310478_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: erCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: zZ Arrival Time: Departure Time: County: / l�,�y/,•�
Farm Name: L-rt ley��y, �,.� Owner Email: �"�"��
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: 6 l
Integrator: j'Yj lj52, _
T%
Certification Number:
Certification Number:
Longitude:
Design Current
Swiae LOOp—acifivINPap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Cnrrent
Pop.
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
arrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oultr Ca aci P.o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
T urke s
urkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �no ❑ NA ❑ NE
❑ Yes Z'No
❑ Yes P No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes TjNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued
_ i#i

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L�rNo ❑ 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 Q o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
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
P +No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�allo
❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rVo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;]kNo
❑ NA
❑ NE
1 S. 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
P 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility'out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of.first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose -an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
[�rNo
❑ NA
❑ NE
[:]Yes
0 No
❑ NA
❑ NE
[-]Yes VrNo ❑ NA ❑ NE
❑ Yes ❑' No ❑ NA ❑ NE
❑ Yes P' No ❑ NA ❑ NE
❑ Yes V No
❑ Yes � No
❑ Yes 2No
❑ NA ❑ 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):' V`
Farm fi re- c o A j,�,c cO
3
Reviewer/Inspector Name: � Phone:
G I /o
Reviewer/Inspector Signature: Date:
Page 3 of 3 21 /20I

Type of Visit: iFoComptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ;Or'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a.. /H Departure Time:= County:
Farm Name: Le'ie*- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: W. W
Onsite Representative: Integrator:
Certified Operator: ��- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
ePoultry
to Finishr
Capacity Pop. Cattle
rF7Laye Dai Cow
Capacity
nt
PopWean
Wean to Feeder
La er
DairyCalf
Feeder to Finish .,
Farrow to Wean
Farrow to Feeder
DairyHeifer
Design Current Cow
D , P.aui C_a aci_ty Pao Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes�o ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
[:]Yes [—)No
❑ Yes ?TNo
❑ Yes.4fl"No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
�] NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 5' 1 14
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes,,d'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: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes FNo
❑ 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?
❑ YesNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes F'Fqo
❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ❑ NA ❑ NE
maintenance or improvement?FTNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ 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 WfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes A'Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes itNo
❑ Yes XNo
❑ Yes ;?No
❑ Yes FAINo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 4!J'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dN
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[3 NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFacifity•Number: - ! Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 21No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZrNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
;2 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes V"'N' o
❑ Yes PNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes No ❑ NA ❑ NE
Reviewer/Inspector Name: J1Mj4Qr-' C)- _ Phone:
✓ p/
Reviewer/Inspector Signature: Date:
1
Page 3 of 3 21412014

Type of visit: ZrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: uJRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: Departure Time:
County:
'"�'
��
Region:
Farm Name: --ea
�j►�
ors Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►apacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
11
Won -Layer
Dairy Calf
Feeder to Finish
Design Current
D , PiQultr. CaPAC P,o ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes gfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 7No
❑ Yes 2rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: `51 - 4`71 jDate of Inspection: 5Q4 1i3
Waste Collection & Treatment R
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): ,S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
21 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
eNo
❑ 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 ;�J"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RTNo ❑ 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 KI No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �2TNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;;�No [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑No ❑ NA ❑ NE
❑ Yes L'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ 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 )217No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 1 - HM6 J 1Date of Inspection: ` 13L# 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �no
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes �'No
the appropriate box(es) below. TT
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
?rNo
❑ NA
❑ NE
❑ Yes
[?rNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes V'No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
0No ❑NA ❑NE
XNo
❑ NA
❑ NE
Ff No
❑ NA
❑ NE
E�rNo
❑ 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 hazes as necessarv).
TV w r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C�+mod
Date: 5b�
21412011

Type of Visit: Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: b(Boutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t j Arrival Time: 11 Departure Time: �j'— County: Region:
Farm Name: _r - l_6L*SXDAI Owner Email:
Owner Name: j&✓ _ iAo,-�ToA j Phone: glop qq - 3 y5­4 /
Mailing Address: - J C..
1 d f' S ! f-� JADCAS ) CVJ 1L-CY � f /�! 1� (� L L �G Cq&5 3 oC
Physical Address:
Facility Contact:
Title:
Onsite Representative: I q, I_�XA57_C>) % Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Murrent
Pop. Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
11 INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dr, P,oultr, C*_a aci PLo ,
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:)No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili N4mber: - t-{ Date of Inspection: 9 ! q /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: C69
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):']. S
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes j No ❑ NA ❑ NE
waste management or closure plan? 7�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [j No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ]]��
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? )6
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes {k 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): `VO(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
l5. 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
10
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
Q Waste Application 0 Weekly Freeboard ❑Waste Analysis Q Soil Analysis
❑,VZste Transfers
0 Weather Code
0 Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fa ili Number: - ( Date of Inspection: 91/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes [:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ° ;,b�'
Use drawings of facility to better explain situations (use additional pages as necessary). 4
������ oN a
�� ,,� ; w � c�DS
F �a a C�1 C_ G� *?
9)G. V GE v�> � [3 l G 1-1 U
tcic�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91U 19 & 4324
Date: I—1 IOc
21412011

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time. �0� Departure Time: County: t— Region:
Farm Name: Les TeCZ Rc�tSi__ _ I _ F4 z AA_ Owner Email: �+
Owner Name: `FQS�1 �_ Cai.<<� i{-�s�r Phone:
Mailing Address: ` ^-� LES 1 �� l `[�.�5 O�1/ ►`'t--' Y/J{/K �A► Z.LjAJ '. cnxg S'Ia
Physical Address:
Facility Contact: Title: Phone No:
(�
Onsite Representative: 1 ', i LL I -A 1 u ,CMS 710?V
Certified Operator: LL_ t1V HOu $ 1 cw
Back-up Operator:
Integrator:
OpeY'tor Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= A 0 Longitude: [= ° = ` =
Swine
Wean to Finish
Wean to Feeder
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Ll Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 ElNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
&TNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

. Facility Number: r —LrM
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L"_Cro ti
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 XNo
❑ Yes ❑ No
Structure 5
❑ Yes VNo
❑ Yes 'b[J No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
El NA El NE
❑ 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) �yC,
9. Does any part of the waste management system other than the waste structures require El No ❑ NA El NE
maintenance or improvement? I 1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive 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) CC3 GM
13.
Soil type(s) FOLIC-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes
No ElNA
ElNE
17.
Does the facility lack adequate acreage for land application?
ElYes -
No ElNA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
# :' Explain an YES (srers and/or any or aoy other ccimuients
Comments (refer to p Y Y
Use drawings of facility to better
better explain situations. use'additiooal a es as necessary
Reviewer/Inspector Name M A14014 GA IN _ S
Phone:
Reviewer/Inspector Signature: y, . Ourr3a
Date: 3jcgg Ij 1
Page 2 of 3 12128104 Continued

Facility Number: 3 f — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�] No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
ElNA
ElNE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis El/aste Transfers
❑ AAaual Certification
El Rainfall ❑ Stocking U Crop Yield El 120 Minute Inspections El Monthly and 1"
Rain inspections
0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ 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
Q�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
)0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
191No
❑ NA'
❑ NE
Additional Comments and/or Drawings:
wAJk
p//C) Ll
e�
,t a� 90)0 c_gU13§?ATICAl
Page 3 of 3 12128104

2Division of Water Qu
Facility Number '7 0 Division of Soil and N
—...-- ---� N
Q Other -Agency.
utrt %_:uuaci rxiuuu
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: ix/ Region:
Farm Name: LesTES Okk%-TcW Pp2zrn Owner Email: ram,
Owner Name: LoE -rEL�ST�
(t 1 lOn� Phone: 9 d� )0— a—I'SLl9
,l Mailing Address: D LC � I �.g- �A oxs TOIL! Y�{? �l /V c �A1 LL zvC o/d 5 � a
.1
Physical Address:
Facility Contact: Title:
Onsite Representative: �QAG�tS"-b,�cl
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 0 A= Longitude: =° 0 1
Design Currenit- Designer Currentga �D_esign Current..
Swine "
. CapacityPo ulatioti Wet Poult ' *'
p # ;Capacity Population C le Capacity Pa "Mateo ".
Y
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
- ❑ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish 14940El
Dairy Heifer
Farrow to Wean
Dr Poult,
❑ D Cow
Farrow to Feeder I
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other I`•
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Beef Stocker
Beef Feeder
Beef Brood {
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
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 —G/ Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design � Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 1111�o
❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard E] Waste Analysis 0 Soil Analysis ❑>&ste
Transfers❑,)&ual Certification
0 Rainfall ❑ Stocking Ej Crop Yield [3 120 Minute Inspections 0 Monthly and 1" Rain
Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes $,,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
A 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
ElYes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[--]Yes No
❑ NA
❑ NE
Ioj�s,F� i. s
�io� pr•� �Ip
CpD G31M s ao/(2�, o �� ,�� 1 �F
GF_i cryP `� o F
122&/04

Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
"%
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1'q, S
Observed freeboard (in): S L_1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
X
(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
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1P 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
ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.)
!!!! `"`
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) r_�OILi <�?
13. Soil type(s) Not AjGK,
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
lNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 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 recommendation' or any other comments°: ��
"Use drawings of facility to better explain situations. (use additional pages as necessary) ".
Reviewer/Inspector Name �� S Phone:
Reviewer/Inspector Signature: Date: Sid
12128104 Continued

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: L EsT0� V c>tx57-c_w OwnerEmail:
Owner Name: LC—STE.12= "QU S70A/ (� Phone: `+ f��� ' 8n3g SofL�9 /'�
Mailing Address: i qd LE5'T�2 1.Aa ltSi Ll�� n, `
I i"1 JV !C tA F>�, / Y C o!
Physical Address:
Facility Contact: l Title:
OnsiteRepresentative: 28 LL yST�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = d = Longitude: = ° = t = «
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity. Population .
C•attle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
ILI Non -Layer I
i Calf
Feeder to Finish16qD
Qb
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ C a ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
) No
\\
El NA
El NE
Discharge originated at: El Structure El Application Field El 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
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 1 of 3
12178104
Continued

Facility Number: '— tog
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: LA('cC*)
❑ Yes No
❑ Yes ❑ No
Structure 5
[I NA El NE
[I NA El NE
Structure 6
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 M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N1No ❑ 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 (0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need - ❑ Yes
No
ElNA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
'kNo
❑ 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) I 0
13.
Soil type(s) So
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[A No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes]
No
❑ NA ❑ NE
.16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes\
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
EQ No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
VNo
❑ NA ❑ NE
1169 O i C CA(LDSNOT Chu c G T— cie-D 4 !L ACT! 6C_
5;Aj At 4 M «.rN7 0 F V.A<; rE 0 i kouwb Q>I_ H//VfJ IDS P_ - No 1' �'d j �v E A�v� w�F Rr
? jjGL Ll� LAIL(— Cr- PO(L k P2LZZ4-�E
Reviewer/Inspector Name I HOPN Phone:
LA
Reviiewer/Inspector Signature: '` Date: 6
Page 2 of 3 12128104 Continued

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes MNo ❑ NA ❑ NE
the approprrate box. 0 Vv'Up ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑yaste Transfers ❑ Pinual Certification
0 Rainfall 0 Stocking ❑ Crop Yield p 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1% No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
%No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J% No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
r7 No
Vy
❑ 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
A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O.No
❑ NA
❑ NE
AdfllllOOAI COinme s.apolOr+DraWm s A x a.*� 3' r = a e i s
Page 3 of 3 12128104

-- -' O Division of Water Quality -
Facility Number. O Division of Soil and Water Conservation
O Other Agency
Type of Visit (9 Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: o"Z I �a Arrival Time: Departure Time: �� County:'! X Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ „ 1 u t-), H GtkS 7QN
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish J KO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E
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?
;i
❑ Yes � No El NA [I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
i1J No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes . No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L A 6 O(3N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1�1 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 ErNo
❑ 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 f'No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes IRNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f� No ❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes 'MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M,No
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
td
VI 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):
yt6c.D 7C� ��Q
L
erlInspector Name 4AI G IQ 1 � g ) Q,+ 4/V WE-- e- L Phone:er/Inspector Signature: Date:

Facility Number: — Wal Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,R1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes f No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [X Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking E&Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes .M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ET No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q 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
5No
❑ 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
KNo
❑ 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
E� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

[Facility Number
�j Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Q1 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
�►^- ,
Date of Visit: D Arrival Time: /40 Departure Time: 7,7,9 C linty: �i�Gz�t/ Region:
Farm Name: �V616;1_0 Aj SW17 Owner Email:
Owner Name: G
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �<< Orr
Certified Operator: L:LZ_^)
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: !y pi4 �rJ
Operator Certification Number:
Back-up Certification Number:
Latitude: a o [= c 0« Longitude: =o E--],
Design Current; Design Current' Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Ca.pacity Population;',_
❑ Wean to Finish ❑ Layer
=, ❑ Wean to Feeder I ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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?
Page I of 3
❑ Yes pNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes PfNo []NA ❑ NE
❑ Yes 'ONo ❑ NA ❑ NE
12128104 Continued

J
Facility Number:, j =
Date of Inspection �P -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Spillway?: V
Designed Freeboard (in):
Observed Freeboard (in):`p
Structure 2 Structure 3 Structure 4
❑ Yes P No
❑ Yes ❑ No
Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
(ie/ large trees, severe erosion, seepage, etc.) P,
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
through a waste management or closure plan? XO
❑NA El NE
El NA El NE
Structure 6
❑ NA ❑ NE
El NA El 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 El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 [INo El NA El NE
maintenance/improvement? //
1 I.
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 > i0% 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
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 acre determination ? ❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
� No El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? [I 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): ,
Reviewer/Inspector Name ���5� p �d/{� Phone 4?/9
Reviewer/Inspector Signature:, �,lf��j,1, - / �cgf/�i Date: = Gy- 169
Page 2 of 3 12128104 Continued

rA 1�
Facility Number: U% Date of Inspection 2 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [2[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?
❑ Yes No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes /❑ No
NA
;_21
[INE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes �No
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes /ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
ElNA
[INE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes /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 A 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 P 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 XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2/2&04

r
Facility Number
Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency .✓,
Type of Visit Qj compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
j .
Date of Visit: Arrival Time: t?!110_4 Departure Time: t�,� County: Region: 4
Farm Name: Owner Email:
Owner Name: `r Phone:
Mailing Address:
Physical Address:
Facility Contact: ___ Title:
Onsite Representative:
�Q BN
Certified Operator:
�LG
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
In Other
Phone No:
Integrator: / ' / !J�� �Ddr%A%
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: ° I --]"
Design Current, Design Current. Design
Capacity Population Wet Poultry Capacity. Population . " Cattle Capacity _P[
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures_
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo ❑ NA ❑ NE
❑ Yes yNo ❑ NA ❑ NE
12128104 Continued

F %
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
El NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 5 N o
El Yes /❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'XNo ❑ 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 IVNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IV
❑ 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 [INA ElNE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes !/J 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 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
12. Crop type(s) e
%�lt�
13. Soil type(s) ,%�/� 4
!
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I[I No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �[J No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes /� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes m No ❑ NA ❑ NE
Comments (refer to question ft 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):
21) N�/-O LiPOP Y;ZXID
—.6,; aew ✓
r
��o�T /yrp S Toc�z,.►�- L�TT 2
Reviewer/Inspector Name I ' 1 Phone: 0 '
Reviewer/Inspector Signature: Date: O
Page 2 of 3 �� pl6 I2128/0 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;9'No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall XStocking XCropYield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
/1%!i
❑ Yes YfNo ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑Yes 4No ❑NA El NE
❑ Yes �No ❑ NA ❑ NE
[--]Yes [:]No gNA ❑ NE
❑ Yes
;�No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
No
X
❑ NA
❑ NE
El Yes
ICJ No
❑ NA
❑ NE
Page 3 of 3
►N
1212&04

V
I
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: �Td� unty: Region:
Farm Name: f % O S�/� '*— Owner Email:
Owner Name li�j ���� / G! �✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Bach -up Operator:
Location of Farm:
NOUN' Rollo Big AMMAM
Design � Current,
Swine ,gpaci'`{L..y�''.. Population
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish / /
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Phone No:
Integrator• LC
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 = Y YY Longitude: = ° = Y ,1
Oil 1Design. Current
Cat#le Cap ac ty P�opulatioo y
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry COW
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
[j(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE'
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
VrNo
❑ 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?
12128104
Continued

1
Facility Number:Date of Inspection 19�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes YINo ❑ 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?: /V 0
Designed Freeboard (in): l
Observed Freeboard (in): C113 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes YfNo ❑ 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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I� No ❑ NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) L.Kt2-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes VNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
VA
gN,E1-eD
f� A 44
Amd
❑ Yes '� No El NA [I NE
El Yes VNo ❑ NA ❑ NE
Reviewerlinspector Name r'rjLf �� Phone•
Reviewer/Inspector Signature: Date: 2
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 ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists r ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. )KYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield A 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ONA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Cl No
A NA
❑ 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 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
y
ElNA
❑ 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
VrNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: • >..�1 ;
mg
AlQ
12128104

r e R i
4µ t J Dtnsio�n of,Water Qnaltty�_ y
iihvtsion of Soil and Water Cons" .y
_ don
O°Other Agency s
Type of Visit O Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit I 4Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1 Y4
Date of Visit: Tune:
Not O erational Q Below Threshold
�Permjfted�Certified © Conditionally/Certified
+ Registered Date Last Operated or Above Threshold: ..._ ._....... �.
Farm Name: .. �%f .- j!%SN. - lY!- •--.......... .............. County: _.� �u��!�!.�................. ...._ . ...............
Owner Name: Thone No: W..._ ..-- . _W.�..W.._. _. ... _.
Mailing Address: ................... ...........................................
Facility Contact: ...-- ........................... ..],4� .......-Title: Phone No:................................ ....... .. ... .. .....
.................................................................Onsite Representative:,,_,$ —._-•- Integrator. .. W CM S
Certified Operator:
Location of Farm:
Operator Certification Number.._..
[]Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 6 44 Longitude • 4 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
S7cture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _...................... .......... ...... _....... _...... ........................ ....... .......
Freeboard (inches): (7
12112103 Continued

Facility Number: 3 —qfg Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [ fo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
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 81C
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ErKo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ElYes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 10
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ Tfi o
❑ Excessive Ponding ❑ PAN ❑ Pydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �7 NAMI e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VNNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ;� �o
b) Does the facility need a wettable acre determination? ❑ YesPIN
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes Fo
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 31N;
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
"Comments (refer to;.quesbond#) F.zplain ant YES artsweis and/ar any recomaeendatrons o y oter,cosnmehts. ,�
Use di?awmgs_of facility to better explain sitaatioas. (ase addihonal pdg`es as necessary) ; ❑ )~field Copy ❑Final Notes
�EUM O P;gv'\ M6"`/1n/
b>J-P.ihl U� (49A 6A) G kASS &VCK of Dike WU,
�-�
4G. 3,a
Reviewer/Inspector Name
29'Date: -
Reviewer/Inspector Signature: 3
-
12112103 1 1 Continued

)F'aciljty Number: ?� — [� 70 Date of Inspection
rReguired Records & Documents
/
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
,M/No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N
23. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C1419
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Rio
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
28. Does facility require a follow-up visit by same agency?
❑ Yes29.
rv4ov/
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
E14
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 ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

"s
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit /Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted P Certified © Conditionally Certified E3 Registered
Farm Name: —' %
Owner Name: _ L IVOZIS
Mailing Address:
Time:
Date Last Operate or Above Threshold:
County: G/
Phone No:
Facility Contact: T"tle: Phone No:
Onsite Representative: 4")AM Z �USf D/l% Integrator: 4"10116 S
I
Certified Operator:
Location of Farm:
Operator Certification Number:
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 4 " Longitude 00
Wean to Feeder I U
Feeder to Finish ❑
Farrow to Wean
Farrow to Feeder 04
10M
Waste
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lalroon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
i
ield Area
i"
❑ Yes 9fNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
PNo
❑ Yes
ONO
❑ Yes
;2rNo
Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 51 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
lLJ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Anulication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
PfNo
11. Is there evidenEilover application? ❑ Excessive Ponding ❑ PAN ❑ ydraulic Overload
El Yes
XNo
12. Crop type S MOM
13. Do the receiving crops iffer with those designatol in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�YNo
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
QoNo
16. Is there a lack of adequate waste application equipment?
ElYes
/�No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
A No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
['No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
l i1 No
21. Did the facility fail to have a actively certified operator in charge?
El Yes
VN0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
ZNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� :: a _ ;. .f�� .T .
Com�inents!(refer to que"scion #) Ezplam any S answers an or any recommendations or any other�cowments... .+ k ..
;Use dravnngs of faciltt , to,better explam situations. (use,addtttonal,pages=as necessary) !. Field Copy Final Notes
J%Ji
�r G10r2,05 .LN �•QDE,�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

s �y
Facility Number: 8 Date of Inspection i1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes VNo
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 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
jUditional Comments an or' rawings: = b rr k w rimy

Dh406in of Water Quality
O Dtvison of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit )4 Routine O Complaint Q Fallow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
*ermitted [3 Certified 13 Conditionally Certified
Farm Name: .....Le��..�&4in...............
Owner Name : ................................................... ...............
................
Facility Contact: ...................................
Mailing Address: ...................................
Onsite Representative: 0L'..A.'.s0.......................... .........
Date of Visit: ® Time: ® Printed on: 10/26/2000
NNot O erational Q Below Threshold
© Registered Date Last Operated or Above Threshold: .........................
County:.....:
Title:. ...............
Phone No:
Phone No-
........ ........ .......................... ............................................. I..... ..........................
Integrator:.... :Z4_ -ss . �v
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� Os. Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I I[] Dairy
❑ Non -Layer 1 1 1[3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imuact5
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
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. 11' 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
1)(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
�To
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .................................................................................... .................................................................................................
Freeboard (inches): 6(.O
5100
Continued on hack

U
w d
Facility Number: — Date of Inspection C� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 )?fNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type r'ct,, . SJve� -V��
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes WNo
❑ Yes KNo
VYes ❑ No
❑ Yes �No
❑ Yes (V No
❑ Yes RNo
❑ Yes kNo
❑ Yes �fNo
❑ Yes KNo
❑ Yes lPo
❑ Yes No
❑ Yes RNo
❑ Yes WNo
❑ Yes ❑�No
❑ Yes 9 No
❑ Yes Z No
❑ Yes f No
❑ Yes ,J No
❑ Yes No
❑ Yes No
0: i�o A6latioris:or• & idertdes *ere plated during �his:visit' - Yoii will-tecK.Rio fufth&;
corresporidence. about this .visit. . . . . . . . . . . • . . . . .
eomnnents_(refer to question #): Explain any YES answers and/or any recommendatii4ns7or any other comments. r
Use drawsnigs of facility to better exphdn siWations. (use additiional,pagesTas necessary). -
; t Moi, max.
, p#
sir P M� 5�fKV.
sin, 0 Alv_- J&,
fV
Reviewer/Inspector Name
1
Reviewer/Inspector Signature: Date: 5/00

Facility Number — Date of inspection Printed on: 10/26/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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 blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional -Comments and/orDrawings:
kr C�
�V Let R_X�L_lw 11�_'
(Cx-e_�
e
k`Yes ❑ No
❑ Yes 'No
❑ Yes k,No
❑ Yes [NNo
❑ Yes gNo
❑ Yes ((No
❑ Yes 4No
5100

JeLDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit )@ Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint X Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number 31
Permitted 131certified © Conditionally Certified 13 Registered
Farm Name: LCS-Q r- �p uS[ p ... ... ..................................
Owner Name:............. e 5P,5 .k 34o l
......... ...................................................................................
Time: Printed on: 7/21/2000
10 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County:. .t� ...' .........................
Phone No: :
.....................
Facility Contact: ..................................................................... ..... Title: ... Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
.. ....... ....L.e�.�0 I�S7ar
Onsite Representative:!..Integrator:
II !!
Integrator:....L!r'''[. r..�................................................
CertifiedOperator :........... ..................................................................................................... Operator Certification Number:......................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° ��� Longitude a
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 12 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I 1 ❑ Subsurface Drains Present IrO Lagoon Area ❑ Spray field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... ... .... I.... ............... .... . ......... I..................... .....
Fr-ch-ard (inches)- Z 8
❑ Yes �K No
❑ Yes No
❑ Yes No
h a
❑ Yes ,RrNo
❑ Yes WO
❑ Yes )2�No
❑ Yes §eNo
Structure 6
5100 Continued on back

Facility Number: 31 —q 7B Date of Inspection d D Printed on: 7/21/2000
'5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes j No
4 seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
$Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
`® No
Waste ApRlication
10- Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
11. Is there evidence of over application? ❑ Excessive Ponding� ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type Go+r"1 ���b2q�s,-S''►�Q�� I'��G�''1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan {CAWMP)?
Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
Z No
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
❑ Yes
N'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
P No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
40 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
2fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[I Yes
`� No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
j No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ;Eq No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 10 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? `Yes ❑ No
: .Rio
-violaf ions oe- deficiencies -mere nbfed- during fbis:visiC - Y:ou N01-receive Rio rurther: - : .
cones- oiidence: ahout: 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):
yG 1a peir-for-Ve o re✓-�/ recur S r2 reYlc ur,n� Oo trt_S;on. +r
7. l-•jDr iLo e4a61(s� a 5rG15 GoveY ovi qrt q Gc,S 6f ��a0 Lv`tI
f9Vr1 z �h svMr►-�e� )171.'Pull &-_- is nor+`►%
I�tir�c ���n. � fv►�e � 6V 111 (a)1ot �hh41 wail rcccir� w�s-f�
Ivo4e- : G_awcf sZ,aN 14 w,tike some Arel;.10t�;o�..r 46 � egnj �� rlelr It-4ure
4-6 10tve, ia�oon Ieve 1 10s40P �?vr�11� � I Q resfo1s"6i" 4 ;^1+°II� y,.\an+ler.
IReviewer/Inspector Name 574o #1 e vv r4I I 1+ f a j� i S i I I
Reviewer/Inspector Signature: t fA/ 11 TY_� — Date: D/ I'f 100 5100

_6 19 Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1WRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
tale of Visit: �t7 rime: iZ 45 Printed on: 7/21/2000
3 j `j
Q Not Operational Q Below Threshold
Permitted 0 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...............
Farm Name: /.......................
�.......... h...... ..............................................County .. U ... .'�
..........................�...j. ...... � � s .. r...it .... i.......................................
Owner Name: �" ► rr Q� �" Phone No:
.............. @....................................................................................
Facility Contact:.............................................................................. Title:
MailingAddress:..........................................................................................
GW � ))O'L
Onsite Representative: ....... ... .. ...............� `S T............. ....... ..... .
Certified Operator:
Location of Farm:
Phone No:
..........................
.......
Integrator:.... pro J/ / S
...................... I ... ............... I......
Operator Certification Number:
t`9
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Z Lf JE1 Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 Subsurface Drains Present ❑ Lagnnn Area Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Disc�hart!es & Stream IImuacts
1. Is any discharge observed from any part of the operation? ❑ Yes,8 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes tRNo
h. If discharge is observed, did it reach Water of the State`? (if yes, notify DWQ) ❑ Yes EfNo
c. If dischar<<c is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notifv DWQ) ❑ Yes 0No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes /] No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................................... J.......................................................................................................................................
.
Freeboard (inches): Z
5100 Continued on back

Facility Number: 3 f — y?e Date of Inspection asTlan Printed on: 7/21/2000
5.' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[I Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
)gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
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
❑ No
0: Rio violati6 is:or• &flciencies •mere h6 ea• during this:visit' • Y:oir will •receive iio further
eoriespo>ndence: 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): r 1
7, G(7vl-�lydl weeA5 A-14 �t-i 44// GriptV7ri otl ,'a�oah WA+!I 5-, Jjd/'fJ r 7d �
i q/'4sf cover, em tAr JIr�eAr � ja joOh taaij� eSreci 1� lnk)er' WAX
J
24. F,-, 11,06,, t,P -W-:,* is .sGhed VW -for wi ° `� � a � 4 u., v- ' I q j 2 :.30
f0 rev i cw record S.
IV
Reviewer/Inspector Name �a, kt i,s
Reviewer/Inspector Signature: Date: MP S/00

Facility Number: 3 j —L nB Date of Inspection p�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes 9 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 E5 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 P'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
T..
_ttona__ omtnen :an arT, rawuags
.&I
3123/99

Division of Soil pand Water: Conservation - Operation Re' iWvv
U Division of Soil and Water Conservation-'Compliiance Inspection
:Division of Water Quality Compliance Inspection
__
-13 Other Agency Operation Review
122!outine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number g Date of Inspection
Time of Inspection 3= 24 hr. (hh:mm)
© Permitted )d Certified E3 Conditionally Certified 13 Registered ©Not Operational I Date Last Operated:
f p I ,,,,,,..,,,,-
T -KS �..- ...... ......
FarmName: �p"f.............................................. County:.........................................................
Owner Name: ...................
Facility Contact: .............................................................................. Title:....
MailingAddress: ..........:....................................................................................
Phone No:
Phone No:
Onsite Representative:....... LEsT£+2-. f.0 ....................................... Integrator:.... A..�r�.-.. r.......................................
.
Certified Operator , .......I..................................................... Operator Certification Number:,,,,
...............................
Location of Farm:
A.
.......................................................................................................................................................................................................................................................................
Latitude �' �� �•� Longitude
Design Current:
Swine _ Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number ofLagoons - Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes J; "o
Discharge originated at: ❑ Lagoon- ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P(No
b. If -discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes V] No
c. If discharge is observed, what is the estimated flow in gal/mi0
d. Does discharge bypass a lagoon system?(If ycs, notify DWQ) ❑ Yes PNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2f No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......................... ................... ................ ..................................... ......... .......................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, 0 Yes � No
seepage, etc.)
3/23/99 Continued on back

FaWity,Nisjnber: 3) — l�q Date sr#'Inspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12_ Crop type
13. Do the receiving crops differ with tho�/designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio •yioiatioris:oi- deficiencies •mere noted• during fbis;visit: • Y:oik :will reeeiye pia [further
corresvon nce: agouti this visit~ :::::
Z3
❑ Yes VNo
❑ Yes VNo
❑ Yes 0 No
❑ Yes j{j No
❑ Yes JZNo
❑ Yes ZNo
[]Yes gNo
❑ Yes ONO
❑ YeseNo
❑ Yes [� No
❑ Yes ;3,510
❑ Yes fi?'&o
❑ Yes kNo
❑ Yes 101q,0
❑ Yes E No
❑ Yes Vo
❑ Yes ZrNo
❑ Yes ,�No
❑ Yes '01N�o
❑ Yes N0
❑ Yes -�Na
Comments (refer to question #)t Explain any YES answers and/or; any, recommendations_ar any other comments
Use,drawings:bf facility td.better explain situatiois. (use additional -pages as necessary)
r
t'i " t° 0
3 5S -
Reviewer/Inspector Name44
-
Reviewer/Inspector Signature,Dater
3/23/99

r
Facility Niienber: I S Date of Inspection z.3
ndoy 1,ssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below /n 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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;21�o
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 ice`""
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
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
2. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [4es ❑ No
_.Additional Comments and/or Drawmgs:-
POC,.O,A' C_E' 4-c Svs T-Z st<E F-Lo- r.,I i' 7—A P-- S A 4
1 s O1P9,YFVr-"e (-
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
JJk Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other I
Facility Number
3 Date of Inspection 1 Z
Time of Inspection 24 hr. (hh:mm)
Registered 9kertifted [3 Applied for Permit © Permitted 113 Not Operational I Date Last Operated:........
Gd c/s County. ,�,,�
Farm Name:.........L�. i?.....L................................................�... . ' .......... � /..�'Y..t.......................................
Owner Name:.........L�.. ...5. Ted ....�...................... /"�� ✓Sl' ....................... Phone No:........ ... G�..�......................................
Facility Contact: .... ... .:..�. .. A-f_A Title: .................... Phone No:...
Cep
Mailing Address:...... �.....L.11.......L ............. `� �.L....... ............ G .�Gtrz:.4. �'.................. ............... ..................
Onsite Representative:..."/—.!�.`../.i.z.................... .................. Integrator:..... f1lL..j-...........................................
Certified Operatorz......` J` 1- ............................ � '� 5..::\ Y........................... Operator Certification Number,...........................
Location of Farm:
Latitude Longitude �• �� Os
General
1. Are there any buffers that need maintenancelimprovement? ❑ 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 roan -made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes P No
❑ Yes UdNo
❑ Yes 1A No
❑ Yes
91 No
j� Yes
v❑`Yes
❑ No
U�No
❑ Yes
0 No
❑ Yes No
❑ Yes No
Continued on back
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97

t
j Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons.Holding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
..... ........
Freeboard (ft): ........,w�..............
10. Is seepage observed from any of the structures?
Structure 3
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type C0..1... :...................................... ° .' ...... . .....
❑ Yes
No
❑ Yes
No
Structure 5 Structure 6
❑ Yes
No
Yes
❑ No
Yes
❑ No
❑ Yes
(Z No
❑ Yes
i jNo
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Qnly
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.violations-ot deiiciencies.were-noted-during this:visit. You'Will. recei've•no•ftiri er• .
c6rres0ortdence about this:visit:• ::
❑ Yes ❑ No
❑ Yes O No
❑ Yes ❑ No
❑ Yes J, No
❑ Yes RjNo
❑ Yes allo
❑ Yes WNo
13`Yes ❑ No
❑ Yes M No
❑ Yes UNo
A -rt P_&-.ej ` rs/aaz.s{Q1
G/�l[ G�ivy� �j Gr 5 � . Y✓+�-S �-C i/lt�t�/ /�f �.t���� ��t..,�/'�3'i� �. ' J �dr� �u���.�
y��+.RLr'S��-- !� rY�Gf .-v W�"""C �lL�4c- fs-�ltGi+-�i `�v L �''r'"`�5�►'T� CiQ.G[��.
j?,4 P,1 h as . .,�vrt �/1v�• G arrr a�eFiG of tills. w '°�,��
l�. 04"'� e4n_4G . (,tlG'7lif1, !� [!{,::G
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

v
Division of Soil and Water Conservation 0 Other Agency
P] Division of Water Quality
14DRoutine O Coni Taint O Follow-up of DWQ inspection O Follow-u of I).SWC review O Other
Date of Inspection
Facility Number t
Time of Inspection S!4 24 hr. (hh:mm)
13 Registered [3 Certified © Applied for Permit [3 Permitted 113 Not Operational Date Last Operated:
—i_' 1
Farm Name: L �f�'�.....�01 kt,.......IY TS.&.............................. County. � LCY.................................................................
Owner Name: ii __
LfS.Y................t1s�D^................................................................. Phone No: ... L91.e).Z`L`$..`]................................
Facility Contact: ........ ZtAr,,r......�.9,:11�a .......................... Title :....... t?asw......................................... Phone No:..��!.�°���.�'3��1�..........
Mailing Address: ......13.0....... , S C)'... Qt1............:.........
Onsite Representative: ........ ,LC .... _......I.L 1_15kh...................................... ................ .. Integrator: cam.11,5 .................. Certified Operator;---...•.,& f.Ly ...................................................................... Operator Certification Number:.J..f?
.!.....
Location of Farm:
....a ........ ........�. rIQ .. a .. . xt-.... xiL .......�.ufr.........Y.. a� ...........37.i. �...... x, n...e3.......l.aaai. r.,�..............
... R,
Sov.....ssi. .�.
- r...............
Latitude r_�0 =' 61 Longitude 6 46
r
Design; Current
Design Current Design Current
"Swine n..;
Capacity Population Poultry
Capacity
Popuiation Cattle Capacity Population
�.
m u_
M
❑ Wean to Feeder
❑Layer
❑Dairy
Feeder to Finish
2.4 p
❑Non Layer I❑
Non Dairy
�.
El Farrow to Wean
r x
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Destign Capacity f�
❑ Gilts
❑ Boa rs
..
otal LW
Tyr Sv
. _
. ........
h .
Number of Lagoons 1 Holding Ponds
ubsurface Drains Present ❑ Lagoon Area VSprayFieldAres
rs:
�� ❑ No Liquid Waste Management System Sys
nn
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes Wo
2. 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 convevance man-made? ❑ Yes 13 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. if discharge is observed, what is the estimated flow in gallmin? PJJA
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoonslholding ponds) require ❑ Yes No
maintenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IR No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97
Continued on back

tiFs
v
Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (laa oons.11olding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
f
Freeboard(ft):...........2.:`t...................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
IN No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
51 No
12. Do any of the structures need maintenance/improvement?
($Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
`'Paste Application
14. Is there physical evidence of over application?
❑ Yes
J9 No
(If in excess of WMP, or runoff entering of the State, notify DWQ)
waters
15. Crop type ............5CIf1............................. 54l'C41'1S ...................................... ................................................................................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Wo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
P No
18. Does the receiving crop need improvement?
❑ Yes
C.No
19. Is there a lack of available waste application equipment?
❑ Yes
IN No
20. Does facility require a follow-up visit by same agency?
fa Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
19 Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
50 Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
K[No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
19 No
0' Na vitilationsor. defieieineies.were-noted-during this.visit: You;will receive`ito_ftirther_:
OrrespQndence. about this'visit: ;
�, ,�.
C©mtneirts (refer to grieshon) `Explain any YES answers and/or any recommend at tons or�any other commtenls
Use diawings of facthty to better explain situations (use addtt pages as;-Ei&essary) =x F 4k.
anal
12. 3A."C 5��s 6r, 4agp ,, 0.Vj w0l 5�ovid be- rezeejtd, incur walk o-F lash siwufd be v+cwcJj
•
a*, & rss, 56VIS be
2-7-113. W. ccr�i ted l 6rr ov sNlD' +rccordx were or 1 nspectb,,. P1,-1,
7/25/97
Reviewer/Inspector Nameri Ay �-.���+1 �. � ��4� � s � A
yti
Reviewer/Inspector Signature: Date:

0
Cl
Site Requires Immediate Attention: IlIO
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _7 , 1995
Time:/
Farm Name/Owner.s
Mailing Address:
County:
Integrator_
C,-t
d uiS
On Site Representative: n
Physical Address/Location: 62A1 S M)
Phone: q
Phone:
Oe, ar-' _Sle_ 171GI ��
y� 41 .
Type of Operation: Swine /� Poultry Cattle
Design Capacity: / Zya Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 Longitude: ' �� ` % a 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) No Actual Freeboar4,2_ �O Inches
Yes r
Was any seepage observed from the lagoon(s)? Yes o N�C Was any erosion observed? Ye r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes o
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells7 es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing sv_ stem, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: /Le /per
i)o � Ajz,27- (W t/e-R 0-2VP 0_oe11 �S7-0,66«
cc: Facility Assessment Unit
Use Attachments if Needed.