310557_INSPECTIONS_20171231

Z 14
NORTH CAROLINA J
Department of Environmental Qual

I j2rType of Visit: Com nce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
t:C Routine Q Complaint O Follow-up O Referral Q Emergency 0 Other Q Denied Access
..
Date of Visit: z( ( Arrival Time: 4g Departure Time: )..a County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact:
Title: Phone:
Representative:
aOnsite G
/
L
0/
1 +l fle 4—) Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
can to Finish
Design Current
C**specify Pap.
T
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pnp.
Da!a Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oW C•_a aci P,o ,
Layers
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
IN
Dischary,es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 ❑ 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 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 of a past discharge from any part of the operation?
❑ Yes
No - NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Ins ection: 3 rg f Z7 7
Waste collection & Treatment
4'�Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Ej`NNo ❑ 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 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 environments hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
'❑ NA ❑ NE
S. 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ 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
Y
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Permit
NA
❑ NE
the to the Certificate of Coverage & readily available?
]"Yes
❑
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
eNo
❑ 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 Flo ❑ 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 - ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciHYNumber:Date of inspection: 3
24. Did t1i facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the�anate boxes} below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
es ❑ No ❑ NA ❑ NE
❑Yes ❑No ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes PXo— ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes q<0 ❑ 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 No ❑ NA ❑ NE
�f C9�% of QPTMr� i^rec9/fs, D�
r
Mom.
� 9 n s, .� � c `'— a �,r, cis
Reviewer/Inspector Name: "/ '9
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1(0 7 2 71CX(
Date: �A 1 0
21412015

Type of Visit: (Z) Co Lance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: q0
Arrival Time: Departure Time: r .. County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
a, '�G C ow YeKc< <____
Latitude:
Phone:
Integrator:
Certification Number: I ,K/ Z Y
Certification Number:
Longitude:
Design Current
Swine C►►opacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop:
Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er
I I
airy Calf
airyHeifer
arrow to Wean 1 zo �` O
Farrow to Feeder
Farrow to Finish
. P,oultr..y
Design
C•_a acity
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
on -La ers
Beef Feeder
7Layers
Boars ullets
Beef Brood Cowurkesurke
Other
Poults
Elother
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Vr No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: - 5_EZ Date of Inspection:
Wriste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes,-E ❑ 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 , io ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [;I -No' ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [ "go ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes LEJ ` o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E]-No ^❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes � ❑ NA
❑ NE
acres determination?
t7. Does the facility lack adequate acreage for land application?
❑ Yes
Jo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JC3,Na—
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
' 11 o
❑ 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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes -®'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes sue' "o ❑ NA ❑ NE
Page 2 of 3 21412015 Contoued ' .

Facilitv Number: n t - ; Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
a No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Ej No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[a Yes
❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
[] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer.to.question #):-Explain ariy YES answers and/or any additional recommel
f 5,�ec_Dzio !�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Ye No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA '[3-E
❑ Yes Ij No ❑ NA
[-]Yes rNo
- ❑ NA
❑ Yes [] NA
or any other comments.
❑ NE
❑ NE
❑ NE
Phone:
Date:
21412015

7
Type of Visit: 7Rou
ance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit:tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (Z tJ Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: t % Title:
h
Onsite Representative: [ �+A 7 Q
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 12—
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
111
INon-Layer I
EEJ
Calf
Dairy Heifer
eder to Finish
—Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Z s—
209 Design Current
D . P,oult . Ca aci Plo ,
La ers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
t?#her
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E3 15o ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [ o _NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

JFacility Number: - i % Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ejl�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z ZD
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [s] 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 0 o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q No ❑ NA
❑ NE
8. Do any of the structures 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 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. 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 to ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zu, 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
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EI'N(
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ef No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes C3'—No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [3'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - S Date of Inspection: / s`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Q':lo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
2T 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 0- 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
[" 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
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
rNo
31:. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes❑
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.:;;
Use drawines of facility to better eknlain situations (use additional pages as necessarv)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` 9y 73a�
Date: /
21412014

Type of Visit: VCompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: S2rRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 10 -q-lei Arrival Time: Departure Time: �® County:L
Farm Name: ,�� OtOM's.'d Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 131.1�1 Q� �
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design Current
Swine Capacity Pap.
Wean to Finish
I
Design Current Design
Wet Poultry Capacity Pop. 10111111M Capacity
La er airy Cow
Current
Pop.
Wean to Feeder
I
lNon-Layer
I airy Calf
Feeder to Finish
Dairy Heifer
Design Dry Cow
Farrow to Wean
Farrow to Feeder
D . P,bult . C•_a aci P,o Non -Dairy
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
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 ONo ❑ NA ❑ NE
❑ Yes
P'No
❑ NA
❑ NE
[:]Yes
�no
❑ NA
❑ NE
❑ Yes
[�fNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - 155rl jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L _ L. ;
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): a _ Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0 No ❑ NA ❑ NE
FZ"No ❑ NA ❑ NE
Structure 6
[:]Yes Rt No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 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
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
J'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
2fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 Windows ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �a.� - 1,/1..�� ` fj•
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Callo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �T­No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ff No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j6No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Qa No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PrNo
❑ 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
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
V] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

I'
Facility Number: 1- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes @ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �' o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [Z] No ❑ NA ❑ NE
❑ Yes [%f No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes VT No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers. and/or any additional recommendations or any other comments.;
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
7zLa 1 J a) — - - Phone:
Date:
21412014

Type of Visit: compliance InspectionG Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: SO Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q Departure Time: County:
Farm Name: 'SA C^ C AYy0j j" J:kX . 4 1 _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 1 1 ..DA I Od —"Sff.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: w�
Integrator:
Certification Number: oil
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry C►apacity Pop.
Layer
Design Current
Cattle Capacity Pap.
Dai Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Design Current
I) , P,oul_ C•_a aci P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qthe_r
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes J;?r'No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes paoNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 21]..�
Spillway?:
Designed Freeboard (in): 1/q�. ] .
Observed Freeboard (in): ;cO a*_Z Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZI 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 PfNo ❑ NA ❑ NE
maintenance or improvement? '
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V1 No ❑ NA 0 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
X No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes •
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes E!r No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes WNo
❑ NA '❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Ins ecdon: U
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 KNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes KNo
❑ Yes KNo
[] NA ❑ NE
❑ NA ❑ NE
❑ Yes 04 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes WINO
❑ Yes ZfNo
❑ Yes �NO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question h): Explain any YES answers and/or any additional recommendations or any other comments...
Use drawines of facility to better explain situations fuse additional na2es as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.. � >n tti � �' �'1�U1r3►
Phone:=--3� 1-2;t5o
Date:
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j / Arrival Time: ® Departure Time: ® County: 1 ]�J�. N Region:
Farm Name: ��<C — CpgoL.LI 5 a 19cc? I Owner Email:
Owner Name: iA_�)I(--LI Pfy) I L0 LA__'3 ��. Phone: q }i��o�93 9�5 EYT L/*)) S
Mailing Address: t7� `� �+3 W�E%V S �} I SON , /y C CO R'13 - O&b S
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
a19
Ce Fcation Number:
Certification Number:
Longitude:
j 1�f71Dt4
Design Current
Swine. Capacity Pop.
Wean to Finish
Design C+urrent Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
sign Current Dry Cow
D , P,oultr. C•_a aci P,o , Non-Dalry
ILayers Beef Stocker
X Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
JBcef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No
[:]Yes [:]No
[—]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ONE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge? 5ZL_
Page I of 3 21412011 Continued

Fsicili Number: j - S Date of Inspection: J
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 ` Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 'k f /LLB (-q\
Spillway?:
Designed Freeboard (in): �J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 'j No ❑ NA ❑ NE
waste management or closure plan? V�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes *No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement? *3,,,No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes *No 0 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): 0 t2�C�T-6r) C-I,5C, A �� J�� l Jys
13. Soil Type(s): GD����
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design Q Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 10 .N.�o
❑ Yes. I 1 t �vo
❑ Yes No
❑ Yes No
❑ Other:
❑ Yes �tNo
Q Waste Application Q Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste Trans ers
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

ht'cili 'Number: - S 4 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
l JkNo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
�ycs
No ❑ NA
❑ NE
the appropriate box(es) below.
9❑
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: ?Q5J/�i
aoN
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
777❑���"' No �4 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 0 No
[:]Yes VLNO
❑ Yes %No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes K No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ej No D. NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
Comments (refer to question #f): 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).;
Lu.A. a
1.3
CL03
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 )6 -'�9 & -'�32�
Date: Q lg l hCQ
21412011

`err`
Facility_Number 4 SS
I
Division of Water''Quality "
O Division of Soil and Water Conservation :
'
Q, Other Agency
Type of Visit )j Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �!`� Region:
e_ C�acL t5=0 98(3q
Farm Name: x � Owner Email:
Owner Name: cola-1 orn /V �l I �� Phone: q16
Mailing Address: )uV ��"��A S ea' t`41►/V C 0 BLI I aVOS
Physical Address:
Facility Contact: (� Title:
Onsite Representative: ]J✓� C} Cx r t-P� Certified Operator: . 1 LL[ A � / . 0L LAw S�Z:•
Back-up Operator:
Location of Farm:
Phone No:
Inte rator:
CA\
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o =
Design .Cdrreq. p Destgn Current ..
Swine , a Capacity Population =°Wet Poultry : Capacity{ Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑Non -La er
.; ❑ Feeder to Finish
Farrow o Wean d
Dry Poultry
❑ t
Farrow to Feeder
❑ Farrow to Finish ❑ Layers
n ❑ Gilts ❑ Non -Layers
r-, r ❑ Pullets
lL_ vuai3
- � ❑ Turke
Other m " ❑
Turke
❑ Other ❑ Other
ttie` -
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
3 d
POU1t5
Nurr
Discharees & 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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes to
ElNA ElNE
ElYes❑ NA ❑ NE
Page I of 3 12128104 Continued

L
` Faciiity Number:
Date of Inspection 1D 11
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 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: n
Designed Freeboard (in): M. p-
Observed Freeboard (in): n O
5. Are there any immediate threats to the integrity of any of the structures observed?
(iei large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )(No
El NA ❑ NE
❑Yes ❑No El NA El NE
Structure 5 Structure 6
❑ Yes y No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo Cl 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) XNo
9. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ////// ��\��\
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
OfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tX0
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYeso
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
, No
❑ NA
❑ NE
Comments {refer to ,question #) Explain any YES answers and/or anysrecomm endat�oas or any other comments
:Use drarnngs°offacility,to, better.explain situations (use additional pages as ttecessa.i
lam• �- } `
00lia
Reviewer/Inspector Name Phone: 6 49ID4. ....
Reviewer/Inspector Signature: Date:GLI/3111
Page 2 of 3 12128104 Continued

1
Facility Number: 77 _ss� Date of Inspection D
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
[] WUP ❑Checklists 0 Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [INA ElNE
0 Waste Application ❑ Weekly Freeboard El Waste Analysis 0 Soil Analysis 0 Waste Transfers
////// ❑���`�` )elnual Certification
0 Rainfall 0 Stocking E]Crop Yield 0 120 Minute Inspections El Monthly and F Rain Inspections 0 Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
V No
❑ NA
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other IssuesXNo
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
[]Yes
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ' No
❑ NA
❑ NE
Additional Comments and/or Drawings:
C Ru �3"-s) any LA �C� 1
Page 3 of 3 12128104

• Division of Water Quality
====cifitqymber 3 - 5J 0 Division UriSoV206WE—erg-bonservationn
0 Other Agency
Type of Visit ' Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance }},
Reason for Visit )opt Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date o1 Visit: ��s3 w Arrival Time: ®n {Departure Time: County: WRegion:
t
Farm Name: cc— CA?-Qcy"%l-ISS] Owner Email:
Owner Name: 1 W AfYI / ' �--�t� W Phone:
Mailing Address: c Q` l scyV / Y�6 0
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: & 1 C371 C_Aca CALA_') Integrator:
Certified Operator: U_ 1) I LLLA8& 'N . %� L14W VOperator Certification Number: IR1,2y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = f =6. Longitude: = o = 1 =
16
Design C+urrent
Design C*urrent
Design Current
Swine Capacity Population Wet Poultry
GapaClty PopUlatlpn C►attle
Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer
❑ DaiEX Calf
❑ Feeder to Finish
❑ Daia Heifer
Farrow to Wean -1 Dry oultry
❑ Dry Cow
❑ Non-DaiEy
El Farrow to Feeder
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other I ==110
Q]Turkey Poults
Other
I
Number of Structures:
Discharges & 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 discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
*No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: _! CQ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes 1�1 No
ElYes I❑`No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ^ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) J ,
6. Are there structures on -site which are not properly addressed and/or managed []Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Cl Yes
XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ 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
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
kNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) M
i L LCT
re SC V F
13. Soil type(s) (f-) r3 9 R-a,� I Y b A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question'#) . Explain 4ny YES 'ans*i rs and/or any-.ecommendations or any,'other,comments t a� ti
Use drawrngs.of facility to better explain situations. (use additional pages as necessary):`
µ
r a '
4&
P5110 o.3s
ala�1Oct OML/ 1
Reviewer/Inspector Name QA110 E5, - Phone:
Reviewer/Inspector Signature: � Date:
12128104 Continued

Facility Number: f -5541 Date of Inspection U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box.
0 WUP 0 Checklists ❑Design C1 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
)ANo
✓/
El NA
El NE
0 Waste Application [f Weekly Freeboard 0 Waste Analysis [3 Soil Analysis 0 Waste Transfers ❑Pnual Certification
EIRainfall ❑ Stocking O Crop Yield 0 120 Minute Inspections El Monthly and V
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PO No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t<No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P(NA
❑ NE
Other Issues
1�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ICJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,cc]
MJ No
❑ NA
❑ NE
CAC.1 P,2A7�o� p�1 E �Q l �
Q.q_-CoM S ;I+-+qT *
12128104

Type of visit compliance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit §0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �7 County: Region:
Farm Name: — � ! —Ll S Ot 09 Owner Email• n r�
Owner Name: �n i -L ► A m / 1t . (2)ua c—A 1.r,, �Phone: r�r -+c� �pJ'� S l 7 315
Mailing Address: o�olyg DENS_ 1�L t�Al�dN`/W� DSJ`t1 f3�0
Physical Address:
Facility Contact: , /�, Title:
OnsiteRepresentative:[�t 7-�1c' �"'TL-q�
Certified Operator: U--,)1LLuAltin 1 V • QLtfLAw . \2.
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 12 %eV
Back-up Certification Number:
Location of Farm: Latitude: = c =' [—] Longitude: = ° = 4 =
Design Current
Design
C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity
Population
CattleSON Capacity Population
❑ an to Finish
❑ La er
❑Dairy Cow
❑ an to Feeder
on -Layer
❑Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
10 Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to -Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
[I Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
El Turkey Poults
❑ Other
❑ Other
I
I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 1ANo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�x No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
I�No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — rJ5 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;*0 ❑ 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: a�
Spillway?:
p
Designed Freeboard (in): . rJ 9 . (.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes $ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0,No ❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
� No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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.
ma¢- s e pT Ak4,- Sku!S
Crop type(s) L (. f~ ` Q 6 CA' I M L//0*4 cjA ag5 5(f-) 7F5//o6
13.
Soil type(s) 6fl, & (� a- ONO A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
1XNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
o ❑ NA
El NE
18.
is there a lack of properly operating waste application equipment? El Yes
to❑ NA
❑ NE
��
4Commen#s {refer to queshori:#)-Ezplain�any YES answers andloraany recommendations or any.otherecomments.•
Use drawings of facility to better explain sttuateons (use additional pages as necessary)_,.� � � -
spiuDl cA'4C CY- W14eaE SLulz>6E, S(A�LuB was Pf�►� Fob
�a �3
f � A S N07" 5 E 1N CoAPLIE,G.� Fc> tZl Vl
Reviewer/Inspector Name (' S Phone: (3)K3` +Qf ia'
Reviewer/Inspector Signature: Date: o[-)oQ3�Q�J
Page 2 of 3 12128104 Continued

Facility Number:} Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �fNo ❑ NA . ❑ NE
the appropriate box. El WUP 0 Checklists El Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
�f No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ )(nnual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
0
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ 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
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ja No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ANo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [;(No ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 55 O Division of Soil and Water Conservation
Type of Visit .compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 3D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f o�a�� Arrival Time: Departure Time: County: bkX W ^f Region: _
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �l1�TGl•(DuT C Ate _
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0 = ' ❑ « Longitude: ❑ 0 0 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
1 A O
/ 00
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population'.:"
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 71
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 (gattons)?
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 [4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

t
Facili(yWumber: (— Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
12 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: L1lr-,nood I 1C'0CW<9
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1913 y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
US 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
N 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 El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M 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 [0 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5fl No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f
�
Reviewer/inspector Name qM1QNEA t~-1q NGS .SON/Y _AeN C-4 4Phone: 910 '_0-19I0 -13a1_
Reviewer/Inspector Signature: Date: I 1 as 108
r 12128104 Continued

Facility Number:] — Date of Inspection r7�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ly] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�SNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Y[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
[� No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
8 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
[@ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3� 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
5� 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
R1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

h—c—ifity'Namber
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 50 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /0.'05 Departure Time: ! County: �[l'�6 �� Region:
Farm Name: . �f� (�i�O�G 5ZZ� / Owner Email:
Owner Name: �iVZGG �/�iY) p��-�� - �C. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative L��AInJ Integrator:
Certified Operator: �� D _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 6 ='
[=] « Longitude: = ° =' =
Design Current Design Current Design Current
Swine Capacity Population. Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean /2 D / D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - -
❑ La er I I :::::],
❑ Non -Layer
Dry Poultry
Non-L�
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockej
❑ Beef Feeder
❑ Beef Brood Cowl
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
ElNE
❑ Yes
YNo
❑ NA
❑ NE
12128104
Continued

Facility Number: — j5 Date of Inspection
Waste Collection & Treatment 5141
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA [I NE
a. If yes, is waste level into the structural freeboard?
El Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:f
Spillway?: /VD Ajo
Designed Freeboard (in): 5 1 ,_J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
No ElNA ❑ 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
L[J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/
9. Does any part of the waste management system other than the waste structures require
[] Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No ❑ NA ❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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 ❑ Applicatiop Oytt�ide
of Area
12. Crop type(s)
13. Soil type(s) J' -p 1q, /�'} / V0
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?
ElYes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
o
Y
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
El
❑ Yes
No
No
El
❑ NA
ElNE
❑ NE
Commen /(refer to question #,) Ezplatn any YEStinsrv""e rslaad/sor any�recommendations or any other co menu.
Used awrngs of fac ity to better explain situations: (use4ddrtronal pages' astnecessary):
l A f� 1 /✓GfO ��Ls. e7141VO
NGL� L
Reviewer/Inspector Name'Phone:
Reviewer/Inspector Signature: Date:
121128104 Continued

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

W Division of Water Quality
Facility Number 3 ,5,� O Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
OB Departure Time: � ""-'1 �C(J
Date of Visit: Zg O� Arrival Time: %. p nty� Region: g�on:
Farm Name: t- D L Z 2 c> Owner Email:
Owner Name: �/�GLz�4l�? ?!2Lr6Lil cam`! Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �6"rr � 12'eaak
Certified Operator: SJ8ZZV4 10d al &4
Back-up Operator:
Location of Farm:
Phone No:
Integrator: c�
Operator Certification Number:
Back-up Certification Number:
Latitude: = n ❑ I = Longitude: = ° = = u
Design -Current -'.Design Current Design Current"
,. ter,
Swine Capacity .Population Wet Poultry `Capacity Population Cattle -Capacity Population:.
❑ Wean to Finish ❑ La er
l❑ Wean to Feeder ❑ Non -Layer
LYE,
❑ Feeder to Finish
Farrow to Wean / Dry Poultry
Farrow to Feeder
'; � ❑ Layers
❑ Farrow to Finish
❑ Gilts ❑ Non -Layers
❑ Boars _ ❑ Pullets
El Turkeys
Other .
❑ T'urkev Poul
Other
`r _
Discharees & 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
EEI
❑ Dairy Heifer
_j
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Struct
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
ures
❑ Yes ?No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No
❑ Yes ZNo
❑ NA ❑ NE
❑ Yes ANo
❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Structure 2 Structure 3 Structure 4
Identifier:
WZ
Spillway?: O
/1/0
Designed Freeboard (in): �LI.s
&.s
Observed Freeboard (in): Zf3
30
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ZNo
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 'VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes gNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window_ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
r
/
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
S G,
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
yrNo ❑ NA ❑ NE
�No ❑ NA ❑ NE
No ❑ NA ❑ NE
X-No ❑ NA ❑ NE
Qf No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any recommendations -or any"other comments.'=:
Use drawings of:facility.to better explain, situations. (use additional pages as necessary):'
� � L� �0-'j AL
/U
Reviewer/inspector Name 1 Phone: O- 4 f1— i`ZC?!jy
Reviewer/Inspector Signature: Date: 7%8 fYp
Page 2 of 3 12128104 Continued

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

i
__ _Division of Water Quality
Facility Number Y j 5 0 Division of Soil and Water ConservatMR
Qther Agenc=Z]
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 16 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied 'Access
Date of Visit: ! Arrival Time: ,3:05 Departure Time: ounty:
Farm Name: _ t5e�� 1i4/i/LLzG �5 ��Z�� _ Owner Email:
Owner Name: c.fT�J� Phone: _
Mailing Address:
Physical Address:
Region• GyA90
Facility Contact: Title: Phone No:
r
Onsite Representative: wr,-,w G integrator: �!
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g [= " Longitude: 0 ° = f
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean /2 D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischameses & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
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 m No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
;Z No
❑ NA
❑ NE
12128104 Continued

E
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 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: All 61Z
Spillway?: A10 /jo
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes m 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 Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V1 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 VTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V] No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/oaf Wind Drift ❑ A\pplication Outside of Area
12. Crop types) �L7z=�i?t/G i'44 L�� �.�".I f�(J�QSF_.e�D 1 ��'[rF_ /�2CGE7�A�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�ffNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
I?fNo
❑ NA
❑ NE
�6S 6_ /✓p�J � U/i�STF_ �NA� �S�s� �F�l
/ / w AP.�T-i tt'14 5�rlle I ���G G�i Yz•O/`��, V �,� 4
AAzzc. 2005 ,, PpGzC,g 74DiJS} GP,S� /�i�r-cJ /gi►/ �/ sus,
Reviewer/Inspector Name
t w
Phone:
Reviewer/Inspector Signature:
Date: / D
1212810Continued

i
Facility Number: % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'0
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑l NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
GQ NA
[I NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XVNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�lNo
❑ 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?
❑ Yeso
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
/'1V
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
El NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
!!!!
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
P/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Atdidonal Comments and/or Drawin
Zi��Sf �.�QovF_o cam. o� �r-z.✓� �4.✓o GrJ.�' ku� ���
GivzZz N�fDF.� Foe �/V.5 ' I��•J l ✓ �v7.1
Ila
12128104

Type of Visit RrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: Tune:
Not O erational O Below Threshold
permitted Certified 0 CConditionally Certified 13Registered Date Last Operated or Above Threshold:
eC ..�_._ _. ..
Farm Name: ....._ �? ' `
..-!y�� s. r�........_....... County: _._' ......._ ..__ ._ ....w».»......
OwnerName:........................................................................................................................... Phone No:............................................ ..............................
MailingAddress:._.......... -—.... ................ ................ ...�..._.. - - -__............._......_..._.....»........ ..
Facility Contact:........... -------- _ _ ....- Title:..__.. _._._. _ ... Phone No: W�_,_ �. _�.. .............
It
h
Onsite Representative:_ �i�l"1 _.�._. _.. Integrator.
Certified Operator :....................... ....._.,.. ........ .................... .. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 1 41
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes 0 /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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier• 1 Z
Freeboard (inches): 3 y a
12112103 Continued

Facility Number: Date of inspection IJ
41
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 3 fLMOVA (G) SGD n tML L_CT
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAAW)?
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?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes E No
❑ Yes No
❑ Yes 7No
'
❑ Yes
❑ Yes EeNo
❑ Yes 2
❑ Yes Co
❑ Yes eNo
❑ Yes
❑ Yes o
❑ Yes
❑ Yes No
❑ Yes 91 o
❑ Yes
['No
❑ Yes
2r il� o
❑ Yes
�o
❑ Yes
L�No
aad/ar ao tta comet A
Comments (re%r to questaaa)Explaan°any YF.S answers y'irerammenda ns ar:any ot3ter ants.=.
-u ., n ,
;Use drawings affstctLty to�better e�cplaun srtnairons.,{ase;ad�#iwl pages as sieeessary3 Field Coy ❑ Fetal Notes
a 3d
QEw tAt-000 is,60 08- eaof-C)
jl3Ct.J wwP �o1J� CNA�f;TJJGt 5oryti� FCS"E Pv 'fib MLt,�fT'R�E
AOD l 10v0 FARPA-J TO IFEED CK -1b llb 5 Ft a,(LaW 'C� 6,3E AO, 0 4A1/Laa3
Reviewer/Inspector Name`E
Reviewer/Inspector Signature: 9& Aullkk Date: 5 03 o
12112103 Continued

Facility Number: 3 _&S Date of .Inspection ;5 0
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 31-35)
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?
❑ Yes No
❑ Yes L
❑ Yes Z1N�
❑ Yes <0
❑ Yes 21ro
❑ Yes No
❑ Yes EM
❑ Yes
❑ Yes [210
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

i
Type of Visit 16 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit o Routine o Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 13 Certified 0Conditionally Certified [3 Registered
Farm Name: S C C/, ag ua /s �ZZ�
Owner Name: (J
Mailing Address:
FWR
Date Last Operated Above Threshold:
County: ,�lGZ/ii
Phone No:
Facility Contact: Phone No:
f� f M
Onsite Representative: 1 2fLLz i)n ri'!• -r-otf t� R a Nr�Integrator: ('M2ae l. 5 A 1' �aR '/_ �' c
Certified Operator: Operator Certification Number: J
Location of Farm:
[A Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 Du Longitude # 6
Wean to Feeder [ [ 11LJ Laye
Feeder to Finish I IFI Non -
Farrow to Feeder Q U Other
Farrow to Finish
Gilts ;yR
Boars x
Subsurface Drains Present
No Liouid Waste Manaeen
DDi charges & tream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area II_I Spray Field Area
❑ Yes 10 No
❑ Yes ❑ No
❑ Yes ❑ No
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
S cture 1 Structure
mare 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes
❑ No
❑ Yes
No
❑ Yes
91No
❑ Yes
Ld No
Structure 6
/
Condnueid

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10_ Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
I2. Crop type L�2 ("06EV t �
I3. Do the receiving crops differ with those designated in the Certi
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 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 VNo
❑ Yes VNo
❑ Yes No
❑ Yes [YTo
❑ Yes 0 No
❑ Yes
-
❑ Yes ONO
❑ Yes No
❑ Yes [ No
❑ Yes VNo
❑ Yes ONO
❑ Yes VNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
XYes
❑ Yes
❑ Yes
❑ Yes
�No
No
No
No
❑ No
ONO
VNo
VNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cont eats (refer-tu questt6n #)=£xplatn any YES ansv ers sntilor anyreeommeii&diins or an�Vother cromments: x '`
s
Use drawings of facility to betterezpiatn'situahons. (use 2RJIitZ0_iW pages as necessary) Field pv ❑Final Notes
5 f a p l H r 1-u oae F a c r u r/lo n` {E Oz0r-_5-r
LkeGeotAU -ro- A) L �57- w�f �, Zp�*s 4,®,oz,-rE4
l0 LA-A)O ; !�F_FpF,p F2 15,004AVIr- �e-0-5, /"ff 4MAVIV7- of
nNa
j K,0 av,-, Ae e o/ZDE',o Aso S•Go Qr✓
/41
S
C, o�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued
Id

t
Facility Number: _31 Date of Inspection L Z5{T
Odor lrssues
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 X,NO
No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [
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 JzNo
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 XNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /❑ No
Additional Comments and/or Drawings:
Is
EE' �F • } fJE1O L4,t�,J Fs ��,� �2 N �a5-r C=�orJ,.
Ca �tQo u t5 2 r.{�LZN S D ZL � Ltd&-z�2 l445 Or Ste.
Put,,-6 4kr ditc:- Adzq
o 'z--F-� 0s OF rm��
J _
ze A 5 5 S P-4-n1
t R FRE_F.BDp2b PiF Cvp.DS
L v--j r-,- D r- 19 " 4P DN APRzC- i1 I o�2
tRECVQD-S 0606
rAS4 (o
f�©o —I 6 0 o
0510.3101

iry
f F-
ttvwon ofwatery h'
OD5 -
2 f+ C
^DiviSiOli [1 a[fllpaald �8�i' OIISCl'vati0ll , ``�
a ;
O't7ther A
E
sit Compliance Inspection O Operation Review O Lagoon Evaluation
r Visit (KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: �[ O
0 Not Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name. 5_LQ_$1.N4., QL\G� ......................................... County:.. � ��t'1..........--------..........................
OwnerName:........................................................................................................................... Phone No: .......................................................................................
FacilityContact:.............................................................................. Title: ................................................................ Phone No:
MailingAddress:.................................................................................................................................................................... �............ .............. ...................:....
Onsite Representative: -`"............................-----........................................... Integrator:.... ................. ........................ I................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ����
DesCCurnt DesgCurrent .- .Design rn yrrent
Swine Capacity Poultry Cate' Cact
Po iulat>con
❑ Wean to Feeder 10 Layer ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder lj(j+;j ❑Other
❑Farrow to Finish TotAl Design Capacity
❑ Gilts
1.
❑ Boars T_ fatal SSLW
Number of -Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Vischarg & Stream trnuact5
1. Is any discharge observed from any part of the operation?
❑ Yes KNO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................
LlFreeboard (inches): - -
5/00 Continued on back

i
jFacili%y Number: 3 — - Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes WNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes b(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? XYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
11. Is there evidence of over[[ application? ❑1 Excessive Ponding ❑ PAN ❑ Hydraulic [Overload El Yes 9No
12. Crop type f Vv_t4 c' ch y-o''z2 % ! . C4 t? Cx'z @ . , Si--4` V�_t L n vp_'�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
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?
Reauired 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?
LJ; NO-*ibiatidtis :oi' deficiencies -were poled- dtir M9 :his; visit: - Y;ou will-Teceiye iio: further
. • coriesporidence. ahout: this visit. :..:.. :::.::...:..:::: :
❑ Yes
❑ Yes
Cl Yes
❑ Yes
ZNo
t<No
5�No
F No
N(No
b(No
❑ Yes XNo
'Yes ❑ No
WYes ❑ No
❑ Yes KNo
❑ Yes XNo
❑ Yes XNo
❑ Yes 0 No
❑ Yes DfNo
❑ Yes NrNo
Contmeim&:(refer id question #): Eolaili any YES answers and/or any recommendatiohs-or anywother comments - u=
Use drawings of facility to better explain. situations. (use additional pages as ;necessary) _
Ct)
��-�-- � c� ��+e �p � �:i�� �- �❑ ��, � Cam• � ._
w i �Qe t
Reviewer/Inspector Name tZ
Reviewer/Inspector Signature: Date: 5100

Facility Number: — . Date of .inspection Printed on: 1/9/2001
Odor Issues ff
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 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) ,1
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 1xrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes & No
Additioomments-and/or Drawtn gs.. e_ M. a rt
tit-
e�,�-� �.e�.r. �e�- ���--. �l .� �;►d.�A�,,;�� , t4-� i`� tee.
y� C rr^►^-e `^� G� �-2 �s ..�L, ' S t\ S� 1�.�ti t... Ml. of
A, U
] 1c�'•-� " � 1.-�G'`� � � �\Q_�-d�f ���
5
(
5100

�-Division of Soil ari&Water Conservation ©peration Review _
Division of Soil ands Water Conservation— 'Compliance Inspection
•Dii ision of Water; Wi Cam lance Ids ection r
Qu t3' -_.- P P
_ 0 Othe"r Agency Operation Review -
- -
lgLRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number / Date of Inspection
Time of Inspection d: 24 hr. (hh:mm}
Permitted ©Certified Q Conditionally Certified E] Registered Q Not Operational Date Last Operated:
Farm Name: ... ............. ad-1A.W ................. County:........ %................/............ ----- .................
C.� .
Owner Name:..... /. (f.� �.....................1�..'-� tJ-......._................................ Phone No:.....(%v�. %l��
IJ�}y y . ................................................
Facility Contact: ... ��.f..+ -#.1.K......... ..AJ444:rJ l.--...---_-Title:......j44./ e..r..... .... Phone No: ...................................................
MailingAddress: .......................................................................... .
Onsite Representative: i!il�lltX1.......t!,1/C./r�..l��/�(................
Certified Operator:...(,.zll.�i/t!L...................��lrfTl.aiv..................................
Location of Farm:
................................................................................. ....... I..................
Integrator: D�l s
.........................................................................
Operator Certification Number
a
.......................................................................................................................................................................................................................................................................... �
Latitude ' ° i Longitude • ° 46
Design Current Design Current . Design Current
Swine ' f Capacity Population Poultry Ca acity Po ul . on : cattle Capacity Po ulahod:
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
® Farrow to Feeder Dp fl ❑Other
;p,
❑ Farrow to Finish TOt3i DQS! II Ca aClt
-_ ❑ Gilts _
❑Boars _ Total SSLW
s �Namber of Lagoons 10 Subsurface Drains Present ❑ rea
Lagoon Area ❑ Spray Field A-_
Holdmg:Poiids Solid Traps ❑ No Liquid Waste Management System
,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made'?
h. 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 gai/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 Sir lure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ................................................................................................................................ ............................
❑ Yes
P(No
❑ Yes
❑ No
❑ Yes
[:]No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes FdNo
❑ Yes TKNo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes J�RNo
Continued on back

Fac][Ay dumber: 3-1— rr Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Q(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat; notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 14No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type F1� + ST 56 Jove f Setd
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
(LNo .
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
EKNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
PLNo
15.
Does the receiving crop need improvement?
❑ Yes
�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0No
Reuuir-ed Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1�[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
tallo
19-
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
C&No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EANo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
§4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
No
(ie/ discharge, freeboard problems, over application) ❑Yes V
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes MNo
0; bNd ant-You Will-. &iye 1iofurth-•.r
correspondence:wt this.visit. ' ' '
C©iinments (refer to question #). WE1clain any YES ainiswers and/or aiy recomiisendat�ons o`r any other comments;
UwArawifigs.of facslsty to=better explain sttuatinons ;(use addiitional vaees-as necessary)- Lx
So;I T pcs : ►4 Goo,
/mot � ms . "00 JI-
�n-r�et�,�• l�rs%� �. �ve�... tN t�t,P ,,,P� � yr I�
J
lmr 0w4U,,,..f 1 s P•ro — O lti�i L w7-�va ti,
Reviewer/Inspector Name. z— =
Crsu! IlIG !i w
Reviewer/Inspector Signature: _,::7 4��/ i -f ' Date: 9, /
3/23/99

Fa4ility Number: l — Date of Inspection
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ANO
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ( No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
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 (ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �<No
Additional,Comments and/or rawings:_
crop
1A-
0-1 KA
J

V] Divisxon of Soil axad:=Water Conservat.on -Operation Review
- ',_.Division of Soil and-VCrater'Conservatxon = Co`mpliance ln� ipection A , _
ivision of Water Qualify :Compliance Inspection
' M Other Agency4 Operation Review `, r
Routine 0 Complaint O Follow-up of DWQ inspection O Follow -tip of DSWC review O Other
Facility Number J S$ Bate of Inspection 3a
Time of Inspection 24 hr. (hh:min)
Permitted OCertified [] Conditionally Certified [,] Registered 0 Not O erational Date Last Operated:
FarmName: ..................... . K'...r..... ............................... ....-.-............. :..... County: ......... ..ti .f L ..............................................
OwnerName................................................................................................ Phone No:.......................................................................................
FacilityContact:..............................................................................Title:.......................... - ...... Phone No: ...................................................
Mailing Address:
Onsite Representative: t� :1 1.
............. ( Integrator:
... ........ G
...
Certified Operator:................................................................................................................ Operator Certification Number:............... ..................
Location of Farm:
L�..............................................................................................................................................................................................................................................
Latitude 0-,=` =•` Longitude =' =` =11
- Design Current Design Cut i ent< = Design Current
Number of Lagoons _ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding ftiids I Solid Traps -- ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0"No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [2rNo
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 ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes dNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.Identifier:
Freeboard (inches) : ................ . �.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
...................................
El Yes W(No
Continued on back

Facility Number: 3r — S$7 Date of Inspection
& Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type <_, $,--n,►
$ Zs
13, Dothe receiving crops differ with those�signated in the Certified Animal Waste anagement 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?
l& 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/ irri tion, 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?
io. Mations:or• defcier�cies mere nQte� dpring �his:visit: Yop :will receive trio iu>ither
: corresnoiideitce: about: this visit.
❑ Yes &No
❑ Yes �No
❑ Yes O No
❑ Yes 4n No
❑ Yes 2<0
❑ Yes 13<0
❑ Yes RfNo
❑ Yes [j No
❑ Yes No
❑ Yes No
❑ Yes ErNo
❑ Yes ,ETo
❑ Yes YJ No
❑ Yes I?No
❑ Yes P-110
❑ Yes L2,No
[]Yes ;3'(Io
❑ Yes ,0'Kio
❑ Yes o,&No
❑ Yes
❑ Yes .tom rvo
Comments (refer tv,questiion,#): Explain.any YES answers atd/or any recoiinmei►dations oraany oilier comments
- mm-
A
Use drawings of faeilrty to better;explain srtuahons (useWadditionalipages as necessary) - ;-
��� ✓ Gc� LSPO-p', R`Et_n�s -
WX "%
Reviewer/Inspector Name Ff 1576j
Reviewer/Inspector Signature: L
`�►�) 3? S-3'
Date: �3
3/23/99

Facility Number: 3! — 5S Date of Inspection $ 3�
Odor Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
liquid level of lagoon or storage pond with no agitation?
4w<)
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
P'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
E'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
X32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Addi
tional. omments an_ or�rawrngs:.
_._ ro -__
vs:LL P—ZrCwJE wE�(a _
3/23/99

Facility Number. r — e Z I)ate 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 J�o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PKNo
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 WNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes V�'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? ❑ Yes ;24
Additional omments an or awxn
HA
3/23/99

❑ Division of Soil and Water Conservation 0 Other Agency Y F
' • Division of Water Quality
Routine O Com laint 0 Follow-u of DW ins ection Q Follow-up of DSWC review 0 Other
Date of Inspection 0 9
Facility Number I, Time of Inspection OS 24 hr. (hh:mm)
MegisteredCertified [3 Applied for Permit Wermitted JE3 Not O erational Date Last Operated:
Farm Name: .......................�.LQC..... YY4.�.� 5.....:... 8�! ............ County:......?iir........................................................
............................ .......
Owner Name:..........r ............ ......... Qf✓T w tC............................... Phone No:.....� L� Z�.�: a
Facility Contact: ................................................................... ....... Title:................ .... Phone No:
MailingAddress: .....:AA3....... krr ..................................................... ........ ]C�-WNJ...... 1 Ce.......................................... ..�3 1.......
..k }.At ails—. ............. 1.1� K �Ll
Ontiite Representative: ................ ......................................... Integrator: tart]f.�................................ ....................
Certified Operator;............................................................................................................... Operator Certification Number,....----.----............................
Location of Farm:
S?r, ...... �zs......a......... k..I. 11......VA.......xt3 .6.........Rz s-f ....01..... 5 .. !iL:......................................................................
..................................................................................................
Latitude Longitude
v Design Current Design 'CurEent
Swine P.Capacity 'Population Poultry Capacity Population -_ Cattle,-,
❑ Layer ❑ Dairy
rl Non -Laver ❑ Non-i
❑ Wean
to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
1()00
Farrow to Finish
❑ Gilts
[] Boars
......... ...... ....
Ip Other I
Design`' Ci
Capacity 'Pop
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IN No
2. Is any discharge observed from any part of the operation? ❑ Yes CO No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [9 No
b. If discharge is obsened, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in gal/min? N 4 jPc
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes [P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P9 No
7125/97
k

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ;RNo
Structures (Lagoons,IIolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes MNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(ft).............. 3.:............. ........... ,,?r................... ......................... .......... ....... I ............................ .................................... ...............................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? PYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Sf.tl .............� 1CT,.,,U �..............5i. [.... Vb:k►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?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[]- No. vitilations-ordeficiencieswere-ittited-during' this -,visit'. You:will recei've•no'Airther-.
c6rrespunde is about-this:visit:•
IY.. "Ve- Gtr,Ze.r bjOcIcS .I- cr-irA,� " tA"LY 0.0 W1,Ik
oar ' t s6vlO be, "kk , icA Marc! areas or\ 3, vL, t, &, I l
Wwl``t o {u,)00,•jj Z 5ha d�121C
`` A;1 !cJ
1-2— a. C�[S ighS q c�-.mvLU e W i {�t t'L� YYl� muvvG . A
IgV
f'�,� llt=aclr� G7a9�1 ,Y� �C y� zoiu ,
+ need
D; S cs11.41 av& Vm �; f\ t .r~ 161oon # 2. im 1 aa►� �� 1 j s o,be�rc
I,�,�k�
❑ Yes M No
❑ Yes No
❑ Yes iJ No
❑ Yes O No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
PYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 0 No
s6dj ► ,— mve,
8;j
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: `�{,�,� �� / Date:

0 Division of Soil and Water Conservation [3 Other Agency
RIDivision of Water Quality
IS Routine 0 Complaint 0 Follow-up of DW(2 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
DRegistered OCertifted El Applied for Permit [3Permitted JUNot Opera Date Last Operated: ..........................
r
Farm Name: .......a .....................................
.................. Owner Name: .... ....................... Phone No: ... ( .. 11a) .... z.6.3 ....... 71.o.5 ...................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:
Mailing Address: Lt. ma.xQ,�.,,,. S ...... ?4.0.4 . ......................... .... F ................................. 2w 1A
Onsite Representative:.._((
epresentative: .... ........................................... Integrator: ..... ................... I ..............................
Certified Operator-_V.1'.J].1AM �_...Okl�lqk/ .... je . ..................................... Operator Certification Numberd.?JZE ...................
Location of Farm:
0 C,IA% ... ...... N
.....
_
.A A .
I
Latitude [�* Of], DT-11, Longitude ETD* 9 44
t V Current
Curren,U,Des_Rjff4jkity
�,k-
Ca0ac4 Po la Poultry �,Capa�jty..,.,Poo Cattle„ a eq ­E, p.ij tiloq Population
Wean to Feeder
e�._
FEI Layer Ell Dairy
EEE] Eo
FEEder to Finish
10 Non Layer 0 NonDairyFEEII
k:
El Farrow to Wean
E::. , .
.............
Farrow to Feeder
El Other
0 Farrow to -Finish
71- U D­
OUP. eft'fi
Gilts
El Boars
4
59 ims, r%�
..r
Subsurface Drains Present]JE] Lagoon Area
10 Spray Field Area
. ..... .. ....... ... ... .... .
10 No Liquid Waste Management System
1. Are there any buffers that need
❑General
maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon 0 Spray Field D Other
a. If discharge is observed, was the conveyance
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ)
c. If discharge is observed, what is the estimated
ow in gallmin?
A. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
man-made?
fl
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than
ponds) require
maintenance/improvement?
6. Is facility not
with any applicable setback criteria in effect at the time of design?
lagoons holding
incompliance
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
El Yes 12 No
0 Yes
0 Yes 53 No
0) A
0 Yes IR No
0 Yes tR No
El Yes KNo
H Yes 0 No
®Na
[j
0 Yes RNo
Yes CkNo-
on back
Continued
I

Facility Number: 31—
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes � No
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):............................................................................................ ............. ..............................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes 0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes JRNo
Waste Application .
14. Is there physical evidence of over application? ❑ Yes ELNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.4v.. 5�...................�.
16. Do the receiving crops differ with those designated in the Animal Waste Management...�an (AWMP)? ❑ Yes 9No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18,
Does the receiving crop need improvement?
❑ Yes
[,No
R
Is there a lack of available waste application equipment?
❑ Yes
CKNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
RN
22.
Does record keeping need improvement?
IN Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1jrNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
CR No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Z_No
ELNo.vitilations•or deFtciencie's.were noted during this:visit Yodw'ill ireceive-iro,fdriher:
correspotidepce about this'
-4,�5° .zc- �c*�-e-s.� --aye' s>e. �3 - � `,max.'. �..:
Casnme�nti (refer to questton #} Explar r any YES answers andlor at y recommendations b any other evmments
Use tlrawtngs of facrhty,to better explain sttuatrons (use add►tiottal€pages as;necessary) �x
��.'° e ,
' �v
5 • Gan2. � y+-u � � 1a.� �.o., ff..A..... i w� �S"e.�-'L-�� +�]
,yp - d. L u, ,.r.%ti fur � �+ i p i
S p Lc a �� ��l,-s-a. p a ,�'�wv-S✓w i T-� �f a-S
1 r ✓„ JO�w
a t 3 nti t cl �._ 1,� . P F i '`� A ka v t�-- i� q r e re-u 'l �eL o r S s a inn a ', o .,� I Y
u{,'1
iZ- t] ewu i-o� ha c 5oRQ,,,. b i Le �2.r a,.. L u-o4. CIO ,14_�riv-L �,s toovk-VAUt
w
A- 1
�a
2Z• CrC1 a rv-ti� N ab 51tikuJS ;rr,qq�Ljd-'� rvIts CL,4L CLC i�/lSo� a
qtt 1`1
Aa4-d
Ma {fir o,n k! 3 t�-�ri- Zg) rn ,Lal Se` c.rct rf
Tv,is �ar..v�aYiaCY�esC�tnoL pu4t,�. k� �1M,o.dd; f tori� r.x.w�y G1ia'r
5/ 7
b1ti. U Id-L V, 7/
Reviewertinspector Name z
Reviewer/Inspector Signature: Date: 5 g
QWR
5y-4- W I R, t t cd� t� D w rvK� f 0+1 UV*-- C.� l � +1
�� i=�A i j-Z iRw�1a .vC� a�nrL ��
, t--,.,`+� �.ae �� Dtn3 Q> ;w T— i� 1 q1� 1 -2 - v-n R-z

1
f
•
i
m
C

Ll
Site Requires Immediate Attention: r\ G
Facility No. — 15 ­71—fo­
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �� S , 1995
- Time: 1 1 I r
Farm Name/Owner: Lo C Lam- c� ) 0 et.w
Mailing Address: 2,1'4 S LEa.)L-n -y :)2 Yl L _ a Z3
County:
Integrator. C . o [ I r fin--, Acx" ti Phone:
On Site Representative: Phone: au —'01 1`
Physical Address/Location: _Q2 i Z n 1 n �� �,i�G._ .Sac__
Type of Operation: Swine Poultry Cattle
Design Capacity: Imo_ �; �L_ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 ' ) a-, 39. Longitude: _3-t ° Q1 O V& 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) oe'sor No Actual Freeboard Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oo Was any erosion observed? 0s or No
Is adequate land available for spray? Ye or No Is t)e cover crop adequate? es r NO
Crop(s) being utilized:
Does the facility meet SCS
�aA
setback criteria? 200 Feet from Dwellings? 6s or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or i�o
is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No W
Additional Comments: cr, , o,--e m'I Cow- -.+-p -- --,Ae
Inspector Name
... !rp a_t_4 e
cc: Facility Assessment Unit Use Attachments if Needed.

V� Site Requires Immediate Attention:
Facility No:.7,)—%
. DNISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: _ I yl�
Farm Name/Owner:-
Mailing Address:
County: -
Integrator. U a t i ( Phone:
On Site Representative: A/ _ Phone:
Physical Address/Location: tic- s1e 130�_ �P rn�l� ko," euPr+u�
Type of Operation: Swine.- NZ Poultry Cattle
Design Capacity: tU Su- Number of Animals on Site:
DEM Certification Number: ACE t DEM Certification Number: ACNEW
Latitude: 2 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) Yes or No . Actual Freeboard: -TFt. Inches
0 Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed?oze
Is adequate land available for spray? 'e or No Is the cover crop adequate? or No
Crop(s) being utilized: SL"t
Does the facility meet SCS minimum setback criteria? 200 Feet from DweIlings?(TrPor No
100 Feet from Wells? &��r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar mart -made devices? Yes or&3 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
V
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 13 ' 95 09: 02pm
Site Rcquires Immediate Attention
Facility Numbcr. .3 f 7 '0)
•� SITE VISITATION RECORD
DAM ZL-y n
1995
Owo.er: . r.B �-rc u c� e�-r- t �'Q Farm Name:
County: IDO PL 1),4 - -
Agent Visiting Site: S Li -A g urSsfi Phone: 4I 2Q6 ---7-1 zQ
Operator: Phone: - _ _ Zg3— d31 S .._
On Site Rep=eatative: _ Phone:
Physical Address: ,? d V 4.tm,1 M 3 0 0 3 S 0-.
0
•
Mailing Address:. R-r 7. T _
Type of Operation: Swine X Poultry Cattle _- _ .
Design Capaciry: i7 ca 4 Number of Animals on Site: %r-rb Sw.) _
Latitude: ° Longitude. o
Type of Inspection: Ground X-- AerW
Circle Yes or No
Does the Animal Waste Lagoon have suitcicnt freeboard of i Foot + 25 year 24 hoar storm event
(approximately I Faor + 7 inches) Yes or No Actual Freeboard: I Feet Incites
For facilities with more tl= one lagoon, please address the other lagoons' freeboazd under the
comments section,
Was any seepage observed from the lagoon(s)? Yes o(p there erosion of the dam?: Yes CO
Is adequate land available for land application? Yes or No is the cover crop adequate? Yes or No
Fax to [phone]
Agent

OPERATIONS ERRICH - WQ F'a.x : 919- f 15-5048 Aug 1 ' 95 11 : 58 P. 16/20
' JLL lJ 7J L'7Y.'(rYyls
•
Site R=quisas Timnn d'a :G Attecnon
Facility Ntucb r. ^+
SI'f' 'VISITATION RECORD
DATE: T' -L V r7 , I g a s
C]wtter: .gam µ Cc.)-r P- Farm Naive:
County- Z)OPL/o4
AA=r Visiting Sher �rSs�' phone: �?1� 2�E� --� I Z0
Operator: - pizonr: za3_ A3 is --
On Site .1 -Preseutzuvc:
Physical Ad4ccss: d � s'!�. is _ ' - — _ rl 'Imo•
Type of Opcnatiozi: S xini ?CPoultry Ca:tlt.__�
I7Lsi Ca�aclrv; ( d ' Nmnhej of AdmaIs oa Site:
Latitude:
Tfpe of Inspection: Cro�md �,_ Aerial -
Curet Yvs ur No
Does aie Ardmal W-aste Lagoon have sufficiw: t freeboard of I Foot •� 25 year 24 hoz:r s*o-nn anent
(.-1PPMxirnaxe1Y I Foot; -t''1 Imes) Yes Cr -No Act z Fr=bonrci f . Feet __� _�9 — inches
For faci?.ities with more tfm ortd lagoon, pleasa address the other Iagav ns' freeboard under the
c:c�mrnents .;ecttaz2_
N112s any seepage ohserred from the la�Gonl's)" Yes 0���A zs there erosion of the dam?: Yf:s
Is adequate land available for la.-zd appiicauo :? Y" or No I- the cover crop atiequ3le7 Yes er NO
r
Addition-d Co=erfrs:
_r try ram__._ ___._...
Ft,A t7 (9 J '1)- -715-,;359
SifmaoaWLk.f_+.gzn.