310517_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: U Co=outine
Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I{
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: { ^� C i�-c Integrator:
Certified Operator: Certification Number: 1 7Z
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Wet Poultry
Layer
Non -La er
Design
Capacity
Design
Current
Pop.
Current
Cattle
DairyCow
DairyCalf
DairyHeifer
D Cow
Design
Capacity
C►urrent
Pop.
Farrow to Feeder
Farrow to Finish
I)ry F,oultr.
Layers
C•.a gci
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. [s 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 ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
��o❑
❑ NA
❑ NE
[:]Yes
NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
Page 1 of 3 214120I5 Continued

Facility Number: 7 - IT 7 IDate of Inspection:
Waste Collection & Treatment
4-Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q-7To___❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EfNo ❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm;�N
l rent, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes�FNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VJ o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.}
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesF?"No, ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EJINo❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes PNoO
NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ YesNA ❑ NE
Remoired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q'l o ❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FNo
N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4� o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes De5o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes eff No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E2'<o ❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
❑ NA
❑ Yes No NA
❑ Yes o ❑ NA
❑ NE
❑ NE
❑ NE
a�✓r 4�-✓� i MA L Phone: 2 Irle
re: Date: Ag /a
2141201

(Type of Visit: Q Co pliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: g County: ])&L_,Z� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: a_r Aj�' rA-rnryIntegrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: 11 i (42-5 Zj
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Qesign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle C►apacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish tM
Daia Ficifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, I;oultr,y
Ca acit
P.o P.
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
her
Poults
Other
Discharges and Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence ofa past discharge from any part of the operation?
❑ Yes
� o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
YNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fa 'li Number: 113ate of Inspection:
Wt;ste Collection & Treatment
4. isstorage 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: .j'r�D11� OLD r-0
d.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes �Noo ❑ 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 M 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 �o CD NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7No ❑ 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 LZJ /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 6
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes T_�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El.'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6/No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Fa9lity Number: jDate of Inspection:
24.pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E/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 N [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 ,% No ❑ NA ❑ NE
❑ Yes [(No/ ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ElYes
34. Does the facility require a follow-up visit by the same agency?
[] Yes
VI__l '� ❑ NA ❑ NE
Uz
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #} Explalnany Y,ES"answersandlor any addit�onal'recominendatlnns o`r"eny other coinnnitients
Use d.rawings oflacility�Ttvsbetter explain situations{use additionalpagesras necessary).z;.;„ "�gti ":
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3of3
Phone
re: Date:
2/4/201

Type.of Visit: 0 pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Co(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I G_I .5 I Arrival Time: a5 Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
pp �n Title: Phone:
6 Onsite Representative: 1 " I L-r(- H U A— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
IELa
er
Wean to Feeder
Feeder to Finish
Non-L
Farrow to Wean
Farrow to Feeder
D , P■i
Farrow to Finish
La ers
Gilts
Non-L
Boars
Pullets
Other I I IN IOther
Latitude:
Poults
Certification Number: �9 '7 2,5Z
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [7No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FTNo ❑ NA ❑ NE
❑ Yes VN
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection.
Wasty Collection & Treatment
ZNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
1
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: �� W A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-L
5. Are there any immediate threats to the integrity of any of the structures observed'?
E 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
ZNo
❑ 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 env ronmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ef 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
❑ Yes2Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RJ'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
g
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ryNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 E2<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Wastc Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ectian:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes7No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a 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 [J"'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E3<0o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2 "'o ❑ NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑Yes Zo ❑ NA ❑ NE
IC,,o-mments I efe' to guestioi e#); it
EzPlain aniy YES"°ari"sweirs and/o�iiny additional ieconriiiriendionsior,anytotNer comments :
tw�t:tl�g�siie�i
Use drawtniQsoffacilito btter�explain situ_atians.^(use adtlition_al'pagesgs necessary) q. , l r ,, ;
T7) 40,c`��tf C-310' (- 2u-T
? L�. A SE R(rylovc
Reviewer/Inspector Name: �_Jti*g�J M-911J
Reviewer/Inspector Signature:
Page 3 of 3
ST-ILU-
PC- (us ts T6tvT
Phone. �T 5 6 '
r,, r
Date: w
2/4/2 15

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation C) Technical Assistance
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l7 J Arrival Time: Departure Time: County: W Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 13az v-r u=rfl &(.L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: �Tq?,(;7
Certification Number:
Longitude:
Wean to Finish
I Layer
IDairy
Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P,ouitr Ca aci P,n
Non -Dairy
Farrow to Finish
iLayers
I
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
V�,
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: IDate 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: LA100N ED
Spillway?:
Designed Freeboard (in): , !,
Observed Freeboard (in): 3Y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 27No ❑ 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 [Z/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�'Yesronmental threat, notify DWQ
❑WUP ❑Checklists I—] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o NA ❑ NE
❑❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections S udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Downy of the structures lack adequate markers as required by the permit?
❑Yes
Ej/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
ZNo
❑ NA
❑ NE
maintenance or improvement'?
Waste Auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
No
❑ NA
❑ NE
❑ Excessive Aonding ❑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. Sail Types}:
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or hand application site need improvement?
❑Yes
51N�
❑ NA
❑ NE16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No
❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑Yes
❑
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑Yes
EKN
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
[— o/❑
NA
❑ NE
the appropriate box.
Page 2 of 3 21412011 Condnued

FaAlity Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [✓ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 No
❑ NA
[] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ul?
❑ NA
❑ NE
permit? (i.e., discharge, Freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
E ?'i es
❑ No
❑ NA
❑ NE
Comments (refer°to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7 3q. C0 LACE 40 PaO0 Y &"Wtfi . 4C AS&P Ta 6V�
U9 sT 3 wrl fio cc m�I edTfl L4,1,W "as,
�bu,au/ t/P
VIC r_rt TO
ponl�_- W/-LU Ll--40 70
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
13E
Ndv
S614E'00LO U_�'Ryf up !J�
Phone
Date:
11

Type of Visit: Z) Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
(d
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ 3 Arrival Time:© Departure Time: +rd T County:0LVUJJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: R4.4,t N L3-vA4 CLL, Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Finish
Design
Capacity
Murrent
Pop.
Design Current
Wet Paultr�y Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
]Non -Layer
DairyCalf
o Finish
" 6a
Iesign
DairyHeifer
o Wean
o Feeder
EFarrowo Finish
Current
Dr, P.oultr, Ca aci F.o .
La ers
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
R
urke s
urkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
OlNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Fa�lity Number: 17 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes 0 N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L� Wla o CGnm
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 [!(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? dYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C2<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes do ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [] Yes [:;�<o ❑ NA ❑ NE
❑ Excessive 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
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesvl�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l� I i ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
W No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNoo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
[3Yes
❑ 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

Facili Number: -231 117 7 jDate of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o [] 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(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
,--
Yes Q'<o ❑ NA ❑ NE
❑ C,
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 2--No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Io ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ NA ❑ NE
❑ Yes F��VNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations, or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary):
7,) SrvnnLA, TRH-C- - 0 E ED fo '3C- GiIT
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
DOv40 aJ 'PD'A(X LAGm J.
Phone: " b
Date: �� g
121412011

Type of Visit: 9 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /® Departure Time: County: Q Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: gai--or 01 =N"(.1 c� Integrator:
Certification Number: 9 Lt Z_Z_' T�
Phone.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La cr
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P■aultr
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
LLT'urkey
Poults
Other
I
10ther
Discharns and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes VNo o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility umber: - Date of Inspection:
ell 12—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes iNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
[:]Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErND NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA FINE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Vo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require [—]Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ca4o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes [�/No
10 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
/No
L�'No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
I d No
''TT'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 31 -50 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U No ❑ NA ❑ NE
Other Issues /
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
�N0
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:)Yes
[�J/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C�/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
i
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej/No
❑ NA
❑ NE
Comments (refer to.question, #): Explain any_YES;answers and/or any:additoral recommendations or°any other=comments,
Use drawings :of f tcility o Better explain situations `(use:additional'pages as neeessary),
CSC. L+4�� �/E �S�C.�,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I � — I566
Date: ?/
21412011

Type of Visit (Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit wRoutine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ounty: Region:
Farm Name: 4Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title: Phone No:
Onsite Representative: �! ,S P Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 ° ❑ d Longitude: °
g 1 ° il)esi ne fi„Carrent °,` `::- ',i. 5Des� n Current''` �.,.: z �`.' g.
-fix" +x `�l.i,QDesi n Carrent `11
5wtne. Capi�city. I?opulattorr
a rot
Wet Poultry, , . Capi citp,,Population.
5 Cattle ., , Capacity
Popi lat�on
❑ Wean to Finish
❑ LaA cr
El Dairy
El Layers
❑
El Pullets
[]Turkeys
❑ Turke Points
❑
Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No
❑ NA
❑ NE
❑ Yes [--]No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes )ffNo
❑ Yes �o
❑ NA
❑ NE
❑ Yes �No
❑ NA
Page I of 3
12/28/04 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,,f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identiger: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes );E�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )27No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ET'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes .ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes , No ❑ NA ❑ NE
t 6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes /�3No ❑ NA ❑ NE
acres determination? /—
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
.2-No
❑ Yes Fj`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 E 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 .[fj`No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [f]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

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA ❑ NE
25the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
.J�Ef
❑ 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
.FZPNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ZNo
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
4No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�TNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ZNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L'J No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
6rotAjer W c « Me / a (W Pb A- -6 r ia5a oy—
leuels uA4r De404- V-0-Ls-e— t
&C'OrO6 A60�-- rl
Reviewer/Inspector Name: ^zOn &C-l" qz__ '
Reviewer/Inspector Signature: L_
Page 3 of 3
Phone: ` 7'�
Date:
/4/ 011

L
f Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
n for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �r Departure Time: County:&40Region:��
Farm Name: l Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: a'it "I'es-0 Integrator:
Certified Operator:�'� r Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c 0 6 Longitude: = o = 1 = 4[
x. e Design ,,current;; xe ; .,, �. Destgn Current' °� ,' tDesignCurrent�s
Swtne Y Capacity Pt►pulatiotie ,Wet Poultryr3Capacity Yo plattan: gCattle1'opulat�on°;
.ti.�.. .a p aCp,z. t
❑Wean to Finish UpLayer El Dairy
❑ Wean to Feeder [] Non -Layer Dairy
El Feeder to Finish }
' ❑ Farrow to Wean Dr`y Poultry
❑ Farrow to Feeder ry
Layers
El Farrow to Finish
❑ Gilts t
ti :f
;t ❑ Boars p`
} rs iqs g�2�i''i �-m
®ther35 y$. 5
_ ❑Other Number of Structures ;� s. <
El Pullets
❑
Non -Layers
❑Turke s
❑Turke Poults
El
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Cow
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 ;2'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� o
El NA
El NE
❑ Yes
�o
❑ NA
❑ NE
Page I of 3 11/18/04 Continued

Facility, Number: — Date of Inspection
r'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Ll No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;I -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 E ❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 O'Ro ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FeNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
;�r?qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[/No
❑ NA
❑ NE
:Comments (refer: to, question #): ,Explain any YES;answers and/or any, recommendations or any; other comments ,,
Use drawings or facility to,better explain situations,. {use add�tonial pages as necessary): e
$°r. z"ox % k i .4 3-i g.5'.a .:�,Y `�:eE
_L
/r/rfJ_jJ �• /�/
Gv Cl/ O'n C li-plise- a�L
t�„,:. ,�ti�`igF,Z ..
ReviewerlInspector Name . ' _ _ . ; ,. r, ;d,7 7�
Phone-
Reviewer/Inspector Signature: Date:
Page 2 of 3 1248104 Continued

Facility Number: —,572 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EKo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes � N ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ YesXNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ 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
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ YesP�'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Plo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[;Ko
❑ 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
<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,
L� [ [qo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

NJ
!-
—0-My
ision of Water Quality .1 r
Facility Number j 0 Division of Soil and Water Conservation i
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitQ,.RcFUtine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (!� Arrival Time: �. � Departure Time: County: L .� Region:=-J
Farm Name: ` ��� �'V p Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone N
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 c =' = « Longitude: = ° = 6 =
td
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity PopulationCattle Capacity Population
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes _12<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,ErNo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
12128104 Confinued

Facility Number: r — Date of Inspection 7
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
Identifier:
Structure 4
[]Yes PNo
❑ Yes QNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ 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 PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ YesjENo ❑ 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 environmentalth at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 'LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes (No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
,,
❑ Yes No
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Wbo
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes No
❑ NA
❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary,):
a
Reviewer/Inspector Name .7. `- ;� i��i " Phone:
Reviewer/Inspector Signature: date:
Page 2 of 3 12178104 Continued

J' ' "
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ W­Up [] Checklists ❑ Design ❑Maps [I Other
❑ Yes P o ❑ NA ❑ NE
❑ Yes j2No ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes �o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes ,Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �2<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [INo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes ,FeMo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes .211�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes Oo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes/2 No El NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes<o ❑ NA ❑ NE
and report the mortality rates that were higher than normal? /
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ,Q No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ETNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
r 7 3
7 / -7
12128104

Q
Facility Number 3
O Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
IType of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: �rJ
Farm Name: I&J11 Zcr ✓l_s" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
)~arrow to Finish
Gilts
Boars
Other
❑ Other
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ I ❑ Longitude: = ° = & = 4i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dair Calf
❑ Dairy Heifei
❑ Qry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ,a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZNo
❑ Yes
< I
El NA
El NE
El Yes
WNo
❑ NA
❑ NE
12128104 Continued

5
Faciliiy Number: 31
Date of Inspection I J/b/p7I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes /El No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 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 QNo ❑ NA ElNE
(ic/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �IlNo ❑ 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 �INo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes E2-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QWo El NA El NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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
P'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
qNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P-No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ 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):
i C�✓ �U�jiS �10 , e.co'rc 5 Yet. a-av r'
A.
Reviewer/Inspector Name �J Phone:
Reviewer/Inspector Signature: Ir Date:
12128104 Continued

14
l
Y
Facility Number: , —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 014o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
,❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P-No
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�3"No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZYNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
,�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
EYNo
❑ 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
�3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Rf/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
GL'
��
AL
I1�1.�1U�
06
4•-/l
l
o
C,16 6
{>le 0 � 1
e L5Cj r
rt d- 4�°w l`
h s �reu �me��' �►�.sia
12a8/04

-
lltvision of Water Quality
i Facility Number [ 0 Division of.Soil and Water Conservation
- 0 Other Agency
Type of Visit 0,,O'ompliance inspection. 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: :DO Departure Time: County: Region: wrrc
Farm Name: 1. / f1Q;m et , 2us rae ' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
i
❑ Wean to Feeder
i
Feeder to Finish o'lbd /V0 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts !
Other
LEI Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
Poults
IElTurke
E:l Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
DairyCow
❑
DairyCalf
El
Dairy Heifer
El
Dry Cow
❑
Non -Dairy
El
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: �I
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 J2-lqo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes effNo
❑ Yes e No -
❑ NA
❑ NE
❑ Yes�Io
❑ NA
❑ NE
12128104 Continued

Date of Inspection /
Facility Number:
Waste Collection & Treatment
4.'=ls storages e capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes PNo
El NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes O-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 El 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 [INo
❑ 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
P-No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA ❑ NE
maintenance/improvement?
,�
I t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes )ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J:kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J2'No
❑ 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
J2—No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;5,1�o
❑ 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):
AL
Reviewer/Inspector Name Phone: r
Reviewer/Inspector Signature: Date: d
Page 2 of 3 / P2/28/04 Continued

Facility Number:31 — Date of Inspection
„ReguWed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E1 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. gYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Plcrop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes �o
❑ NA
El NE
El Yes El"No
❑ NA
❑ NE
❑ Yes ENo
❑ NA
❑ NE
[:]Yes ,❑ No
❑ NA
❑ NE
❑ Yes ;3No
❑ NA
❑ NE
❑ Yes
4fNo
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes
�2No
❑ NA
❑ NE
/❑�o
❑ Yes
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: �fl
- r'raAjY6- llezle/
Page 3 of 3 12128104

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
r
/Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: r% Arrival Time:
��
Departure Time: County:
Farm Name:
% Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l/4 ��
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:__�����
Operator Certification Number:
Back-up Certification Number:
Region: �`
Location of Farm: Latitude: = e ❑ 1 ❑ {1 Longitude: = o =' ❑ N
Design
Swine C►►opacity
Current 't Desrgn Current
PopulationG Wet Poultry Capacity Population
Cattle
Design` Current
Calietty Poplato�n_
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
$'Q
Dry Poultry
❑ Dairy Heife)
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑Non -La ers
❑ Gilts
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
Number of Structures: �'
❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes QoNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ,.ErNo
❑ NA
❑ NE
❑ Yes E<
❑ NA
❑ NE
12128104 Continued

Cr
Facility Number: 3 — j Date of Inspection
1 i
�r
W.aste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,2No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Zlqo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 21"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 J2-,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ,ETNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes .ENo
[DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes .BI;o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 21 NO
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s) 6��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .ETNo
❑ 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 -'E:T—No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Er —No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E5rVo
❑ NA
❑ NE
... '.-, r H -a�Ms T�K W ��` nwif,�
Comments {refer�to question',) Explain ariy YES answers;audlor anyrecom�ttendahnntany othe"rAcomments
Wsedr�7awings"of facility to better explain sttuat�ons'.(use additional pages asnecessary).s? .
{ ecdx'4S ilea. 0 Y- r �
00d S �1 ot'r(2-
Reviewer/Inspector Name Phone: G
Reviewer/Inspector Signature: Date: D G
12128104 Continued

Facility Number: —5" Date of Inspection
ReRuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21,10 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
. 3No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7 No
❑ NA
JWNE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
XNo
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.,QNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EI'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
-EYNo
❑ 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
r8"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
,O'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
21 o
❑ NA
❑ NE
Additional Comments and/or Drawings:
1 'P7 4y00
12128104

Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation !
IReason for Visit fi)"Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Date of Visit: 6 6 Time: %
Not Operational Q Below Threshold
�erndtted,Ej`Certified 13 Condi�tionallly�Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .....f�[/�lQ ...G..,.. County: ..olfdl..211"........................................................
Owner Name:
Phone No:
MailingAddress: .................. ............................................. . ................................................... ...............................................................................................................
FacilityContact: ............
...............
.........................Title:................................................................
Phone No:............
Onsite Representative:..S11
y._.
Itz�................................................
Integrator:....,,��LGZ
Certified Operator................................................................................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Swine �z ,g� s
❑ Wean to Feeder
-- — - ,.--
-- --
1�
f
❑ Layer
-
eeder to Finish
1,A00
/ 0
f; ;
❑ Non -Layer
❑ Farrow to Wean
• ;.: rr�s :: , Y : .. ,�, , t ;> .!t;
[] Farrow to Feeder
"
❑ Other
(] Farrow to Finish
° 41I
.;Total Desi
�E:a �I�fi Ei))-
f!l�31}6f Yf FdrF 1 f if ' f i f1�K�f Ni r
,❑ Gilts
�7
❑ Boars
Discharges & Stream Impacts
►i
1. Is any discharge observed from any part of the operation?
❑ Yes ,O'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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 ,211�o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0' 10
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,[JONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... .............. ................................... ............. ...................... ................................... ...........................................................
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
5. Ate there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
jF,�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
;lNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
[ .Alb
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
'Flo
elevation markings?
Waste ApBlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
;IQo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ per and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
)2NO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
[R'No
c) This facility is pended for a wettable acre determination?
❑ Yes
P No
15. Does the receiving crop need improvement?
❑ Yes
OTo
16. Is there a lack of adequate waste application equipment?
❑ Yes
JZN0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
;Rlgo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
2vo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[^o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
PNo
Air Quality representative immediately.
alas ���e
Reviewer/Inspector Name J
Reviewer/Inspector Signature:
Field Conv ❑ Final Notes
«� te 6_/"zC;4�2e
Date:
12112103 Continued

ti Facility Number:
Date of Inspection
Required Records & Documents
,, .
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 12rNo
❑ Yes eNo
❑ Yes ONo
❑ Yes J;?IVo
❑ Yes 2'No
❑ Yes Rio
❑ Yes allo
❑ Yes M-No
❑ Yes ONo
❑ Yes .=No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

' ` '.� Division of Winer
i Q lDirlslon of Soll ar
i Fps€PEfe �� r: iris � siE p 0 bilibr
'
Type of Visit 0-Compliance Inspection 0 Operation Review •0 Lagoon'Evaluation
Reason for Visit 1 Routine O Complaint O Follow up O Emergency Notification ' 0 Other ❑ Denied Access
Facility Number Date of Visit: Time: ��..
Not Oiperati.Qnal 0 Below Threshold
® Permitted UCertified 13Conditionally Certified © Registered Date Last Operated or hove Threshold:
Farm Name: �► �li� ^'f' d+ 5 l / . �Rr� t County: u
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: 41 11d Integrator; Y
Certified Operator: Operator Certification Number:
Lavation of Farm!
[:]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0. 0 " Longitude �' 0
E } a .',Design,
;$wine.`' Ca achy°
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
A. f i iE
N ihbefof Lagoons ' 3
'Holding Ponds /:Solid :Traps
` t No Li -quid Waste
nrrent F'�� DCSig �* CItCTCnt ' E=
iulatio> .Cattle' � , 'Ca' acity , Po" ulation
❑ Dai
I JE3 Non -Dairy
al Design Capacity:;` ,?
1 �
':Tota1��SSLW;��f
Disr-ha egs & Strgam Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2rNo
Discharge originated at: ❑ Lagoon ❑ Svray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []-No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J::I-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches);
■Y6
05103101 Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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?
❑ Yes [2No
❑ Yes B''To
❑ Yes ENo
❑ Yes 0-90
❑ Yes B�o
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ZNo
I t .
Is there evidence of over application? ❑ Excessive Po/n/ding [I PAN ❑ Hydraulic Overload
[I Yes
❑'No
12.
Crop type --� ,(� /f (.�L
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ff No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ETNo
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
ErNo
Required
Records_& Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 NO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0-No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 2rNo
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 2rNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
- it
Comments (refer to question #) Explain anyYES aiusweis andlor any recom'irtLendtions,tiR a¢nv otter c©mments. ,
EF_
4r,. ff :. E) jled !� I,
Use drawin's of facility to better explain situations. (use addittonal3pages as necessary) €err `�'❑Field Conv ❑ FinaI Notesr
��Lai'/�� ✓i,t 2a16.s 4!5�0�
a°n Z-o✓el wky ;�7 e's 6yy -f"� �.h 'PUAP1-'�
fij "wil'a lie _'014'r Gldy r )e Ali/ ei �1 /n e cr J�90J-r 'elIt,-
Reviewer/Inspector Name
Reviewer/lnspector Signature: Date:
05103101
Continued

M
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes -E:I'No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Z—N o
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q-11-0-
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 ET—N.o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .0<0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �o
05103101

y Division of Water Qualety
d l]ivtston of Soil and Water Canservatton
f 4r
Other Agency
L
f Visit f�Compliance Inspection Q Operation Review Q Lagoon Evaluation
n for Visit I'Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 D'Z Tina: ��Printed on: 7/21/2000
Q Not O erational Q Below Threshold
12�Permitted 13 Certified [3 Conditionally Certified ❑ Registered Date Last Operated
/jorAbove Threshold:
Farm Name. . ............/✓r(f/it....„►�A7 ....... County :.......fUy'rt:.!...........................................................
bf/!;L(�!t�.. Phone No Owner Name. r..............................................................................................................................
FacilityContact: ............................ Title:................................................................ Phone No:...................................................
MailingAddress:..........................................................................................................................�............................................... ..........................
Onsite Representative:..... f............................................................................. Integrator: ......./.Lkf101.......... ..............................................
Certified Operator: ................................................... .............................................................. Operator Certification Number: ... ............................. I.........
Location'of Farm:
Vq
I!
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• �� ����
d Design Current
Design Current Design Cuirrent
lE
C.
Ca, oulaiio Cattleelation
Wean to Feeder
❑Layer ❑Dairy
t. Feeder to Finish lzDa
❑Non -Layer ❑Non -Dairy
:'... Farrow to Wean
?,� Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacitj
Gilts
::. Boars
Tota1.SSL
m r of:Lagoons
t. ❑ Subsurface Drains Present ❑ fagom Area
❑ Spray Field Area
aPQnlis'lSolyd Traps ,
❑ No Liquid Waste Management System
L
Discharges & Stream ImpacEs
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. II' discharge is observed, what is the estimated flow in ga[hnin?
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?
Structure I Structure 2 Structure 3
Identifier: ................1............... ............................................ ........................
Freeboard (inches): 36
5/00
❑ Yes X. No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Spillway ❑ Yes 91 No
Structure 4 Structure S Structure 6
.......................................................................................................
Continued on back

Facility Number: _ j1 —317 Date of Inspection L�
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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?
Wa§te Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of ver application? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload
L
12. Crop type l/[ �ll�r > 4—* �- dee,-row,-e ..._
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?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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 MNo
❑ Yes MNo
❑ Yes allo
❑ Yes (Z No
❑ Yes �9 No
❑ Yes [j No
❑ Yes CKNo
❑ Yes M No
❑ Yes 91 No
❑ Yes to No
❑ Yes �]( No
❑ Yes allo
❑ Yes QE�No
❑ Yes Z[No
❑ Yes PNo
❑ Yes P No
❑ Yes R[No
❑ Yes S No
❑ Yes ZNo
❑ Yes ® No
❑ Yes No
❑ Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
(refer�t"uestion,#) Explain any YES arisweraiand/,or:any. iecommertdations or any other comm ;.
�C�omments
Use di•awtngs�of facility to better explain situations ,(use additiona[.:pages as necessary,) �,- [] Field Copy ❑ Final Notes
rht d' htorpt4 dre ix dyol( ��Gtl9t
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: EZ'74 'Z
05103101 Continued

Facility Number: — 3/7 Date of Inspection Z % Z Printed on: 7/21/2000
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes CKNo
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 FJNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes EF�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E3 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes E5 No
Additional omments and/orDrawings:
5100

Type of Visit , JWCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit }0 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 31 vale of Visit: Time: Too
10 Not Operational 0 Below Threshold
Permitted © Certified 0 Conditionally Certified 0 Registered Date bast Operated or Above Threshold: .........................
Farm Name: .�.; I.4... ..G . D`T� �..`..Sx.�r.....Fa . M........................ County: ,� val"ex..........................................................
OwnerName:.............. `..1�..'.G!',.....•lJGY..:f......................................................... Phone No:.......................................................................................
FacilityContact: ................................ ..............................................Title:................................................................ Phone No:...................................................
Mailing Address:
Onsite Representative:...�� ��....,i..S...................................
Certified Operator:.... ................................................ ...............
................... ..
Location' of Farm:
Integrator: „
Operator Certification Number;,,,,;,,,,,,,,,,,,,,,,
$Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • i Oa Longitude • 6 14
Design Current Design Current e CDe"sign .!PCourr6v
Capacity population Poultry. lbapaac`rSwine it ;Cattaulatian
❑ Wean to Feeder ❑Layer ❑ Dairy
_EE1
Feeder to Finish1200 2-A (� ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to Finish ' .
Total Design Capacity
❑ Gilts
❑Boars to,:w:SSLW'
" Number of Iai<gootts ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Pon Solid Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream lmpack4
I. 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 ........... .. .............. ....................................................................................
Freeboard (inches): 2 :3
5100
❑ Yes ANo
❑ Yes No
❑ Yes No
ti !a
❑ Yes CgNo
❑ Yes ® No
❑ Yes C9 No
❑ Yes .8 No
Structure 6
Continued on back

aciliity.Number: 31 -- 5] Date of Ir3spectiott 12/ I TJD I I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes ,� No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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'`"� v �q 004.y , Synqd I & -A � +1
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?
6) 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?
(ic/ 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`?
�; �'�1Q yi9laiigris:o;r defciend $ •mere ln4ed during �bis;visit: • Y;oi1wi11-Tec0iye do fuf fte
Correspondence'. 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):
w ra,co t4has sq�#�s-lac d� we44,gb)c acres ;nhr•�0.4;ai
7 I
F c,;1 ++ nrVA rcrorc s jr'e welt k-ep-f,
❑ Yes 19 No
❑ Yes 29 No
❑ Yes 0 No
❑ Yes ® No
❑ Yes No
❑ Yes 9 No
❑ Yes ®'No
❑ Yes No
❑ Yes No
❑ Yes PNo
❑ Yes )J No
❑ Yes IKKA No
❑ Yes R No
❑ Yes 10 No
❑ Yes Nf No
❑ Yes $ No
❑ Yes CK No
❑ Yes &rNo
❑ Yes 9 No
❑ Yes 29 No
AL
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: s,
5/00

Facility Number: r -j j7 Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes %No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JS No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (I 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 JR 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 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? C5 Yes ❑ No
Additional Comments, an or rawtngsq ,.: «.. "',
,,..
Ab
5/00

II�41 s i,• II - va F •_;ofi
4 DivisionIrWater Quality ,i" .�
Q Division of Soiland Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit a Routine' O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: ® Printed on: 7/21/2000
O Not Operational Q Below Threshold
© Permitted [3 Certified © Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: ...f//�!l LAM .....!rl%� .��.......Sf[L................ County:......clpGl�Y.........................wl.Q.....
............ ... .............. .
Owner Name: WL(L.... '' l Phone No: f G 2 ro %%
Facility Contact: l � LtAr??. . I S ..... Title: VW/ .141.R. .... Phone No:... ................................................
Mailing Address:.... ......:..4.r .G ..5....4.1?'�t �i ... .�1.,.... S�:�,1.N..Sp !Y ........
j� �....
Onsite Representative:......I . .�l.G�. .........bd.-2�1.s........................... Integrator: pl`.............................................
Certified Operator:......LlL( .%...... �..... bTr.ills.................................. Operator Certification Number:.... 7.,V1.............
Location 'of Farm:
axC G 2fS�nl, pA/ S. S-11),e- oG S6 1-2 % .c%-11 e-Alor _`
Jd5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ©a GOTT ®« Longitude ©• 6 ®«
Design1, Current
S'Wiae' • ' ' U Canneity Ponulation
Wean to Feeder
Feeder to Finish
Z p
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Ij Boars
Design Current Design Current.-
Poultry Capacity Po ulation Cattle Ca a l PQ elation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity''' Z4�
Totai.SSLW /(o Zd710
or La [] Subsurface Drains Present ❑ GagnonArea JE3 Spray Field Area
• Hddiaig Pords / Solid Traps ❑ No Liquid Waste Management System
Disehar�es & 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/rein?
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 JeNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes tNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... ..........3.3...1.......... .................................... ......................... .1,....... ..................... ........................................................................
Freeboard (inches):
5100 Continued on back

Facilify Number: Date of Inspection Printed on: 7/21/2000
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [],No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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 ARRlication
10. Are there any buffers that need maintenancehmprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type &A� j/� rh-,, / )/&—
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?
�'VQ yi6l Wijs'or- dgf cje ncies *Oro )noted• O wing 4hls'vjsjt; • Y60 Wilj •;eetriye rtti fu>!-t��r.. -
cotrres o><i�ence:a�out this visit.
❑ Yes it No
❑ Yes � No
❑ Yes No
❑ Yes ANo
❑ Yes dNo
❑ Yes $ ,No
❑ Yes MNo
❑ Yes JZ � No
❑ Yes XNo
❑ Yes 4 No
❑ Yes JaNo
❑ Yes J�No
❑ Yes �No
❑ Yes 0 No
❑ Yes gNo
❑ Yes OfNo
❑ Yes bNo
❑ Yes KNo
❑ Yes ,o No
❑ Yes XNo
C,omments (refer to;question #) ;Explain any YES answers and/or any:iecommendations or any er comments
IJse tirawin of facility to`Isettei• explain situations. (use additional:pages;as,necessary} '` ' , i
A.
b&re' I I,1 4 ro calNStb°tom
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
rlr,

Facility Number: Date of inspection ]}J //1L/SDI Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or Mow ❑ Yes No'
liquid level of lagoon or storage pond with no agitation? L
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 9No
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes *No
rtiona :Comments and/orDrawings: r +77771
1--- -
1. 4s �-r /
J
5100

0 Division of Soil and Water Conservation 0 Other Agency
0 Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection EL0 24 hr. (hh:mm)
D Registered a Certified D Applied for Permit D Permitted 113 Not Operational I Date Last Operated:
Farm Name. 4'v I L1.�Qk1...... .... ,�fi /1�...... �ir....... p.n............................ County:....1?l r.,......................................... ........................
y . M1 T� q
Owner Name: ................... W�.1. AR..............1,1G�,Y�..`�.................... Phone No: �a�.... z.l.....121.1.
Facility Contact: .................................................................... ..... Title: ...... Phone No:
..................................................................................................................
Mailing Address: �!�Q.........
1�.�.I.. .......... :s.................................................I�tu� Onsite Representative•............�J11� t Integrator•..
Certified Operator.................................................................................................. ... Operator Certification Number;.................. ........... .......................
Location of Farm:
Qa...�c� ...... i .l'....P......... ... ... lQ. ,....�.Y��.. .....nnr.........o........'? ....!.....................................................................................................................
.......
Latitude ' =' =" Longitude =• 0' ..��� "
uulatnon w
Design Current
Design Current
Swore
Ca ag t
p y
Po Poultr
p ., y
Capacity Population Cattle „g
Capacity .'Population
;>
❑Wean to Feeder
❑ Layer
JE1 Dairy
Feeder to Finish
�QO
3'
❑ Non -Layer
`+
❑ Non -Dairy
❑ Farrow to Wean
a ,a,
p
Farrow to Feeder
❑ Other
k
❑ Farrow to Finish
Tatal Design. Capacity
r
❑ Gilts
❑Boars"
`TotaI:SSE W''.
p
Number of Lagoons
/Holding
Ponds
❑ Subsurface Drains Present
❑ Lagoon Area
10 Spray Field Area
�
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
Yes
19 No
2. Is any discharge observed from any part of the operation?
❑ Yes
[4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[j No
b. If discharge is observed, did it reach Surface Water? (If yes, notify'DWQ)
❑ Yes
Ij No
c. If discharge is observed, what is the estimated flow in gaVmin?
'[�'
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑%Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
A No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
1ANo
5. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
in No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
PINo
7/25/97
Continued
on back

Facility Number: 31 — 5'
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagorrns.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
...................................
I`rceboard (ft). ........... :...............
❑ Yes M No
❑ Yes M No
Structure 2 Structure 3 Structure f Structure 5 Structure 0
............................................................................................................. I ....... I ............... ....................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes No
❑ Yes No
12.
Do any of the structures need ntaintenancelinthrovenient?
❑ Yes
PNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public r health or environmental threat, notify DWQ)
13.
t
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
fQriNo
Waste Applicatit►n
14.
Is there physical evidence of over application?
❑ Yes
P9 No
(If in excess of W or runoff entering waters of the State, notify DWQ) _
15.
fMP,
Crop type ..........."?Mkli.1dx.......................sv...�L...C�tf?.u4lh..............................................................................................................................................
16.
Dothe receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
❑ Yes
i j No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
P No
18.
Does the receiving crop need improvement?
JzYes
❑ No
19,
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does. facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes PrNo
s
22. Does record keeping need improvement? 1� Yes ❑ No
For Certified or Permitted Facilities 0tt1
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes Z No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes TV No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
0 No violations or deficiencies were no' te'd-dttring this:visit..You will receive no further
correspondence about this, visit'.,,
Com_ ments,(iefer to question #): Explain any YES'answers and/or any recommendations or, "Anyother comments '
Use drawings of fucihty to better explain situations.'(use additiontii pages as necessary):F;t
1 • S urc Qq tJ l,�j,1 t1+ 5 Kw— W a a a
I S, � � ► v1V- }�O v er-u- Il oy- benhVCb- p11
Z2 • �0.0atr� i S_)1 r, 5 �1D t1� 6 6, i ►-\ F►� . i�g Ye f? 1nlA� l -s j VA�.�y
5e� Im-JL I( fO o�)aCCJ, P"n S 6.) J j
7125/97
P Yy
Reviewer/Inspector Name
Ayt&ice
Reviewer/Inspector Signature: z�__A Date: Z_/ qr

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
R(Certitied ❑ Permitted for Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ....... ...................... ..._.................................................. ........ ................... ....... .....
,...........p........
Farm Name:. .L l..f..wp .�.... , :... t�l �%.L�... fix...... ti ..Y...,�-i.» ...... ...... County:.. �Ll .�.t. ..............................l .Ll...h...© I
Land Owner Name:... .ti.��.�.� ,.. ....p v.1.,S..t.... ew :...........»................. Phone No: `�.� )� .L` ....... . la.i..
FacilityConctact:.................................................................................. Title: ............................. ................ .. Phone No: .... ........ »................ .........
...................
Mailing Address:......r—.........?.zt..�.i?...1..........�kJrd p..Q......:......Pnl.p^7.....�.�..,ra.... ��....� »....U,...Q
Onsite Representative: .s..� .� s..a..�c�..... ,....�?m. C�.... x..................... Integrator:..x.i .........
CertifiedOperator:............................................................................................................... Operator Certification Number% � ......4...................
Location of Farm:
4>h,.....t;.a�. i~....5 ►. ......a . ..... .......0 ., ......A. .�a.ra.x.l..irr .a . i....... n..�... e......ir� �..r...a�..l ....a i.�.. j .�tir..-....... 4
.... t...n.....,,nt.x..1�....,S.P, .....5 3`1.............................................. ......................................................... ........................................................................ ..0
Latitude • Uhl 4 S8' " Longitude ' ®& U 446
Type of Operation and Design Capacity
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes RrNo
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 Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? iJ i A _
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ER No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes J9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Jallo
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes 21No
maintenance/improvement?
4/30/97 Continued on back

Facility Number: .3.1 ...... —... .�•
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons gndlor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
-� .S X
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes JK[ No
❑ Yes ® No
Q Yes ❑ No
❑ Yes q No
Structure 5 Structure 6
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?
Aaste Applica, tlop
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 . o.er. ..^..^... ...... "t. L11A.n.1. E...q.ml.n........................................................................................
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?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
YES answers'and/oi
w e t,.'
I Z' M C V �, t A. i 0 !� b h I-
I
Eg. GaYwec, W.te.J' P�-eb1a.w►J1 s
F -o�C.%OS Q. Ou00 Ln
❑ Yes ® No
❑ Yes ® No
® Yes T ❑ No
❑ Yes IS No
❑ Yes allo
❑ Yes `R No
❑ Yes ®. No
Yes
❑ No _
❑ Yes
2.No
❑ Yes
13 No
❑ Yes
® No
❑ Yes ® No
❑ Yes E[No
❑ Yes ® No
,r
Reviewer/Inspector Name
ReviewerlInspector Signature: Date: q
cc: Division of Water Oualirv. Water Ouality Section. Facility Assessment Unit dl�n/97

Site Requires immediate Attention:
Facility No. 3 ! I- ►
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
. DATE: "" 3 , 1995
Time:
Farm Name/Owner: 9""//Vz / Wxuz-.(�
Mailing Address:
County:
Integrator: Phone:
On Site Representative: c Phone:
Physical Address/Location:
•
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: _�9 bz_s
DEM Certification Number: ACE N n nDEM Certification Number: ACNEW
Latitude: Longitude: { 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) Ye or No Actual Freeboard: ,,-Ft. .=> Inches
Was any seepage observed from the lagoon(s)? Yes or Q� Was any erosion observed? Yes or
Is adequate land available for spray? es r N . Is the cover crop ad uatepv'f',
or No
Crop(s) being utilized: fi C l j^
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. ee or No
100 Feet from Wells? 0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 10
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes ore
Is animal waste discharged into waters of the state by man-made ditch, flushing system; or other
similar man-made devices? Yes or V 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 To
Additional Comments:
•
.1
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.