❑ NA [ ] NE
maintenance or improvement?
Waste A lication
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
[DNA
❑ 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
[f] 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
[f�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
a o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�rNo ❑ NA C] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes QNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility lumber: [ - Y -5 ❑ate of Ins ection: �L L 7 r
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Po ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ti -o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
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:9 if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes Ej'*No ❑ NA ❑ NE
❑ Yes ff No
Yes afNo
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: ��L---tee Date: � �"`T
Page 3 of 3 21412014

• KDivision of Water Resources
Facility Number - ❑ Division of Soil and Water Conservation
❑ Other Agency
Type of Visit: XROGU
lance Inspection Operation Review Structure Evaluation ❑ Technical Assistance
Reason for Visit:tine❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: I County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ther
Integrator:
Phone:
Certification Number: _ i ` 3 17
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
2
Discharizes 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, notil'y 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 discharger ,
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Nnn-I]ai
Beef Stocker
Beef Feeder
Beef Broad Cow
❑ Yes No ❑ NA ❑ NE
[]Yes
[—]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[3 No
❑NA
❑NE
❑ Yes
ZN
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Page 1 q1'3 21412015 Continued

Facility. Number: jDate of Inspection: i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z n M
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PT7No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
C] 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
ONo
❑ 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
WNo
C] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E5No
❑ 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
IVo
❑ 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
E_'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
El"N o
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
.[ rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need i rovement? If yes, check the appropriate box below, ErYes ❑ No
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJ'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Date of Ins ection:
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 eNo ❑ 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
Q'NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes jNNo ❑ NA ❑ NE
❑ Yes r J 'yo ❑ NA ❑ NE
❑ Yes ZJ No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes No
❑ Yes
[:]Yes rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question H): Explain any YES answers and/or any. additional recommendations:or.any other: comments:.;
. . seaddiI[se drawings offacility to betterex lain:situations(ational pages as necessar
y). .
2,1, PItaS� s� r're� ba��
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
rc. c v/cj S 4 r 1 r 3T
t aV! C" e°k_-CI1 © n e—, de/\rjoL---
•t �t .� 4,,.� Phone: O71 ( /73c,�
Date: 14A
1412014

iType of Visit: UCo� ante Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral ❑ Emergency Q Other Q Denied Access
Date of Visit; Arrival Time: ® Departure Time: County: ,• Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
I iNon-LaZer
Dr. P.oultr-
Layers
Non -Layers
Pullets
Turke s
tkey Poults
Qther
Design
Capacity
I
Design
Ea acit
Current
Pop.
Cnrrent
Po
Design Current
Cattle Capacity Pop.
iry Cow
i Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
can to Feeder
Feeder to Finish
Farrow to Wean
Q
j2 <29
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Ot
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ YesErNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes
❑ N
❑ NA
❑ NE
[:]Yes
No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility 'umber: - Bate of Inspection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [?-<o- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 E:rN o ❑ NA [ N E
(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 dNo ❑ 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? ZYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7 No ❑ NA ❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ I ieavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101/1. or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ol'Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
No ❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application''
❑ Yes
LJ o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'!
❑ Yes
N❑ ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? Ifyes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need im ovement`? ]f yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
El Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall D 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F tilt umber: jDate of Inspection: $`
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Nv ❑ 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? Efyes [:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [:3'I A� ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [r]'No [] NA ❑ NE
❑ Yes 7[rNo ❑ NA ❑ NE
❑ Yes E!5"No ❑ NA ❑ NE
[:]Yes ff No ❑ NA ❑ NE
❑ Yes [f No
❑ Yes dNo
❑ Yes [2'�o
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
C.nnimentffi refer.:t&tnl'uiestian # :..Explaiki any,YES'answers'and/orrany $ddit oral,"reeommendatioiis"nrii;any:'other'..comments.-!! i' : ' s . ;. .
n� y ) }. ..}i 3�..drs .�.:.:.. 1 ..cue 'l. c.i4�:, s �� 34 { to i F.S 5 6 ��� Kd 1,
Use drawings of facilit : to.i�etter, ei ' litin sittiatlons (use additional: a es as,neeessa }: ,(..: - _ ; ; a ,A'; r ,' .3 . ,
tom( � �r ♦�rl L O �^�CJ � 1-�� -�,� CS �� a� �i � 9 � �� � �� �� �' � � w
e 4r.-
� � �k � 11�
f PC 'Pr C(. , 54c✓- 9 U �� !'air' � S
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date: '� r
21412014

■
Type of Visit: QTompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint Q Follow-up D Referral 0 Emergency O Other Q Denied Access
Date of Visit: 0 Arrival Time: anti. Departure Time: FFF1w County:
Farm Name: `1NG�olt'1t]^�. �ra.�1 rr.S Owner Email:
Owner Name: N7d�" ��`+� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certifled Operator; W p12LKVZ_ f 9-1-
Back-up Operator:
Location of Farm;
Title;
Latitude:
Phone:
Integrator:
Region:
Certification Number: 1 &3q 1
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Fop. Wet Poultry Capacity Fap.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
airy ow
Wean to Feeder
Nan -La er
airy alf
Feeder to Finish
airy eifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Currentw
Dr. P,oult . Ca acit P,o
Layers
Non -Dairy
ocker
Non -La ers
eder
Boars
Pullets
ood Cow
Other
Turkeys
Turkey Puults
L_jOther
Other
Discharges and Stream Imuacts
1, Is any discharge observed from any part of the operation?
❑ Yes
VrNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
P No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
ONo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
gNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
jZrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - H Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L_ I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P'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
�TNo
[DNA
❑ 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
[2rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ 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 At)nlication
10, Are there any required buffers, setbacks, or compliance alternatives that need [] Yes �i No ❑ NA ❑ NE
maintenance or improvement? �"
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or la 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
�Z No
❑ NA
❑ NE
❑ Yes
VTNo
❑ NA
❑ NE
[:]Yes
�No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
gr&o
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
[:]Yes
VNo
0 NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z'N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

F'acilit Number: - 1.}FjI Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gfNo ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes P No
❑ Yes P No
❑ Yes i� No
❑ Yes V No
❑ Yes V] No
❑ Yes ONo
❑ Yes VrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
D NA ❑ NE
❑ NA ❑ NE
Comments (refer to. question 4): Explain any YES answers and/or any additional recommendations or any other comments.
Us'e drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature
Page 3 of 3
Phone:25�-3b�^
Date: Q_ t - M
21412011

�'
Division of Water Quality
Facility Number ©- ❑ Division of Soil and Water Conservation
❑ Other Agency
Type of visit: prCompliance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: =� Arrival Time: Departure Time:County:. Region: W R�
Farm NameuZ Q &c3ms __ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Phone:
Title:
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: �� Qv
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer 1 4:::�
Non -Layer
Poults
Design Current
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'?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf .,
Dairy lieifer
Dry Cow
Non -Dairy
Bee l' Stocker
Beef Feeder
Beef Brood Cow
[:]Yes ZNo ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes [:]No
[:]Yes [:]No
❑ Yes 2TNo
[:]Yes Zf No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

1
F'adlit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus hearty rainfall) less than adequate?
❑ Yes
eNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):�■
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
7 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
gNo
❑ 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
pr.
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ 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
WrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Annilcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 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?
❑ Yes PTNo ❑ NA ❑ NE
❑ Yes .5�No ❑ NA ❑ NE
❑ Yes
ja No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ;Zo�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )ZNo ❑ 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 Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Anal ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ ❑ NA ❑ NE
Page 2 of 3 1/412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2"No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 2rNo
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) 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 ONo
❑ Yes 2rNG
❑ NA
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes gNo ❑ NA ❑ NE
0 Yes o ❑ NA ❑ NE
❑ Yes
FrNo
❑ NA
❑ NE
❑ Yes
j 4m .
[3 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
[ fiNo
❑ 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.
Use drawings of facility to better ex lain situations (use additional pages as necessary).
Lnewr\ C". --tn C��a� %
0
Reviewer/Inspector Name: _Y N —� Phone: "561~��
Reviewer/Inspector Signature: VAN Date:
1 r
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: L Region:
Farm Name:[���-}Q_� �iL�l� Nl� Owner Email:
�+ 0119.SL*- 'SS racy- 8$-loigy c
Owner Name: Phone:
Mailing Address: 5 �� Q�Z.{ C[ �q�l]� S I � p [�u N , I
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: LA—)oQTs 41'.--1 q . S 7QO-A-r�l
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Dl Certification Number: 394
r
Certificatlon Number:
Longitude:
Design Current
Swine Gapacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
La cr
Design Eurrent
Ca#tie Capac€ty Pop.
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. Nnultry Ca ci Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r Beef Brood Cow
Other
Other
Turke s
Turke Puults
10ther
Discharves 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 x No [,] NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: 7-Lit Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: iAccwy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a
❑ Yes
[�] No
❑ NA
❑ NE
waste management or closure plan?
�C
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
S. 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): ; C(L C 66 n&V 5 CA—) H &4 7-. 5 j3
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.
[DW UP []Checklists 0 Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No
❑ Waste Application Q Weekly Freeboard [l Waste Analysis Soil Anal sis ❑ Vji�ste Transfers
❑ Rainfall ❑Stocking Q Crop Yield Q 120 Minute Inspections El Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

i
Facility Number: .. � !- _ LI S $ Date of Ins ection:
24, Did the iacility 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 t'No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: �(
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 'iV No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes iii❑���No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 0
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
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
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
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.any other comments;....
Use drawings of facility to better explain situations (use additional pages as necessary).
NoT oN317 G war->C agu G A'Tj NV 5 - gooK--5 w IF�G C-E-P7 -
� '-Ai5 �tiD -4 �74-1 � cnraujw7f} r
p0Itrf imp>�J
F� �T D�zED f o]I n ��� -' S4i 16t�� Cam.- Q� � soi z .
ATT;v'. PcmAwvo- agivcS. 9 /0— S50"9 � �
]�!❑ �Di I Sol (- CvuEcTC [S Vk6ASE CJO"EC; - &
l i N 3Q 0'4's o f T4! T INSPC
`'`'. - {a 1S I0/5 fx� M INS 51�►►u= '� ! i
Nv 1_ t��Qoacn P.6c�aos T-'r H�
� f � i�
5*11
aoi3
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Sd 1 L aWR L�S)T
Phone: C
IL
Date: y f v & g
21412011

I
.i
Division of Water Quality .
Facility Number [ �s Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routino 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'Time: 3n Departure Time: C� County: 11QL=IAI Region:
Farm Name: Cx_(4 ME Owner Email:
tom, Q�� �1� � �], 12Q[�� `� 19 - SiaFt-3 83 w52
Owner Name: 1 Phone: Rir�- 99 Z -533 o(wj .
Mailing Address:_! C_C C^i ,�� j_�:YV ►'` �� ��
Physical Address:
Facility Contact:
'Title:
Phone No:
Onsite Representative: {'7 Integrator: a
Certified Operator: S c�_ks�� OpgaQN rtification Number: d `I
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
Back -up Certification Number:
Latitude: [= 0 0 6 0 Longitude: = e 01 0 1I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
El Layer
I❑Nan -La et
Dry Poultry
❑ La ers
Ej Non -Layers
Pullets
❑ Turkeys
Turkey Poults
Other _
DischarLcs & 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 Cali'
❑
Dai Ilcifez
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood CoyA
Number of Structures:
ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
:.
❑ Yes *No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑Yes El No
El NA
El NE
❑ NA
❑ NE
❑ Yes V No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
I No
❑ NA
❑ NE
12128104 Continued

t
Facility Number:"31 —C/S?
Date of Inspection �-
Waste Collection & 'Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: LA605W
Spillway?:
Designed Freeboard (in): nn
Observed Freeboard (in): aL
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 fkNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,[, No ❑ NA ❑ NE
❑ Yes 0 No . ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �{ No ❑ NA El NE
maintenance or improvement? JIS,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes '5�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below, ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) C S a .
13, Soil type(s) U VZCD
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4 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 ? ElYes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes *No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 19No ❑ NA ❑ NE
Comments (refer. to queOlon.#); - Explain any, YES answers:andlor any rec�mmendations:.or: any other.:,commcnts��.;F.�
y 3,.1,
Use drawings of facility to better explain •situations: (use additionai piiges,as necessary]:
.
WASIVO-f
A"i 1145�CTIDAI �Vu..Q.Ec_(3e_0S
rE5CNT
wE[ZG_ LEFT lnimp 1-AC:f-kSe. LA"�1►L _CQt t`wt.i_7
U 1 t,A 1C rJo� }a Ow Ia15 Ti0A1 N i ,
x.
Reviewer/inspector Name 01 r '�_ y_ i . Phone: 915 4,11094
Reviewer/Inspector Signature: Date: 3
Page 2 of 3 12128104 Continued

5
i
Facility Number: 3 j — $ date of Inspection
Re
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Pen -nit readily available?
ElYes No
K
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes ANo
❑ NA
❑ NE
the appropriate box, 0 Wup (] Checklists 0 Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes ANo
❑ NA
❑ NE
[3 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Sail Analysis ❑ yaste Transfers ❑ Xnual Certification
0 Rainfall ❑ Stocking Q Crop Yield 0 120 Minute Inspections C] Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes] No
f
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
Cl 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 ANo
❑ NA
❑ NE
27.
Did the facility !'ail 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 4No
❑ NA
❑ NE
Additlon4 Comments and/or Drawings:
5
C-C4(_lG (ZIP T)D/q �C4 D]
I D'��1C� J. 3
-� 1[fhr3
NA � jLf)J0 �` PumP]�v 6 IN 3111; W4 mac. �Ic
L7 A `�
I•�5 WASiE
1fZCL A Demos AIpT Q-eFLEC ��
WA57e A-NAL-�5 i S 5C3 1 t A Co1IF I�E� AL- S�'� #R � 5'CN i CY►►
15 W41,TING
c.�as� c�rnpc. ; r ado �Er���s�«7 FOX
r E ro �o �p
t� A N
i�e�Gr;} C-f-3Le��R � toNS 5 HU 3O DA�S .
coN,pc.cTC
_Qe.-C�A�E Fa(twwub
���..�ES
IAm&4DQ Fax A�vA GP/jE3
n�e,b�q C�Gz- A7rN
NG�
1ra� �o►NAt��ft..
V�►c..rwtrr£r�� N
IQFsyUrJ
Page 3 of 3 12128.104

Type of Visit Wompliance Inspection Q Operation Review ❑ Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint d Follow up D Referral a Emergency Q Other ❑ Denied Access
Date of Visit: LI Region:
i ❑ Arrival Time: Departure Time: County: g
Farm Name: u AQm Owner Ell..19 � y(C)
Owner Name:. . _ . �Qt'LJ Phone: 10?3' 5130 w
Mailing Address: J�� � CF_
Physical Address:
Facility Contact:
Onsite Representative: �~
Certified Operator -
Back -up Operator:
Title:
Phone No:
Integrator:
Operator Certitleation Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ` 0 `t Longitude: = ° 0 I = u
Ucsign Current
Swlnc Capacity Population
Design Current
Wet Poultry Eapa�ity Population
Design Current
Cattle Capacity Population
❑
Wean to Finish
❑ Layer
DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish y
Dai Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ ers
❑ Non -Dairy
❑ Farrow to Finish
Beef Stocker
El Gilts
on-t.a ers
Non-Layers
Beef Feeder
❑ Boars
Pullets
Beef Brood Co
ElTurkeys
El-
Uttter
❑ Turkey Poults
❑ Other
❑ Other I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence ofa past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5;rNe
❑ NA
❑ NE
❑ Yes
,No
❑ NA
❑ NE
12128104 Continued

Faciiity 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;
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 )kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 10 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JNo ❑ 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 `R,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? ' 1
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesRNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 Q% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12.
Crop type(s) � J �-
13.
_2
Soil type(s) A �A> Cd A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
A No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
19,7�1No ❑ 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
�kNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
, No ❑ NA
❑ NE
..: '.�. �.... �'•..•5 A.:na.Y•t....[:�.e'Y.:.;:�}:b:.:.
Comments {refer: to quesfian #]: Explain any.YES answers:andlor,'anv. recomm ndatians;nr:any.utlter:.evmments:
.I.1SC drawings' of facility to better ezplaln situations; [use additional pages necessary. s s� r �k 7x t t� C�- aj { "�$ i !
e
�Q • c.-zyTecyas c _Qu 56 L�r F& ow l E e.rx. �... or m Y 7� F r 1
rtNAT ` HC t-Ccc_a 0-% cx G C- CW51 ► C
C LDS )V C— A' t a�TNMLI_
F I LB S 14 A U e sLk-PPIC_9 ', �i C0jf Qj4GF -D[kF- 7n ux- w _PQT H C - 7"G kI C A �t r 'S WA C
:
p n
Reviewerllnspector Name - �j j�J j - 't Phone: 14 � is
RevieweriInspector Signature: Date:
12128104 Continued

Facility Number:Date of Inspection
Required _Records„ &„Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes o ❑ NA ❑ NE
the appropriate box. 0 WUP 3 Checklists El Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o No ❑ NA ❑ NE
U Waste Application ❑ Weekly Freeboard O Waste Analysis (] Soil Analysis ❑ W/te Transfers ❑ ,) nual Certification
❑ Rainfall ❑ Stocking [] Crop Yield (] 120 Minute Inspections 0 Monthly and 1" Rain Inspections [3 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
A No
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tgNo
❑ 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
0,,No
❑ NA
❑ NE
25.
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
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3I.
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
X NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
ddltivnal"C�nimeritstariiil�rDrsiwings: �t:�
t
��rr "S poCL 1, �4 7 �,,cc FLh I
AL
�. S ► H Fri' �1
u5F Gt.�ur5�� SLc�DGr ��
W j
Lo . ►A ,
S f C� rF IN 3 G C-PIS
-C' oO ZZ 's - �:J:_ C e )pc7j k
11�
Cold caQb4 P— 4--� f R-Ccods
I2128/04

Type of Visit P Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival 'rime: Departure Time: County: Region:
Farm Name: l,r Fl rIC i ills Owner Email:
Owner Name: �.'�.p�[zQL .Slur Di �� Phone:��
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
un rm
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' 0 " Longitude: 0 ° Q I 0 `f
..
.:
Design Current
Design Current
Design Current
ne
Capacity Populati-on
Wet Poultry Capacity Population
Cattle Capacity
Population
to Finish
❑ La er
❑ Dai Cow
ErWcan
ean to Feeder
on -Layer
❑ Dairy Calf
JZ Feeder to Finish
1440
❑ Dairy Heifer
❑ Farrow to Wean
❑t y Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dair
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number oI Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ 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? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence ol'a past discharge from any part of the operation?
❑ Yes
50 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�%No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r
acility-Number: '3 j —L Date of Inspection 5 ��
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: _ cQN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
❑ Yes [ (No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
RfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed ❑ Yes
EqNo ❑ 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
K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2kNo ❑ 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 Aunlicatiou
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, [3 Yes
,,��{{
IOI�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 Area
g�
12. Crop type(s) <3 G
I3, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
kNo
❑ NA
❑ NE
Comments (refer to question #): E,I:in any YES answers and/or any recommendations yr any other comments.
Use drawings of facility to better n situation. (use ztdditivnal pages as necessary}:
."
pa Ea K t W pLkMp 14COSr
NO 5d1 L p&L ro 9 �T TH � W 1t,L 9 F_ ©PSIC �c-LEC.i E S 500rV Y T W/ RbCO9-0S
Cr T j4( ULSDA DATAR,4-3 a FOR- aG-5Lt L-T 5
Reviewer/Inspector Name fY 1 ..` �. + j(� �.. Phone:
Reviewer/Inspectvr Signature: Date: 51 10�
Page 2 of 3 12178104 C'ananuea

r
Facilify Number; Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes / No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If'yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. 0 WUP E] Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
E] Waste Application E] Weekly Freeboard E] Waste Analysis E] Soil Analysis ❑ W/ste Transfers ❑ /nnual Certification
E] Rainfall ❑ Stocking E] Crop Yield E] 120 Minute Inspections E] Monthly and l" Rain Inspections E] Weather Code
22. Did the, facility fail to install and maintain a rain gauge?
23. 1fselected, did the facility fail to install and maintain rain breakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours andlor document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (icl discharge, freeboard problems, over application)
32. Did Reviewer/inspector Fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes NV"] No
❑ Yes No
❑ Yes No
❑ Yes WNo
❑ Yes ANo
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA
�NA
❑ NE
❑ NE
❑ Yes
9 No
❑ NA
❑ N is
❑ Yes
No
❑ NA
❑ NE
El Yes
No
[I NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
;XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
caTA:S of 'D9 OI G "xb �- -r t.w/ (L c %3 - n 1 r 55 q' Q ]c, pc7 oe
�pu�y�-��c�r! �� ��► 'nR - t��.. � ��� sR, � �AL�B� i 1U1� � SL��s�
V�7► H 1��Q-Cx.IC !E 5'GASo1V fqPC14l/46'N' AlCYTAAOXIT�4 -Ta-( TO
6 & 1 L'PCC"C b c"'w -- tQt.� GA N ?t-& M Q $ r � $ C LC7c� 7 id �) ?Lk KP
CO 115 -- lo/ 31 A-, tAC)NG AS CAA- N A uIr C4 o F T c� i µ r VO L.4, +•1c A(300G 5 AVQ
Page 3 of 3 12128104

I
.� Division of Water Quality
Fcility Number Q Division of Soil and Water Conservation �-
0 Other Agency
Type of Visit 10 Compliance Inspection Q Operation Review Q Structure Evaluation a Technical Assistance
Reason for Visit (V Routine d Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: b Arrival Time: �� Departure Time: County: IN Region:
Farm Name: _
Owner Name:..
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: L,1J0D �k �r2 � _ -.Integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
E]0
Phone No:
Operator Certification Number:
Back-up Certification Number:
Longitude: = c 0 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish ! yya U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
D_ischary-es & 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
Capacity Population
❑ Dairy Cow
❑ Dairy Call'
❑ Dai licifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑Yes
El No
[I NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
[I Yes
El No
El yes
A No
❑ NA
❑ NE
El Yes
VX No
❑ NA
❑ NE
12128104 Continued

I
4'
i
Facility itifumber: — C Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes tkNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �.�ooN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes % No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs [I Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
IX No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
' ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
5(„(�E -ia AI>vq-<S5 CCAC-K 0-Al Sit>SbC- HC�t 5E, tv4)CQ- VC-05LGS7 C.46CCW
•
Ul-Ac`rldc"Il65 Cg ACM tld t
J
9V
Reviewer/Inspector Name and4NOA�AIA161
Reviewer/Inspector Signature: ate:
12128104 Continued

j
F9citity'Number:-3 — Date of Inspection L
Reaulred Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[gNo
❑ 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?
El Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
gNA
❑ NE
Other issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
Cl NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss revicw/inspection with an on -site representative?
❑ Yes
J�TNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
kNo
❑ NA
Cl NE
Comments and/or Drawings:
f 212VO4

j Division of Water Quality
Facility Number Q. Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection ❑operation Review ❑Structure Evaluation ❑Technical Assistance
Reason for Visit XRoutine ❑ Complaint ❑ Follow up ❑ Referral ()Emergency ❑ Qther ❑ Denied Access
Date of Visit: ❑ Arrival Time: Departure Time: County: ��L�� Region: ZZ A
Farm Name: �fi /rDF t4tr 5 _ Owner Email:
Owner Name: _ IA'q 0,2 ow L�wpup Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: /1')CnoV �'�. _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feedcr to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No: Q
Integrator: _ey&4'1_. ,ts1
Operator Certification Number:
Back-up Certification Number:
❑n ❑6 ❑�� g ❑o ❑� ❑
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
-�.��.. �� I ❑Non -La et _. .
Dry Poultry
Non-L,
Pullets
Pouits
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 licifci
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:. �.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N i;
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes,gNo ❑ NA ❑ NE
A
12128104 Continued

Facility Number: Date of Inspection ll d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
1�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway'?: o
Designed Freeboard (in). _
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed? Cl Yes ff N❑
❑ NA ❑ NE
(ie/ large trees, severe erasion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A!1 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
'ffNo
(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 ZfNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA ❑ NE
/VlNo
❑ 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
Evidence off+ Wi d Drift El AP lication Outside of Area
❑ Outside of Acceptable Crop Wir;'94
12. Crop type(s) I�fl2 1 fIQ �?-
, [ ,- r� elf 2SF_, eo"e'F�4,tIS'
13. Soil type(s) Rd
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable aere determination?❑ Yes ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
2� 660 ,o GrJ-��,-� - ���Gzzee t�,D�� •� ��2 2� � s
�G.50 L �!!/NrJ l/ocl�.g�sd
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 6o Ifs G
12128104 Continued

t
Facility Number: — Date of Inspection
Re wired 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes ANO
❑ Yes PNo
❑ NA ❑ NE
❑ NA ❑ NE
0Yes ❑ No ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 L' Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Revicwer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional
Comments and/or Drawings:
�G&e9w f7
❑ Yes No
❑ NA
❑ NE
❑ Yes ❑ No
�NA
❑ NE
❑ Yes �No
El NA
❑ NE
El Yes � No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes ❑ No
/I'. NA
❑ NE
❑ Yes No
ElYe 0, No
❑ Yes No
❑ Yes No
El Ye No
❑ Yes �No
❑NA El NE
❑ NA ❑ NE
El NA El NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

r►
Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 10 Routine Q Complaint ❑ Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: aArrival Time: � Departure Time: ounty: Region: : 046
Farm Name: 'A I Owner Email:
qOwner Name: �r „. Phone: (0 r dz_� 4�
Mailing Address:
Physical Address: Gzt] cLAf
Facility Contact:
Title:
Onsite Representative: 42,2W -_!S2292("j::j
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a 0 ` = " Longitude: = ° = ' = u
Design Current
Swinlculation
Design Current
WC-ap
mcitypol
inish
❑ Layer
❑Dai Cow
eeder
Non -La er
Dai Calf
rWaon
Finish
Dai Heifer
Wean
Pltry
D Cow
Feeder
Non -Dairy
Finish
La ers
El Beef Stocker
El Gilts
Non -La ers
Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Other
Turke Poults
❑ Other
plumber of Structures:
IN I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ 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? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9N❑
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility lumber: -- j Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
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 ZNo ❑ NA ❑ NE
❑ Yes • []No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes gNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [INE
maintenance/improvement? 10
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 1❑ Evidence of Wind Drift ❑ Application Outsid�e�of'Area
12. Crop types) LJ�� L��fi- (W4V), �• a. Aoes'6'_4��) e iQV zr/if,ErqL�. "" 5
13. Soil type(s) A4rl f__Q,
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
P�No ❑ NA
ElNE
16. Did the Facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
�ZrNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(A No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to Fetter explain situations. (use additional pages'us necessary):
&)
Z11J
'�`-Xo I�RzNF�GG I�„�,o e z.�A T�o� �Q�coRDS d�
�
aP or��� ! a.�,�•.,� , pP \AAW R&0aeV'5 i s .� r 0� A�ur�,a
Reviewer/Inspector Name �,�,�ygfj Phone: "d- &8Z3
Reviewer/Inspector Signature: Date: D
Page 2 of 3 12W104 Continued

M
Facility Number-
, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ClNA ElNE
the appropriate box. ❑ WUp ElChecklists ❑ Design [I Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
01her Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
ko
❑NA
El NE
❑ Yes
X No
ElNA
ElNE
❑ Yes
XNo
/�&o
[INA
ElNE
❑ Yes
Cl NA
❑ NE
Additional Comments and/or Drawings:
2jj�FPu►P�h'Y3
I
6-9 Z5LAO_
Page 3 of 3 12128104

Type of Visit tj Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutino O Complaint Q Foilow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: II T/ Arrival Time: Departure Time: County:
Farm Name: -.-�f�G�D��- S Owner Email:
Owner Name: _ 1�?D+P�c�J �% Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: eLy o, �aj
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
❑ 0ther
Phone No:
_ r
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: "11
Latitude: Q o = I Q Longitude: = ° = = "
Design Current Design Current
Capacity Population Wet Poultry C#pacity Population
i
❑ La er
C C ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heitei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;j`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
El No
❑ Yes
0No
El NA
[I NE
❑ Yes
P No
❑ NA
❑ NE
12128104
Continued

ram+ 1:
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ 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 h
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes VfNo ❑ NA [IN E
maintenance or improvement?
Waste Annlication
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenancelimprovement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ElNE
ElExcessive 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 Widow [:]Evidence of Wind Drifl ❑�AI46�z=
plicatiof Area ,per
12. Crop types) , ��11,o�. �1njj,L �ie��JLCr� 44•�T ��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
joNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
�TNo
❑ NA
❑ NE
I7. 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
/0
VNo
❑ NA
❑ NE
�€:'�:�'d`.9i:.5eN' ux:�:::;-�L � r.5'nSM.+!:1:.':':.�`°a�:.:"�,F3x"%:;�T.�w4�.::::•:i.:•9 :�;.8s i'�:. �.�" r•� ;:�.��:'Ts�;T.Sk� � ��,+inw;;�'".�.eAP."�P9��sW'-J:�i. �IP+li9�un'4,.�F.�'-^'""ram
r ��1P,4fl�,IF G[�.�-r�eu���- /�.vA ►a.P�z��,� �_ F��..�.� 'fir- C�rxd�'
1�)&12,J AW,05
Reviewer/Ins P ector Name ---T� — - —'- '�.`':..w�"; Phone:
���,�
Reviewer/Inspector Signature: Date:
12128104 Continued

I
..6 , }_
]Facility Number: 'J j$ Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? lryes, check ❑ Yes 7o No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists [I Design El Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. )zYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking OCrop Yield JVf 120 Minute Inspections ❑ Monthly and I " Rain Inspections Xweather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Ycs �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit? ❑ Yes ANo El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'? ❑ Yes ❑ No 9NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the ravility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
El
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 duality 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency`?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
p� �Av�i'•��' Z-15 rr_ rZG�J �FG�5
%ez, gate 4 Re
1`t•5 � C�pv/�!L �iec�P �,e �;_Ft� �� � ��� S � ,�.� ��2 ��F
A� �a �v 2 GAO P . ��7 �vsrrV t5
i ..� ,►� Aj .45 ,�a�-? l �-�•J
EmsVco
'
i�F Gol�� /Qft�n1 F44 z�
5
[tom Lvury r • v I .T r �-v�v- - - 12128104

Time: F
Permitted oCertified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: •••....••....••..........
FarmName: .............. �W)................................................... County: ........ DIAltj........ ....................... ........ M............
OwnerName: ........................................................................................................................... Phone No: ... .................. ....................... ............... _.........................
MailingAddress: ..... .......... ................................. ..... . ... . .. . .................. . ..............................
FacilityContact:............................................................. ..._............. Title:............................................................. Phone No: ,.................................................
Onsite Representative: ........ ��ND...... `S..7. U............................................... Integrator: .......... CA Ls.................................................
Certified Operator: ... ....................................... ....... .................................................. . ......... Operator Certification Number:........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 46 Longitude • 6 «
,DesignCul+ept ; +,. Design,. t Cttirresiti3
awioe: ail:['
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ soars
MR
:.Poultry Lj..iN Capacity ,: Population
17.
'�.11i{ JI i! Deli .italS'.
�� it l�
'l. .3 CaoacitV,.. Ponulatlan
❑ OtheI I I
''ri. is .;:.•: yip �i f 1' '� J .,''S
' TotW.Msign Capacit`y!p jC
'' �,siNurnbrr of Lagoons- r : ;' `li- „ k 3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes <0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes
io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B<O
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ....I. .............. ..... ... ....... .......... ..... »...... ...... ............... .............. ...... ............. ............... .».... ............. ............. ...................................
Freeboard (inches):
12112103 Continued

Facility'Numberjl -- Lj f' Date of Inspection
5 "Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [ KO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E2 No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ;�<O_Z
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes L
❑ Excessive Pondinngr ❑ PAN ❑ Hydraulic Overload ❑Frozen Ground ❑ Copper and/or Zinc
12. Crop type isa L7CA?Nt M H 56 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes io
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ YesO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [ Yes E00
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 10
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes L/o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �io
Air Quality representative immediately.
��:. _......,.,.�.. ,».:., ...,;:p�:.:r:y�: .. .......xzv+�:"�rN�•:r:* -:H•.' -- �:+ux' .�+��a te;..:..... •pal;��-..':nr'rr; :��l:;ie •f r�l :. .,.,.. �y �i ;••w'<..:..,
Comments (t efer to queshon� #): ���Explaan anypT;'YE5 answers an any.. rerommendatiiins or. any,ot er eommenta:'���� F�,�;� i � .' 3
.,.3r::. ` i8:' , w1d i[d;• !6-M"'-�W ,I ': . P.1,:Ni""k�.,�i:^'•:lytllrFJ��•.il,{ :iOHlIC •..• -••r•• Sv.: :::'. �I�: :.��i •I �.aS '41�3+:K:.`7'I� .t!VAf:wr:�:..:,�;�e0 .. .7.w:kswna waWW.:..a..:z::.. ,��n�::lYu, U., a'
Use dravings;of tbriuty.tolbetter,explain sitvstiot�:.(use additional pages as ryjeer, ❑Field CopyFinal Notes ��,• I��.4 }h
^I; : ,. ; V :,., ?j :P� � . •'�� �# 1. . ..,rk .i, q, . �++',, : . r, .:� u= t Try
... ...1 �:{�.. '�.�! .Zp:' � �� .H ..�w� l�7' ,. •-`T:':� �.... :�zr, ni:itlrs:;.� a i � !�!@?h.,z^w. w`.. ! ..�I' �!!4`I}f i� I1;
..� ,,.'.l, �•>�:,,. r.r'. k �..4..I... �. ..,:.tin �.,....#�€�i�u�;�1�a.dt��.......w�.._:�-,.�_;�f:=.�-t.:......�...�..,.......�.........»:�...�,:......,�..:,."�114'[.9N=1:�:i.;'�r'�[�1k,"lT!!":ld[rR."...ti�11���eil fiL..�:..
dA/ P0EAT fvr� 2o03 -- Lary SC- -'W Ta 74'4 sfm PAO 8AL4dC(, r+`ron+l P" D,.Ar
dvC-c Ta IA7Ep, At p a cA7, roN Sri ce-r .
r'VAm ri,,*( of Fwgo gs GCva Fo& cAa, iw , sw(r /4As zo*,
Reviewer/bspector Name '
Reviewer/Inspector Signature:
Date:
irrta�w c.onmtuea

l
Facility Number: _ Date of Inspection
Required Records & Document%
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc,) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rZo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes o4q/
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes �;/O'
2
7. 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 wo-
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [ to
NPI3ES Permitted Facilities J
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes C3'N/0
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ RainfaIl ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

': Divisivri of;Water Quail#y
Q IlIvision of Soil and -Water Consecration s• ;i;
Other: Agency
Type of Visit Compliance Inspection D Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up Q Emergency Notification o Other ❑ Denied Access
Facility Number hale of Visit: Time: © Printed on: 7/21/2000
(j Not Operational 0 Below Threshold
Cj Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ...........................
Farm Name:. 4eKh.1 .............6 AJ, County: wx?1 ................................. 0 ..
Owner Name: ......... a)pp'. a ............ tiST�p,�f,� I .... Phone No:.......................................................................................
FacilityContact:.......................................Title:................................................................ Phone No:...................................................
MailingAddress :................�.. l,�......................5................... ..,,.............
........
Onsite Re resentative 'SUIWJI� , C3C ,Q... Integrator: •„��,{ i�%
p ...................................................................
Certified Operator:
Location'of Farm:
Operator Certification Number:
r19
qr
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • ��«
Design Current Design Current Des] Current
t ` Ca d Po ulatlon
Poultry Ca ad Population Cattle Ca Po tito>t
Fi Wean to Feeder ❑ Layer ❑ Dairy
iU'i Feeder to Finish ❑ Non -Layer 1[]Non-Dairyl
barrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish
Total Design Capacity
�F-A Gilts
Boars Total SSL W =
r'Numtbr� etLagoutitis' Subsurface Drains Present ❑^�+ Area spray Field Area
f;IHolding Pumt3s 1 Solid Tra ❑ No u d Waste Management System ps Liq i g y
Discharges & Stream I_mpaci5
1. Is any discharge observed from any part of the operation? ❑ Yes J9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-niadc'? ❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the State? (It' yes, notify DWQ) []Yes [:]No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes �^o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes oNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure I Structure 2 Structure i Structure 4 Structure 5 Structure b
Identifier: ................................................................................. .....................
Freeboard (inches): 215
5100 Continued on'back

Facility Number: — $ Date of Inspection 3 OZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
o
seepage, etc.)
Ili!
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
f
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Yes
�r^]'j No
Immediate public health or environmental threat, notify DWQ)
�I
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
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste —Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
{ No
11. Is there evidence of over application? ❑ Excessive Pong ❑ di PAN Hydraulic Dverlo'ad)
El Yes
�No
12, Crop type Lee febwAC-Apt;, 0 D rJ W _
T ©
11 Do the receiving crops differ with those designated in the Certifie nimal Waste Management Plan (CAWMP)?
❑Yes
gfNv
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
91No
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?
El Yes
XNa
$eQuored Records & Dog}rments
I7. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/VNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
60
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
V,o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes
N
21. Did the facility fail to have a actively certified operator in charge?
El Yes
)ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
9Yes
I❑ No
24. Does facility require a follow-up visit by same agency'?
❑ Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O'No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammcnts (refer to question #): Explain any YES answers and/or any recommicndations or any. other comments =
,Use'drawings of facility to better explain situations. (use addltloriaf pages'as necessary}:: = l
Field Conv ❑ Final Notes
I.� tiDr.I � f� Gl.�i� �o C� frst� ��,,� to ��v� 1►Ir�e r�s.
t,-50.7da 0001� iJ a4mla (�472) a45, 42 4ce' rvf C
[afrD►4 �� ELF �f�r` 6v4LG G'N
{,e F2.o
Lei ISf}?F
qlppp
- -
Reviewer/Inspector
Reviewer/Inspector Name
............ ...
Signature:
Date:
05103101 Continued

Facility Number: 3— 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 ;eNo
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i,e. residue on neighboring vegetation, asphalt, ❑ Yes XN 0
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the Iagoon? ❑ Yes dNo
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 EfNo
31. Do the animals feed storage bins fail to have appropriate' cover? ❑ Yes E!�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑ Yes/eNo
Additional ommen an or ravings:
® 52/-T-, J�f .Qy � e�F 7- 64ck
f _
� JPr',- , �, , , -1-11
A
.y/' �Oa !7� �7/�� U'yF✓,J�£on1S/ Ij,�vey /'!G C�Sr�'sl�oG6�
5100

rt
Division'of Water Quality
Division of Soil and Water Conservation
D pthci Agency.,
r ..
a
Type of Visit jorCompliance inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine ❑ Complaint ❑ Follow up Q Emergency Notification Q Uther 0 Denied Access
Facility Number date of Visit: JTime: [I❑ Printed on: 7/21/2000
erationid 0 =Not 0Q Belnw'I'hreshold
Permitted 0 Certifieed` 13 Conditionally Certified © Registered [gate Last Operated or Above 'Threshold: ................
Farm Name: ..... R.............................................................. County: .... .-.
-. ..
Owner Name:
Facility Contact:
Title:
;Wailing Address: ........................................... ................................................I..........
Onsite Representative:..+►,r.-.ir .............................
Certified Operator:
Location'of Farm:
Phone No:
Phone No:
.............. ...� ........I- ....... I .... I ....... ..-- ..................... --...
Integrator: ...C--7, .4](r.............. ................ I...................
Operator Certification Number:
13 Swine ❑ Poultry []Cattle []Horse Latitude Longitude • ��«
Design Current
Design Current Design Current
``'"gz-. :`` Ca ci Po elation
Poultry
Cti aci Po elation Cattle Capkity. Population
A. Wean to Feeder
Layer
❑ Dairy
�.
Feeder to Finish Q
❑ Non -Layer
❑ Non- airy
qs�i Farrow to Wean
i_ Farrow to Feeder
❑ Other
U Farrow to Finish
Total Design Capacity
Gilts
Boars
Total SSLW
ate:
Discharges & Stream Imeacts
I. Is any discharge observed from any part of the operation? Cl Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [] No
c. II' discharge is observed. what is the estimated flow in gal/min?
d. Hoes discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes CR'No
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure. 1 Structure 2 Structure 3 Structure 4
Structure 5
❑ Yes [N'No
Structure b
Identifier:
Freeboard (inches):
SIa(1
Continued on back

acili y Number: S0 Date of Iu.,pection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'! (iel trees, severe erosion, XYes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,'No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes j(Nu
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 maintenancelimprovement? ❑ Yes gNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12.
Crop types
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
gNo
b) Does the facility need a wettable acre determination?
❑ Yes
11No
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15.
Does the receiving crop need improvement?
❑ Yes
ff No
16.
Is there a lack of adequate waste application equipment!
❑ Yes
gNo
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
[I Yes
KNo
18.
Does the facility fail to have a]I components of the Certified Animal Waste Management Plan readily availablc?
❑ Yes
(iel WUP, checklists, design, maps, etc.)
1WNo
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(iel discharge, freeboard problems, over application)
23.
Did Reviewerflnspector fail to discuss reviewlinspection with on -site representative'!
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNa
El.�'}1c�. I AiWAS.Qjr � it c�e� ie Vv re a te$ �1(tt°ing th}s:v}s�t; Yoh wadi �eetriy u u> t r
corns' dance: a�vut this visit: .........
Comments{refer,to'4uddon #}; �Explain'any- YES answers and/or any. recom' meiiiilations'or any outer"comments
...� n..:., .... .
Use,drs of facillty'ta 5+i tter'ea� lain situa6w. (use additional:pages as necessary}= ,i r F�,±;� s; �.�' ,», :: iz .,
....., f.,.._ _ . �_....... .... . . ...fP..... .. .....,.......,..... �,._.... .... a'�rxf.h. . ,. !ru i Fes_:
� �►tit�s a�s�� �— .i �--4-,e� �.�.�` ►c� ��-:t ►� � yes~ + � �-�-�.Q�
Reviewer/Inspector Name �
Reviewer/Inspector Signature:
A. -,.., w...,....:r.....z ..r....., s�:..
Date:
►ri

.1 Faeflity Number:'? -- Date of inspection Printed on: 14/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
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, etc.)
31. Do the animals teed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes VNo
❑ Yes 0 No
Cl Yes Mo
❑ Yes qNo
❑ Yes ftmo
❑•
Yes qNo
[Additional Comments and/or Drawings: E ,,
q)
14)
��-
r1 ` P
r�� t 1yes� g►-.. C��- �►� is cr— ��� A ,
�Gw �� �i�-�d�� �- Sri i 1 � -� � �� �� d 1�►--�
4��4\vz 4e&j' L.4L.,�,w
Ker-
OZ-401
91\A
VIIIII

S:e' 4 .
13 Diiision'ofSoil and Watee,Conservation,= Operation Review . , .p,.; ti • ''; �"� �t';;;:'�ph
Di S and. Water Conservation,- 'p ;imp :
Division of oil at rCorn fiance eetinn: R , 4s 'pp ;t:
Division of Water Quality - Compliance Inspection:wly;g
©Other Agency Oprratioi Review a` r�Y w t"'v. '
. , €
Routine O Comnlaint O Follow-uv of
I Facility Number I
Permitted 0 Certified [3 Conditionally
Al Certified Regi
FarmName:�... =fi.t'1�4
Owner Name:
Facility Contact:
Title:
MailingAddress: ...................................................................
Onsite Representative<�5 ....................................
Certified Operator:
Location of Farm:
0 Follow-up of DSWC review 0 Other A
Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
stercd 13 Not eration04-11-
allDate Lust Operated:
......I. County:....IN......
Phone No:
Phone No:
Integrator:....c !.J_................................................
Operator Certification Number:
Latitude ' ' " Longitude • C I` "
Design Current Design Current ; Design ;Current
„ .Swine Capacity PopulationPoultry Cattle C`eiaPo ulatiois
❑ Wean to Feeder JE1 Layer I , ❑ Dairy
Feeder to Finish 4 ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other s
❑ Farrow to Finish Total DesignP Y�gCa adt��� ,
❑ Gilts
❑ Boars Total 55LW
Number of Lagoons [[]Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds 1 Solid traps ' p ❑ No Liquid Waste Management System
Disc�harQeS & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system" (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JxNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .......... .................................... ................... ................ .................................... ............ .......... .............. ............. I......................
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, ❑ Yes IkNo
seepage, etc.)
3/23/99 Continued on hack

Fac>hity Number: — YL3 Date of Inspection P 0 Printed on: 712112000
5. Are there any immediate threats to the integrity ofany of the structures observed? (ic/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes WNo
(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 tTNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 1XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ;kpo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes kNO
11. Is there evidence of over applicatiortrI c ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type hA-N , � , GR LIA fG
13. Do the receiving crops differ with those desigAated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes ONo
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. Dees the receiving crop need improvement? ❑ Yes kNo
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage tic General Permit readily available?
❑ Yes
W`No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
E No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
gNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
ONo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over appiicat ion)
❑ Yes
14 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
MNo
24.
Does fatality require a fallow -up visit by same agency?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
yi is iggs:oV ¢ fc�earici 5 re n¢te¢ during th s:�isit: 1'oi wii� ree�iye v i'ul t� r
curses' orideirtce: about this Visit.. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
r C,4,
%� ��e sr-�•- � r,�� �cc� sail � �►--- � � -���s-. �ti--� �a�,
Reviewer/Inspector Name
Reviewerflnspertor Signature:
S
o --3 s o a �C-- -�
Date: —CG 5/00

r
a
Facility Number: — Date of Inspection —�P--CA
Qdnr 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 00
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P(No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes A No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 04 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes dNo
ona ammen nrr: raWrn_,:.. 3 . t: s.,kJVJM

4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /-t
Freeboard (inches). .........��...
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
13 ,
D�vtston of Sotl and' Waters Consei-vatioq - Operatiaa.Review
i 0 Division of Soil and Water,Cotisetwa;iun'� Compliance Inspection �. '. , i,. A;' •:,
ision of Water. Quality. =.Cgiupliwn Inspection
. 0 Other Agency = OAerat�on.Hev><ew ;� E.
.
Jtj'Routine a Complaint Q Follow-up of DW inspection Q Follow -tip of DSWC review Q Other
Facility Number $ Date of Inspection
Time of Inspection 24 hr. (hh:mm)
/�Permittc+ Vertified 13 Conditionally Certified © Registered ©.Not O erutional Date Last Operated:
l
Farm Name: 'T'J e4lcfe Caunty:...... ..Q.10 ..".................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: ......... AAQ..t. A9.A.'....... ......... I ....... I ................... Integrator: ....... ;r..A.. ...............r.�........................
CertifiedOperator:................................................................................................................ Operator Certification Number: ... 1'�'_.�r � .............
Location of Farm:
Latitude ' ° •1 Longitude • «
Design Current
Swine . Capacity Population
❑ Wean to Feeder
Feeder to Finish
j
❑ 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 Non -Dairy
❑ Other
I
Total Resign Capacity ,
Total SSLW
Number of Lagoons JCI Subsurface Drains Present JIET Lagoon Area IEJ Spray F ieid Area
Holdtn Ponds 1 Solid Traps ❑ No Li aid Waste Management System
g P tl g
Discharaes & Stream Impacts
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 roan -made?
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ)
c. It' discharge is observed, what is the estimated flow in gal/min'!
d. Does discharge bypass a lagoon system? (II• yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation'?
❑ Yes [ 1No
❑ Yes 14 No
❑ Yes 9No
❑ Yes )� No
❑ Yes PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
[:]Yes �No
Structure 6
.......................
❑ Yes No
3/23/99
Continued on hack

r
Facility Number: Date of !nspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑Yes �N❑
(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 o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes L&No
Waste A nFlicatiorl
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2<0
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ZrNo
12. Crop type C . gbh, j pxb� �j C0Qn.!
13, Do the receiving crops differ with those designat in the Certified Animal Waste M4agetment Plan (CAWMP)7 ❑ Yes eNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes �No
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes 'j��No
15. Does the receiving crop need improvement? ❑ Yes Z No
16, Is there a lack of adequate waste application equipment? ❑ Yes r_Q>d
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes AN❑
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? INO
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ YesdNo
20, Is facility not in compliance with any applicable setback criteria in effect at the titne of design? ❑ Yes Pp
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes O'No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes j No
24. Does facility require a follow-up visit by same agency? ❑ Yes loe2<0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes l O
�'�fo vi¢lat�igris'vi' ftficj6n3 io$ ►ire jnoted. O(Wj#g 4)his:vjsjt' • Y:op ee lye Ito #'u>j•tp�r
corres once' *e' about: this visit.
Comments (refer to question #)a ltxplain any;YES answers and/or any` recornmee[iations'or any, . er,coi 'L ents P� , 0....::`
a Use drawings of facility to hett r explain situations. (use additional 's as necessaryi s ' h
is£.
r�1 PE X i 172b ( �/-) !-AC-,' L 'r 9 s M VC'- X"O'
Reviewer/Inspector Name
Reviewer/Inspector Signature:1�r _ u.�._ Date: Q] Z3 IFq,
3/23/99

r
Facility Number: — SB Dutc of Inspection ZP
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allot below
❑ Yes
INU
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed ul' properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Vo
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
17/No
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, etc.)
❑Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32.
Do the flush tanks lack a submerged fill pipe or a pernianent/temporary cover?
❑ Yes
No
Additiona omments an or Drawin
p.
r
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
10 Routine 0 ComDlaint 0 Follow-ut) of DWO insvection 0 Follow-uti ofI)SWC review 0 Other I
Facility Number
13 Registered 9 Certified 13 Applied for Permit 13 Permitted
Dale of Inspection
Time of Inspection
24 hr. (hh:mm)
Date Last Operated: ..........................
FarmName: ........... �IAV4-..AC ....... ......................................... County: ......... D.Upl . .................................... .......................
Owner Name: ................ Wo.�.m.w ........... ...... ....... ..............•........ ............ I • •. Phone No:.... L�.. 1 - i.n.! 5 ....................................... .
FacilityContact: .............................................................................. Title: ................................................................ Phone No: ...................................................
Mailing Address:..... ........... tr.j . .....{A......�x .....Jul .... .... .................... .............. ....... .............................. .'4.57;5 .......
Onsite Represen(ative: ......... NO ............. ............................................................ ... Integrator: .......... caxwki .........................................................
Certified Operator ............. t.)PADU) ................. .................... Operator Certification Number-,..1.619_7 ...... ..............
Location of Farm:
Latitude
Design ; Current
Swine" Capacity:: Population
❑ Wean to Feeder
Feeder to Finish
1144D
❑ Farrow to Wean._
❑ Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boars
Longitude
1)6ign, Current Design Current.,..::,,.
Poultry Capcity 'Population Cattle
;Capacity Populati
on„
11 Layer ❑ Dairy
I[] Non -Layer L❑Non-Dairyj
..... .. ...... ..
. . . .......
A.
]D Other
. .. ...... ..
Total Design Capacity.,,
'."T770
. ...... Tota.].SSLW 400
Subsurface 10 Lagoon Area
.Nurnberof ns H ldingio��ds. Drains Present:]
10 Spray Field Area]
... .. ... ..
.. .......... ... .. . .... ..
rQ No UqWMWaste Management System
'engral
1.
Are there any buffers that need maintenance/improvement?
El Yes
No
2.
Is any discharge observed from any part of the operation?
El Yes
No
Discharge originated at: [:] Lagoon [] Spray Field [:3 Other
a. If discharge is observed, was the conveyance man-made?
0 Yes
[3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
0 Yes
No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EP No
5.
Does any part of the waste management system (other than I agoo ns/h o I d i n g ponds} req u i re
❑ Yes
[P No
rnaintenancchmproverncnt?
6.
Is facility not in compliance with any applicable setback criteria in effect at the tirnr, of design?
0 Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7125/97

Facil4y Number- -51 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Nluw ores (LagoonsJJ21Jii g Ponds, Flesh Pits etc.)
9. Is storage capacity (freeboard pius storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Yes P No
Structure 5 Structure 6
Identifier:
Freeboard(Ft): ,..........L44.......................................................................................................................................................................................I...........
10. Is seepage observed from any of the structures? ❑ Yes 12 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 29 No
12. Do any of the structures need maintenancelimprovement? i . (� 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 U9 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) I L
15. Crop type ..............btx7hi13 Q.................. tY.. I.�.... ��N............4 O 4.n........G, � Alk.L ......... . - ...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 10 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certittcd or Permitted FacUldin Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.viutationsQr deitciencies4e're nnted,during this.visit.- You: -kill receive, no-ftirther
:. correspOdepce 6 oW this:vistt::
�y. COr�hU'C e 4ork }0 li;�e'� e1 baA ri+flu or, t&K
18 No ev'.4,c e 4 s rr� � I qp,Yd �. Vvtv"Ce4 : w #-i t (6 * 1 .
L? . ra r r- c. ev �` i-1` C0.C+A� r f+. tw►� ct+� V�t�b. 1611
❑ Yes No
O Yes ❑ No
❑ Yes No
❑ Yes P No
❑ Yes No
io Yes ❑ No
❑ Yes to No
❑ Yes 11 No
❑ Yes No
, V,O t 104z, t r` 41—"- Aro,_
7125/97

❑ Division of Soil and Water Conservation ❑ Other Agency
:3 •�,� i' fee 3
.s
nen .. • • • F• ;
,9®Dtvtston of Water Quality
e i::. .. �.---]i`.ew>u;.++,ww3:!!.."':"�'4� r^.....r....•....ew..w-,e, ye....aro«er.,.sarw�^way......nr.««e...�•««...�.ee•re...eF....2......�...-..;:e..�;.,.,�ww eeu�ee.y i3 e'i�! ��;:; `' i� p�i:'E ai��
e Riwtine 0 Complaint 0 Follow-up of MVQ ins [motion 0 Follow-uE of DSVVC review 0 Other
Date of Inspection C ;1Z-
Facilit►• Number
Time of Inspection LL424 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit © Permitted 10 Not ❑ eratitmal Date Last Operated:
Farm leiaisle:.. .>a.i[.r ,�.�► A. ,.......... .. 3 �, bl..................... County:.....] sw,t�.L.t...........,....................., .t..
Owner Name: ............ b4az. W............. iSt".V&........................................ Phone No: .... �,�.�.�.�...ri'�..�r..�...'r.��.�43�..�.....................
Facility Contact:............i...................................................... . Title:.................... Phone No
Mailing Address: .....-�—r ........ 4.r.:.I.rj ...................
❑nsite Representative:...+.Ari. .,S.. ,.A............................................................ Integrator •....... ....................
Certified Operatos.............................................. _................ . Operator Certification Number.
Location of Farm!
.ox�..., G.�.�...... 5s. .Q......o ..:.. i f....,.4.4:,, �.x..t. n� . ..... K. Y. ......rar<.s... r,*.r. --kk:....d. ....�.�^.............
.�. u. �,.a�t.....5 .f.�.S..4..:.................. .
Latitude 0 ' " Longitude ' 6 0"
Design :.Current ,;
Swine ; , Capacity Population.'
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons (:Holding Pssnds . ❑ Subsurface Drains Present ❑ Lagoon Area ❑ 5pray field Area
l'.
;;.. ❑ No Liquid Waste Management System !; +l' E,;
i .
General
1. Are there any buffers that need maintenance/improvement? R1 Yes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, If discharge i5 observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
(1, Does discharge bypass a lagoon system? Of yes, notify DWQ)
3. Is there evidence of past discharge From any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge'?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 9No
❑ Yes RN❑
[I Yes F(No
❑ Yes .LNo
Continued on back

F,1 V^_
Facility Number: 31 — _C
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes l% No
61ructures (Lagoons,liolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,
Freeboard(ft):................................................................................................................
10. Is seepage observed from any of the structures'? ❑ Yes IRNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes iR No
12, Do any of the structures need maintenance/improvement? ®.Yes ❑ No
(1f 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 .1a �n �,x-w............. �.� 1..�...�. Kv .a..r.....................5+�s++r-ti.................�.{,:w:.r,�................1rn1.��. !4�a+' .................
16. Do the receiving crops differ with those designated in the Animal Waste Management Flan (AWMP)? ❑ Yes 19 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 0 No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For a ifi or Permitted Facilities OnI
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
M• No.violitivns olr deficiencies v'ere Hated during this:visit:Aou:rvill 'receive no ftirtlier
cbrrespbtidebce atfout this'vlsit:-'
ER Yes ❑ No
❑ Yes ,KNo
❑ Yes ®.No
❑ Yes &No
Q Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
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Revwpector Name . t€ ,i.5.5 +•�kxAME
tEi is1
Reriewcrllnspecfor Signatttrc: Pate: 10 ZZ
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•
•
•
Site Requires Immediate Attenti n:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 6' 3 " , 1995
Farm N
Mailing
County
Integra
On Site Representative:
Physical Address/Location:
Phone:9113
€, -�
• r�
(!TA 1,5-q
Type of Operation: Swine Poultry Cattle
Design Capacity: '`;ray. 1) Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' _(�7' ��" Longitude:_' _�26�1 _�" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6es r No Actual Freeboard: 2_L__Ft. Je% Inches
Was any seepage observed from the lagoons)? Yes orn Was any erosion observed? eor No
Is adequate land available for spray9 e or No Is the cover crop adequate? Ye or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinee?or
s or No •
100 Feet from Wells? No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or I6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or do
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -trade devices? Yes or i�c If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated an specific acreage with cover crop)? Yes or No
Additional Comments: ZY 7 3 Q
Inspector Name Sigrtftture
cc: Facility Assessment Unit
Use Attachments if Needed.