310656_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

'Rai v'ision oflew, Tt—erl ReJill I
sources120
Faci i Number ; ©Division:of Soil and�Water Conservation
c . - sc
® Ottier�`Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up Q Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 2pc? County: ► Region:' r
Farm Name: - L4,T14—t,4 , gviei_ 6'01 -4 ('A-V 01, Owner Email:
Owner Name:YrtJ� J Jar �4t. Phone: ftWaft
Mailing Address:
Physical Address:
20
�,1gronU?e %. ,jon Facility Contact: �t,�� �-�/� �✓� Title: l'll�gt��`�-'
n Re eCtrpn
Onsite Representative: t integrator: -AN (3
Certified Operator: �Uu a L,� �,,� J4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1-t e 7
1
Certification Number:
Longitude:
Design
C►urrent
Design
Current
Design C►urrent
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle C**--- city Pop.
an to Finish
Layer
DairyCow
an to Feeder
Non -La er
DairyCalf
der to Finish
`
3'775
DairyHeifer
to Wean
Design
Current
D Cow
row to Feeder
Drf P�oult ,
C•a -city
P,o ,
Non -Dairy
!Farrow
row to Finish
La ers
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turke s
Turke Points
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [5<o ❑ NA ❑ NE
❑ Yes ❑ No E2-NA ❑ NE
❑ Yes ❑ No E:�NA ❑ NE
❑ Yes
❑ No
[3-1<A
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
-v
Page 1 of 3 21412015 Cont deed

[Facility Number: - 5. Date of Inspection:-rc-tcl
J.
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q-Nc-
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[B A
❑ 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
[�tS—
❑ 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
0 Yes
[I]_io-
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate Public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
['r 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
[E��o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
f
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [21<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CA)
13. Soil Type(s): yo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eall�O ❑ 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?
Reauired Records & Documents
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes [jXo ❑ NA ❑ NE
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 E2"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 [2'N-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [!`No ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

iFacili Number: V IDateof Inspection: 1117ZN
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g-<o ❑ NA ❑ NE
25.1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D] o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [21Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q'INo ❑ NA ❑ NE
❑ Yes E],No ❑ NA ❑ NE
❑ Yes ED-No ❑ NA ❑ NE
❑ Yes E]"No ❑ NA ❑ NE
❑ Yes Ear%
❑ Yes [? No
❑ Yes EErNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to"queshon #)• Ei<plarn auy. YES answers and/or. any addrt-onal recommendations arany other corhinents.
. -
Us' rawings;of facility tolbetter explain situations (use ad.,ditt6nal..1pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

i ype of visa: >,�compuance inspection v uperanon rcevxew v atruciure r.vamatwn v i ecnnicai Assistance I
Reason for Visit: &<outine O Complaint 0 Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: 1 Q Departure Time: County: > 1 e\_Region:
Farm Name: C j--. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator: '
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D . Pi©ultr. Ca aci P,o ,
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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?
❑ Yes 12,no ❑ NA ❑ NE
❑ Yes Q o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ET 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 E;(Xo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 3 — L Date of Inspection u'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
ElNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in): aq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L:�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
O'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 UNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J:;�-No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes Q-Mo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,RF4o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Jallo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
81 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21 No
❑ NA
❑ NE
.,
Comments (refer to question #) Ezplam any YES answers and/or any recommendations or a°nyo#hereo meats'..
_Use drawings of facility to better explain situations (use;addrtional pages�as necessary) E
{.
Reviewer/Inspector Name j " C{ j j-I C!' v. „'`f. :' Phone: %lam /`(&/ /,S�
Reviewer/Inspector Signature: Date: �� < C
Page 2 of 3 12128104 Continued

Facility Number: - 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 No
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 �TNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E?'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
7
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
[1 No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VfNo
permit? (i.e., discharge, freeboard problems, over -application)
TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E6 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C]INo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments-(refer-ta;question-#): Explain any YES answers and/or any additional recommendations or any other comments.
Use,drawings' of facility to better; explain situations (use additional pages as necessary)-
3 //a //t /� C `7
�a f 3tl/f
Reviewer/Inspector Name
Reviewer/]nspector Signature:
Page 3 of 3
i
Afr1
1k%,C -�_
C
/oa�.5
�C t�PQ 'e"l >/�o ce
Phone: !!V 7Q6 /3 `�3
Date: 7 ,2_o 1
21412015

I'ypWof Visi : Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /p / ``Arrival Time: eparture Time: County: Region:
Farm Name: L_1 H y, J ti\A__t:�L40n^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number: /Vj //?:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Ponitry Capacity Pop.
Layer
Design C*urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Me'si
Dr. P,oul Ca aci P.o ,
Layers
Non -Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ocher
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?
[—]Yes E'No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
ENo
❑ 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
2To
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
ENo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
6-'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No
a. If yes, is waste level into the structural freeboard? ❑ Yes .j No
Structure I Structure 2
Identifier:
Spillway?:
❑NA ONE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes] No
❑NA ❑NE
[] NA ❑ NE
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 rZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'C2No ❑ 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 JZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes eNo ❑ NA ❑ NE
❑ Yes /ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes � No ❑ NA 0 NE
❑ Yes ;2�rNo [] NA ❑ NE
❑ Yes Z'No ❑ NA ❑ NE
❑ Yes P'&io ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;2'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6'No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
• the appropriate box(es) below.
❑ Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 PNo ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
❑ Yes 12-No ❑ NA ❑ NE
❑ Yes [2-No ❑ NA ❑ NE
❑ Yes EffNo ❑ NA ❑ NE
❑ Yes
�;kNo
❑ NA
❑ NE
❑ Yes
_C2No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
;aT�o
❑ NA
❑ NE
Comments (refer to question;#: Explain any YES answers and/or�any additional recommendations or, any other comments.: d
Use drawings of facility to better explain situations (use additional pages as necessary).
1�' t
q� S
1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (�) 10
Date: V//") 4TI
2VV4120141

Type of visit: fa Compliance inspection V operation Review V structure l;valuation V i ecnnicat Assistance
Reason for Visit: CAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: . Arrival Time: Departure Time: County: Region:
Farm Name: lrr'1 • /'�i+�' VVN Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: lici
" a �9
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Da Cow
Current
Pop.
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
D Cow
Farrow to Wean
Design Current
l C►a aci P,o ,
Layers
f7Non-Layers
Farrow to Feeder
Farrow to Finish
Non-Dai
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Turke s
ether Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[-]Yes 4No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ej"�4o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes )6No ❑ 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 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Fatility Number; - La jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VfNo ❑ NA ONE
(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 KNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes lrNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PfNo ❑ 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 rj 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?
r
❑ Yes fJ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes //J No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
XV1140
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
KNo,
❑ 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
poNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑NE
Page 2 of 3
21412011 Continued

Facility Number: 31 - Date of Inspection: w
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
❑ 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
9
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[!(No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No ❑ NA ❑ NE
0
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[(No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better explain situations (use additional vases as necessarvl.
Reviewer/Inspector Name: �►Jj��_ _ Phone: a�rZ-
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit: 25 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: Arrival Time: I V /A Departure Time: County:
Farm Name: y� �'W�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: K " Laan—,Lex Integrator:
Certified Operator: T~►1�,o�x Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: V1Al
Design Current
Swine MCapacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design CIR urrent
C•at#le Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Calf
Feeder to Finish
Design Current
Dr P,oul Ca _a.ci P,o D.
La ers
—DairyEE
DairyHeifer
Cow
Non-Dai
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ef Stocker
Gilts
Non -Layers
rBeefFeeder
Boars
Pullets
ef Brood Cow
Other
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 Z No ❑ NA ❑ NE
[-]Yes [] No
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes No
❑ Yes`7rNo
❑NA I-] NE
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: IDate of Inspection:
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
T
❑ 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:
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
VfNo
❑ 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 ZTNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VTNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes r No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VfNo ❑ 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
)n No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
;ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
TT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�rNo
❑-NA.
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes' ONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes X No
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

E..
,tv
)Facili Number: - 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 0 Yes No
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 VfNo
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
❑ Yes
VfNo
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
JdNo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O—No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑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).
C
Reviewer/Inspector Name: V\� _ Phone:
Reviewer/Inspector Signature: �/ tp� Date:
Page 3 of 3 21412011

(Type of Visit: Compliance Inspection V Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: S Arrival Time: Departure Time: County:
Farm Name: V
f(IMp ,ftAf 7W q—AA Owner Email:
Owner Name: 1 I µori4 t� SNl 1 T�/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
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
Dr. P,oultr. Ca aci_ P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Putlets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes P 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 l of 3 214120,11 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �§No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: n
Designed Freeboard (in):_
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA ❑ NE
maintenance or improvement?
I I- 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 A(c''c�eptable Cro Window ❑ Evidence of Wind Drift` ❑ Application Outside of
Approved Area
12. Crop Type(s): �I] � X} �-y� 14T I� �Cl L' Or� V `�
13. Soil Type(s): / iGaot- FC &�u 1 Lu� Swm S TAcTo uLtS --- •- --- -
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP []Checklists ❑ Design Q Maps ❑ Lease Agreements
❑ Yes )� No
r2LYes No
❑ Yes ' No
❑ Yes No
❑ Yes �No
❑ Yes No
❑ Yes K No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ W�te Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and V Rainfa 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 ON
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
[] Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3L - S Date of lns ecHon:
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 3, No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
MYes ❑ No
❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes )� No ❑ NA ❑ NE
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
FA No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
t6 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
to
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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)."
`-off IV&MS rcy .ArT�b ' WV (3(- E 1J�
5 SiEOA aY -11 fAE (3F IAt ECCi10" Lk pa-rrJ19,fL- QL w6veAl
wG`i 1
Lqvarec
CAUeq-147i cW
w'03 — � I LL c. lc SDI M S
2� _ s
- �V a l C ,4cTr u E
4 U µ�
Eb CCV / PGC_q R24rioUC 5 <
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1 �C
21412011

Type of Visit: NcRoutine
ompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit0 Complaint 0 Follow-up Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f rS Departure Time: County: T Region:
Farm Name: LAN d- AVA1E7-TE Sm 1714 ( X)ZM Owner Email:
Owner Name: OT M L . SMITH Phone: 059 -3s & [c)
Mailing Address: ^9 '7 � SC Ill - 1"^ A ` Vy f /V r 1 A LC / Vc '3a - - ----
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: A C, SMITH
Certified Operator: 1 f!'10T14 G?') / J H
Integrator:
Certitile )tion Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design "Current
Design Current
Swine Capacity
Pop.
Wet Poultry Capacity Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr,. P,oult , C•_a aci_ Pia .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turkey Poults
01 Other I
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes kNo ❑ NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fatility Number: - S Date of Inspection: S / i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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: L4(ZQiD N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes IM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes No
❑ NA
❑ NE
the approprianb,
OChecklists ❑ Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesNo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑i Soil Analysis
❑ )W4ste Trans ers
Q Weather Code
Q Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes tNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Batility Number: -� 1 - (, 5 („ I I Date of Inspection: / 5 / /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check C] Yes ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? CD Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 ;4 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes dNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes I jy�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes '$'No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional.recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
e
.
i�.A.
913111 1.
!Cjgqj10 G.51T
- � ► fL���E�o�� Fc►�- `��,
50) L DA-r
CAL4 (g qAv ox pxC_ OLD � o�
�-°P� o ` was � E PCa�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: iU - ] / (0�
Date: Wish)
2/4/2011

FacHit ytTNiim r J Co5(9
I -
Type of Visit VCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit _d Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I Departure Time: County: u .Al Region:
Farm Name: �NN d- ORNE77E Skn ITH J7A�L+M Owner Email:
Casa - � 5 r
Owner Name: �l fYidT HLk L- �iY1 17 ►-� Phone• (naSD)` Ss7-339(0 (c)
Mailing Address: of (� �y C ��-�l� r _' U V K_ R I L -, N e 01 g S,4a
Physical Address:
Facility Contact: 'Tittle:
Onsite Representative: L AwN &ntTH l ��O11NNLj L-IAAj,r g--
1
Certified Operator: i !M6 tULk L' M l r H
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
CeOperraattoor Certification Number: 19g�
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° =' = "
Design Current _ ,
Swine Capacity Population '�Wet4Poo
.
❑ Wean to Finish
F0 Layer
❑ Wean to Feeder
I�a ❑ Non -La
Feeder to Finish,,.,
.-Dry P.ouI
Farrow to Wean
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cy alf
Hy eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood C
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
12128104
Continued

Faciliiy 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:
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes "KNo El NA ❑ NE
El Yes !!❑``No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
Po
❑ 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 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 ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 9
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) SG QE CL Cart GJ t-I F 4 T` S9 CG j 1 oA/
13.
Soil type(s) IVn�ZrC e i R �� L_LF k S WA CTO L+ti
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?
El
No El NA
El 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?
El Yes
No ❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/6r any,�recoidd fendations ors any oth6r„comments
Use drawings of facility to better'explain situat►6ns (use additional pages as necessary) Y }„� .0
Reviewerllnspector Name � �(C� '_ ]Phone: 910 +'I �- so
N
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

JlFaciiit; Number: — s(p Date of Inspection
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 XNo ❑ NA ❑ NE
the appropriate box. 0 WUP 0 Checklists [3 Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/Vaste Transfers El_ iInual Certification
❑ Rainfall ❑ Stocking [] Crop Yield [] 120 Minute Inspections [3 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
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)gNo
❑ 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
XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Lo
❑ NA
❑ NE
Additional Comments and/or Drawings: `.� '
- - •
�
o
tJf��o9 � j
QCt.�T,oW�t�r a1Gl�
Page 3 of 3 I2128104

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit KLRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 59 Arrival Time: �� Departure Time: County: a /+► Region:
Farm Name: b-AmAt 4- P NN ET-T(_: S M l . 1+ F(40-f A Owner Email:
.05 -SG$- y--9'S h
Owner Name: 11MCj71.1 ul L SM 1714 Phone: 259- ca S - ` RY'S
Mailing Address: g`-1 ��C _ /Y ! [�rLLT /V`,
Physical Address:
Facility Contact: (� Title: Phone No:
x�H
Onsite Representative:CASLZI S 91AACKILLIAI-X S�M I TO Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� I [� « Longitude: =1 ° = ' = "
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Popplation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
El Dairy Heifer
Feeder to Finish G%
❑ Farrow to Wean
Dry Poultry
❑ D Cow
El Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of[Structures: E]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'M
�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r
acility 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 Structure 4
Identifier: LAx�cl<Ny
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 1
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 �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �f No ❑ NA ❑ NE
❑ Yes �No ❑ NA [INE
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 ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement? '
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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) CZ9,V �13EJ tC 1 1� Q C.'Ty N Q er'&SC
13. Soil type(s) /UdV-fa-K— �Q)HAI S PAC l CY-U c% A L47egU/U"L-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to q�est�on`#} Explain any YES;ansRers and/or any tecommendatsons or<a y;otlhereomments _
Use drawings of factlit} to'.better explain s�tnahons. {use addtttanal pages as necessar}) r -ram µ k
a11�1oQ �� l NITl14 L 1 OF gAj*FAc_Loq_ VVC)e MOJ HL� 5 —tRucsuQAt Cr-4c-sp
i
D / bo Ou7 �c�G31Y�� C31G f�C%I uc
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
r,
Phone: y j()-17LU" 7 _.Qt
Date: '� 1'30 Jag
12128104 Continued

Facility Number: 3 1 �s(p Date of Inspection
Reauired 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 Wo ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists
0 Design 0 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes )6No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis
❑/aste Transfers 0,4 nual Certification
EIRainfall ElStocking E]Crop Yield Q 120 Minute Inspections 0 Monthly and V Rain Inspections O
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 39(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes kNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �(No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes *o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes K 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 Q, No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes P154o ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and. Water Conservation
O Other Agency
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f 64 Arrival Time: Departure Time: �County: L1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
�,
Title: Phone No:
Onsite Representative: CLAR—I C,
Certified Operator:
Bach -up Operator:
Location of Farm:
Design Current
Swine Capacity Population
Lo Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to -Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Integrator,
Operator Certification Number: -
Back -up Certification Number:
Latitude: =] o [::] ' 0 Longitude: [� 0 0 =
Design Current
Wet Poultry Capacity Population
❑ Layer ::::[: I E
❑ on —Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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?
Design Current
Cattle Capacity Population"' -
El Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
960
❑ NA
❑ NE
12128104 Continued

t.
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: LAQo0A1
Spillway?:
Designed Freeboard (in):
.
Observed Freeboard (in):
S60
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 X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes D(No ❑ NA ❑ NE
❑ Yes )allo ❑ 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ElYes
No
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes
E[No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
DdNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name ' 41J Phone: 'if Q
Reviewer/Inspector Signature:6QAM=02Date:
12128104 Continued

Facility Number:? Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JXNo ❑ 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 Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl Yes
0No
❑ 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
R 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
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
[I 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
WNo
❑ 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
1�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number
19Division of Water Quality
Division of Soil;.and Water Conservation
O 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
Date of Visit: Arrival Time: I Q,'Jr Departure Time: ' �C unty:
Farm Name: l rn- Owner Email•
Owner Name: / �/l7 �7ri / �i✓�f 4 Phone: _
Mailing Address:
Physical Address:
Region: Z�20
Facility Contact: Title: one No:
OnsiteRepresentative: ��!/N �iYtzf_q A � Integrator: 4��X _
Certified Operator: L 4/A Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o = Longitude: = ° =
Design - Current Design Current Design Current
Swtie Capacity Population Wet Poultry Capacity Population Cattle Capacity. Population:``"
❑ Wean to Finish El Layer
10 Wean to Feeder �_� ❑-Non La er
Feeder to Finish
LJ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars 4
.Other ,
❑ Other:
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:. I r' J
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
❑ YesRlNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
g(No
❑ NA
❑ NE
❑ Yes
)IzNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —(pS Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes "o
Cl NA ❑ NE
a. If yes, is waste level into the structural freeboard?
/
[I 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 �No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes p"No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] 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 ❑ 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
PNo
❑ 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
XNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ 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):
20�,v �Ro� 1-��/3 � cc�G�/�S 01J f"
SwQG E �F_ �ilOcJ� _0, 2oa�, hJ f 0 S�ECo2 0 5
Reviewer/inspector Name I 1 Phone:
Reviewer/Inspector Signature: Date: p O
Page 2 of 3 &28/ 4 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
No
ElNA
ElNE
ElYes
10
�No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PNo
❑ 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
X No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
:P�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
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ 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
"0
❑ Yes �No
[I 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 WlNo
❑ 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?
❑ Ycs/)21No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes [TSTo
❑ NA
❑ NE
Additional Comments and/or Drawings:
fl/ X117RV,66:�5
151 a,0 60'1 Lit,,
Page 3 of 3 12128104

Division of Water Quality
Facility Number Gsr 0 Division of Soil and Water Conservation
- g
Other -A ency
Type of Visit -Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 916outine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: a�P� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
I
Facility Contact: Title: Phone No:
Onsite Representative: A, pje- Tr SA,.zni Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = ` = Longitude: 0 ° = 1 = "
Design Current Design Current<... DesignC,urrent
Swine Capacity Population "W-et�Poultry Capacity -Population Cattle Capacity, Population
❑ Wean to Finish j
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
-I
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
[]Yes 2J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
,❑
Id N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — s Date of Inspection �i 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: lAG�i�I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
ElYes 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 th t, 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 LJ 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 A olication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes l,d No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ew.s Ca 960, VA4 (? So
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application
❑ Yes
C'No
❑ NA
❑ NE
E NNo
❑ NA
❑ NE
-'
No
l3No
VNo
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ 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):
CAW F_Z&1.x T-N VI-.0 �NA�E
ec rz_►�+tlon L60K_t.N tr
Reviewer/inspector Name 1`}uN�,j �A�ZI�IELI• ( Phone: Q10 qt6 ` labs_
Reviewer/Inspector Signature: Date: 4 1 Y to
Page 2 of 3 12128104 Condetued

-Facility Number: 3 — ( {, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N[I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes �e_
❑ NA ❑ NE
the appropriate box. ❑ W-Up ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IdNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EP1 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E'N.
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CJIto
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2 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?
[I Yes
//
Q o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
0No
❑ 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
L7 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ao
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

31
Type of visit (wCom fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:. Arrival Time: Departure Time: County: aVP Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: p0NNj_Z5 S WZTG _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 S Longitude: 0 Q= 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
I
19
Feeder to Finish 367
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
io
❑ NA
❑ NE
❑ Yes
[�o
❑ 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?
.,%
El Yes EK ❑ NA FINE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: N j
Spillway?:
Designed Freeboard (in): c1,
Observed Freeboard (in): g
5. Are there any immediate threats to the integrity of any of the structures observed?
//
El Yes L-J ivo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 2 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 ONNo El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 ❑ L•J
Yes 'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C &3 S e_Vrr4'—/ 13 E,1'yVWD1% ( l-l) S c o
13. Soil type(s) 'Jo P—P, L��!_ J ' NIJS
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
r--,,
P <o
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IJN
El NA
El NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
;eo-
❑ NA
❑ NE
9LAJ o tzG rL6t1--1JA L— v'T
FA S-VV MAal-�TkLZi f^�TCErl-'i .
C (1C—r (<_ 1'APG—nS 3oJ ''EAC-t,_Y C AL-TGQ.e3` *Utj,
Reviewer/Inspector Name y "' Phone:
JN
Reviewer/Inspector Signature: Date: SLa S'�b S
12128104 Continued

Facility Number: — �`�, Date of InspectionI.
aS oS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ Vv1Up ❑ Checklists ❑ Design El Maps El Other
❑ Yes ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [I 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
El'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
S] No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91�O
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
01`to
❑ NA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElE Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No L 1'NA ❑ NE
Other issues �--,,,,��
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElD Yes o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ekl�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
!!
Q o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Bl�o
❑ 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
_12-�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
_P40
❑ NA
❑ NE
- dditiouaLComments and/or -Drawings
12128104
12128104

Type of Visit �ICompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )6 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 1 Time:
O Not Opemtional O Below Threshold
Permitted ©( C
er
tified © Cond
i
tionally Certified 0 Registered DateLast Operated or Above Threshold:
Farm Name:County
Owner Name: /d% `J �_, _. 'Phone No:
Mailing Address: Q , �,
Facility Contact: . ____ _...... - --- Tiitl L1��!4 one No:
Onsite Representative: ��.±12� �%� Integrator.
Certified Operator:
Location of Farm:
Operator Certification Number:
jdswine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` " Longitude • '
Swaae
:Po
teon . _, PoW�Y,u
.tdle
Wean to Feeder
Layer
Dairy -
Feeder to Fetish
(p
Non -Layer
- Non -Dairy
Farrow to Wean
r
Farrow to Feeder
�" Other
_.
El Farrow to Finish
k
T� Ca amji
Lilts
Boars
Y '. , ; ,. -
To#a1 SSLR'
Discbanes 8 Stream Jmmcts
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 is gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0§0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes xlqo
❑ Yes 0-To
❑ Yes ;*o
Structure 6
Identifier:
Freeboard (inches)
12112103
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
[]Yes �No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
!ee
7. Do any of the structures need maintenance/improvement?
40Yes VNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
eYes A"
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ONO
elevation markings?
Waste Anulication_
10. Are there any buffers that need maintenance/improvement?
❑ Yes Z(No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ArNo
❑ Excessive Ponding ❑ PAN ❑ ydrauhc Overload FrozeSnand ❑ C peer or Zinc
12. Crop type - \� i'W
/
13. Do the receiving crops differ with those esignated in the Certified Animal Waste Management Plan (CAWNWV
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes XNo
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes,'No
16. Is there a lack of adequate waste application equipment?
❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes PNO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;37No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j2rNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes "RNo
Air Quality representative immediately.
g) A'C /,
/ maol2 �
ReviewerAUmpector Name
Reviewerllnspector Signature:
4r1� 1-169-h z.✓a-
❑ Field Copy ❑ Final Notes
c
Date:
12112103 Continued

Ir
Fa ' 'ty Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
.. (ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Waste Application ❑ Freeboard ❑Waste Analysis ❑Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ;rNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes �No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
28. Does facility require a follow-up visit by same agency?
❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONO
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes 'eNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ,fNo
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 XNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall El Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You wf receive no further correspondence about this visit.
AIV./Id
Pao P
�S
12112103

Facility Number Date of Visit: Time: / 0
rO Not Operational 0 Below Threshold
Permitted ©Certified M Conditionalllyy Certified �0• Registered Date Last Operated or Above Threshold:
Farm Name: �f �/`�L� Jn1i7fF r_ /t1 County: 1C�yPGi/
Owner Name: S�i1 a7l� Phone No:
Mailing Address:
Facility Contact: Title: �fPhone No:
Onsite Representative: QF/+�/11Z5 _ n]Zef __ _ _ Integrator:
r
Certified Operator: Operator Certification Number:
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' & 0 K Longitude 0' ` 0
Design
Current Design Current Design Current
Swine Ca acity
P,o ulation Ploultry Ca acih' P,o ulation Cattle Ca acity I'o ulation
El Wean to Feeder
❑ Layer ❑ Dai
Non -Layer I IONon-Dairyt—____
Feeder to Finish Z
EI Farrow to Wean
❑ Farrow to Feeder
❑ Other
ElFarrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Tota[ SM .
r of Lagoons
❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Ares
❑ No Liquid Waste Management System
Iniffigm-6be'
nds 1Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
6
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure
Identifier: /
Freeboard (inches): 6
05103101 Continued

Facility Number: —lp Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed,? (lie/ 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? ❑ Excessi a Ponding PAN ❑ Hydraulic Overto
12. Crop type Aa1n Q Di)V0 �l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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?
S
❑ Yes dNo
❑ Yes V(No
❑ Yes No
❑ Yes No
❑ Yes pJ No
❑ Yes ZN,
❑ Yes )?fNo
❑ Yes No
❑ Yes No
❑ Yes No
El Yes No
❑ Yes I
❑ Yes No
❑ Yes V(No
❑ Yes 'No
El Yes �No
❑ Yes V No
❑ Yes VNO
❑ Yes IV(
V No
ElYes o
ElYes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name [_.
Reviewer/Inspector Signature:
Field Copy ❑ Final Notes
;le -'es Pie a 1-5, C
/ S 'aScIG TS /5
fir
05103101 v - Condnued

Facility Number: Date of Inspection O C2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawings:
❑ Yes �No
[3 Yes No
❑ Yes 41No
❑ Yes 2f No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
O5103101

ihvistan of Witter Quality v r
Division of Soil and Water Conservation
Uther Agency .
(Type of Visit f?JrCompliance Inspection O'Operation Review O Lagoon Evaluation I
Reason for Visit ?Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number "ate of Visit:
im"Permitted [3 Certified © Conditionally Certified 13 Registered
�2'1✓I�
Farm Name: ...... -s"... ....... ....................
Owner Name: . ! ? V i S -5
......................`.�:.....................................................................
D 91 Time: Ia I Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County:.. V. ..."I-.,.........................................................
PhoneNo:.......................................................................................
FacilityContact: ...................... Title:................................................................ Phone No:...................................................
Mailing Address:........;
Onsite Representative: De't ✓1"S i..."� n �✓. r �4 Integrator: •,/'/ Jr.......
+t �q r�h.f ...............................
................................I.... ..
Certified Operator:................................................................................................................ Operator Certification Number:........ .....
Location 'of Farm:
WSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0` '° Longitude • 4 66
-Design Current
Capacity Pouulation
o Feeder
[o Finish
3
to Wean
",
to Feeder
UF
to Finish
Design Current Design ,. Current
Poultry Capacity Population Cattle Ca aci Po ulatioa
❑ Layer JE1 Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design C$pacity-
Total SSLW
Narnber of Lagoa "' ❑ Subsurface Drains Present © Lagnan Area ❑ Spray Reid Area
S A ii raps : ❑ No Liquid Waste Management System
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-niade? ❑ Yes �No
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ) [] yes o
c. If discharge is observed, what is the estimated flow in galhni0 Y) G
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes UNO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes _P"No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JZ"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes�No
Structure; I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .....................................................................................................................................................
... .......................... .... . ............ ...................
Freeboard (inches): 44
5100 Continued on back

Facility Number; 3 -- Date of Inspection ?_(I Printed on; 7/21/2000
5. Are"there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
�r seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes 9No
(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 [i No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 01No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload �^ ❑ Yes 0"No
12. Crop type W � I eC4 bgq S �e ✓ (� dti s+^-.�i j C� °r '�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Man gement Plan (CAWMP)? ❑ YesZINo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? 2Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes,,O"No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ YesNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) �nes []No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JzNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes ff No
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes PNo
24. Does facility require a follow-up visit by same agency?
❑ Yes_fTNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
�Vo yi6lafigns;oi• d0fciencie5 were b6ted during fbisMsit; Y;66 Will •reeOW ii6 further. •
- correS 6 idence. about this visit : '
Comments {ceferto question'#):, Explain any YES answers aadlor any recommeindations or: any other conentsF ' _r
Use drawings of fai . ty.to better explain situations: {use additional pages as necessary) _ _
IO. -r-7cv e is s�wll A►"'touYt� a� wGts�e �o► ed r� +-JCL- til h+'c �'► �ea� A6
e-1 ijt4ke, be✓►��d`i r-t��Ii CA4 0IN E,i'l �e Gc.ui �'aLLs L"-AeA, s�'-4
L)eee 4v avoid runo-6C a� WZIXS�e. from
i Tl? e t,,,1r,_geJ aff l;edr J,9 r 4) b 04 r•4 wr,�
ylOT �afUC s cA. !� (,i/ciS S rLt LJ �(/i wt 1`1 ✓OC( �'llit vP • T �C �AVe
b ee-t e u-I �� &,cd ed �a l , !V e f k a f f l; rd 4 u PJ'Ie_ r f s,
--r e (a( d o es rt 0 f a rf C A two✓ +e 1"rrav,e s-fA A. -
fr :s-�--• --n -fix;-�„--* --
Reviewer/Inspector Name ye f'1 e t-Ici C
Reviewer/Inspector Signature: Date: V * 0I 5/00

Facility Number: Date of Inspection ZD 0 Printed on: 10/26/2000
Odor issues
3.5. 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 ?fNo
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 Z 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 /ffNo
31. Do the animals feed storage bins fail to have appropriate cover? [:]Yes P No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings: .
r9. T,�e 4 cps vF Arf 1 events Ae da 10�
I.'-Ytes -'4e comes on. 4�''`� eve✓NJS 0h 11 e Z KKK- /'r
fa,r s"►^1e � ay� 11 za i dvl5 treed to ee -67C a r d S rape r
c�lsa recaw,�env{ ���f l�,�s e �nm��es L-e a►'rAl7ze0t eti/erI
Lea r4 k�aw ri �� �a s T�^! �►� whaf 0tv-
vrasi a`���Y y Lj
of -N �re7dje►'1.
J
5100

ion! —of Wafer Quality
t� Dtytsion of Soil and Water
Conservation
6 Other Agency
x :
k
4 r3
(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit -
NEON
Pennitted [] Cerh to ❑Conditionally Certified [3 Registered
Farm Name :r� { S ....:...................................
Owner Name:....... ��� �. 5..... ��/�r
Not
3 - 3 Printed on: 7/21/2000
ional O Below Threshold
Date Last Operat or Above Threshold: d
.• •••.
County: �' !°�...
PhoneNo:..............................................................................
FacilityContact: ..............................................................................Title:..................................................... Phone No:
:Mailing Address:
J�
Onsite Representative:---...�/ p'l t S..�--.. �.'!(,............. Integrator:............
Certified Operator:
Location of Farm:
Operator Certification Number:
eswine []Poultry []Cattle []Horse Latitude 0 • ° ~ Longitude • ° 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish % ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present 10 Lag—n Area 10 Spray lFieid Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed; was the conveyance man-made'?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. II' discharge is observed. what is the esurnaled I'low in galhnin?
d- Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure
Identifier: 2&
Freeboard (inches):
5100
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J<No
❑ Yes r 0
❑ Spillway ❑ Yes AZ�
Structure 4 Structure 5 Structure 6
Continued on back

Facility Number: Date of Inspection qp Printed on; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed. (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 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
I(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
IL Is there evidence o ver a pl' ation? Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
J(No
12_ Crop type
13. Do the receiving crops differ wi h those desig ated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
$;�No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
j No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
VNo
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
A�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XN 0
0: Flo.viofaiigris:oir- deficier dici tbis;visit: • Y:of :will-re�eive tno futther
correspondence about this :visit.
..
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AIL
rUK
r CoY�S i� �S
T
Reviewer/1ector Name r°� j
Reviewer/Inspector Signature Date: e2�5100

J
.✓
1W Fac�5lity Number: — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
15-NQ_
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
2&
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
j 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
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
CR�No
Additional -Comments an or rawtpgs:

Division of Soil and-Water-Gonservatlon - Operation Review [/
Q Division of Soil and.Water Coniservation ,Compliance lnspect�on -� F
Division:of Water Qfal� - Compliance Inspection a ' 3F.
_=Other.Agency - Operabon:Rev�ew s _e = - _ _ s
16 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number SAP $�, Date of Inspection i I
Time of Inspection 24 hr. (hh:mm)
IN Permitted 0 Certified 13 Conditionally Certified E3 Registered Q TNot Operation Date Last Operated : ..........................
r J
Farm Name: ........�eY1vt f S J M►%'+� 74 f � ........ County:-.•�Y�IIn................................... .1.............
Owner Name: ............�e/3 Yt J �jrt,��1
.....................................T................................................................ Phone No: ...........................................................
Facility Contact:
MailingAddress: ..................................................................
Onsite Representative:.Den rl t -V S» ]+ 'r"1
Certified Operator: ................................................... ........
Location of Farm:
.. Title: ......................I....... Phone No: ...................................................
.............................................................................................................................. ..........................
......................................... Integrator:.-PnEF ...................................
......................................... Operator Certification Number:..............
............................
A
...........................................................................................................................................................................................................................................................
Latitude 0 4 " Longitude • 6 1.
Design Current " 'Design` Current Design Current `
Swine Ca acity Population
= _Poul£ry _ ;Capacity Population Cattle -Capacity Population
❑ Wean to Feeder
Feeder to Finish
36 7
6 d 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
E.
Subsurface Drains Present ❑ La oan Area Spray Field Area
jNiimber of Lagoons g p Y
H6ldtug Ponds /Solid Traps ❑ No Liquid Waste Management System
.,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C9 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) ❑ YesNo
c. If discharge is observed, what is the estimated flow in gal/min? h/j 4
d. Dries discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 16 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
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, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number..71 —L$(, Date of inspection /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(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? 0 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes tR No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes EZNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Z No
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes S No
12. Crop type C , W 5-6 , ger rnud(o, 401!1 1 :501,114l++ 1 L�rAfn
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JO No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? yeS ❑ Yes No
c) This facility is pended for a wettable acre determination? SM. �� Yes 16No
15. Does the receiving crop need improvement? ❑YesNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
-0 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
25No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
f5l No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports).
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
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
ONo
0: Rio •yioiafigris :or• def ciencies •mere noted• during #his: visit: • Y:oir wail •receive titi €urther
............................
.: corrlispotide' e: ab6i►f this visit.. • . - . • • ....: . .
Comments (refer-.to.question #) Explain any-`:YES:p wers and/or any recommendat�oas`or any o her �oinnleQts
:.:
Llse;drawings of facilitrtoNbetter explain.sxtuations _(use additional pages as necessary)
7- WOr k -to es-}a6lrs�. JcrAsen bares qreA iar Julo» ..... �.�
a4le
;n - rouble gfeaf.
CC1 vre
G.�.., s,'4c ; S in-eX6e.l1er4 q vtd is- well mcotooeGl,,
Reviewer/Inspector Name
Reviewer/Inspector Signature. Date: qq
3/23199

Facility Number: 7/ -- 5b I)ate of Inspection ll Z2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes (XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ' VNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 5 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
Additional.Comments and/or rawings _ _
►-1
L
t
3/23/99

Division of Soil and Water Conservation 0 Other Agency,
® Division of Water Quality
u
QRoutine 0 Com laint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 C Time of Inspection Z'3 24 hr. (hh:mm)
E3 Registered 10 Certified © Applied for Permit © Permitted JE3 Not Operational Date Last Operated:...........
Farm Name Attmnt►. !;;-- County:.....J-)4Vk..................................................................
OwnerName: ............. ................. SW. J.j.......................................................... Phone No:.. `�lQ�.��� .7...........................................
Facility Contact:.............................................................................. Title:
Mailing Address:........ . ��Ll......� oc. 4-:... NL....LAWy--.. M..........
Onsite Representative :........ o .is......... S ?!:. ............................
Certified Operator......................................................
Location of Farm:
PhoneNo: ...................................................
....i +���..... li....t..N(�................................... ...R51z:.......
...........:....... Integrator: .... ....ut+............... ........ ...................................
.................. Operator Certification Number:......1`3 ...............
r..r�r....i ...4 ... }I~5. _..... .� ..�:................tll..,.......r�ns.........I7a�" ..a:.....s......laa-.l........................................... ................................ I.............
....................................... .......... ................. ............... .....................................
Latitude 000' 0" Longitude 0' 0' 0"
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Disebarge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
[7) No
c. If discharge is observed, what is the estimated flow in gal/min?
A}
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
W 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
IP No
maintenance improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
P3 No
7/25/97
Continued on back

F acility N umber: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes bU No
Structures f LaLoons.11olding Ponds, Flush Pits. etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ........... L...................
....... ................. ........ ................................... .................................... .................................... ....................................
10. Is seepage obser- ed from any of the structures'? ❑ Yes ® No
11. Is erosion, or any other threats to the integrit} of any of the structures observed'? [I Yes [M No
12.
Do any of the structures need maintenance/improvement?
r11 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 rnaximum liquid level markers?
❑ Yes
® No
Waste application
14.
Is there physical evidence of over application'?
❑ Yes
JS No
(If in excess of W MP, or runoff entering waters of the State, notify DWQ)
15.
-!
Crop type.........c4y.m......................yt}kl�L.....................uli.fA......GSi!19LaY1........ 4.�C1�. ��i]Ytl1l0.........................
........... ...............
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility, have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
¢jJ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
t
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.vio'Ntions or deficiencies ware noted during this.visit.-.Yoit.will receive no further
correspondence about this. visit,
CO Yes ❑ ,No
❑ Yes P1 No
❑ Yes QO No
❑ Yes 1�6 No
Commt=nti,(reler'to question #): Explain any ITS answers and/tip any recommendations or aiiy other com3men'ts "
ofy to
Uscdrawings facilitbetter explain situations. (use additional pages : necestiarv}
_ .
rr; + L
it' QPre Q.*4" Qh 3li�-4 WA1� �Ra�it} b.e vtseee,J. gncio,, o&",ri on 4k, {Knw �.)a-(( ofJ,,vt-s6,,lj
(Of- 4tW «j roseeM, Coev � Diks}ynruf &6,k 4ts ay. d(Vt tktl-
2-Z-. l� corrfc acY.U�e t,d 1�AAj skuid �,e Use rr, 'S�rq,� vtcotk • ()se *j,c earned
TYla. + i+� S rc,,,wh . list c..- SE tu�f I � Z.alp Y'ui'\..
7/25/97
.r
Reviewer/Inspector Name _ s
Reviewer/Inspector Signature: Date: S
i

[] DSWC Aiiiihitl Feedlot Operation Review '•
-
x "
DWQ Animal Fi dlot'Operatlon Site Inspection
Routine OComplairit 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: [I Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
RCertiiied ❑ Permitted or Inspection includes travel and rocessin )
❑ Not Operational Date Last Operated: _ . ........_ .. ..... _ ..._. ... ...._ _ .... .....� ..............
Farm Name: ........ ........... Cou nor: ��rh.... .... .. �........ ....._ .
Land Owner ......... ....... N1t.... ..... Phone No• (�� `1....-��e$-.49!i.
Facility Conctact:._.1XL _--..:�it1!bti.St �..... ... Title: Phone No: ..�3d��?Z
Mailing Address: . N�?' ... �!.� ._���. .... ........... .. .....
Onsite Representative: .......... &ftL ......{.. ......_........................ Integrator:..._�f�.._.......
..._....
_....I.........f........._......
.............
Certified Operator: .... D&_PILS ...........................523N ^ .._.... . .......... Operator Certification Number: _Ji%............ ......
Location of Farm:
�F Y. ti ... m ... o , . Frart:n .a~�. �.... FALC
SR�tn----...L�.1.7:....A�'__. kQn....... 4r...�...�s°s..s._.%....:..._......_._......_........_......._...........
Latitude �• ��« Longitude ©• �� �"
Type of Operation and Design Capacitv
� ' � 9' h ,�,rT?°.w,�� -- - x,'.-SAC _ b# �3�x�, � _� --
Design Current DesEgnA Current - DesEgn�= Curren#
Sw a ci , 'Po alatian` Pouliry Ca aci Po ulat�an Cattle Ga icy ixPo ` dlation,4
❑ Wean to Feeder �❑ r ❑ Dairy
Feeder to Finish ❑ Non -Layer 10 Non -Dairy I
Farrow to Wean;31
Farrow to Feeder Total Design CapaCit3'°
IEJ
Farrow to Finish
Z
TotaI�SSLW
❑ Other �;�
m v E s
Number of L goons! HaldingP ids , Subsurface Drains Present
- ❑ Lagoon Area Spray Field Area
General
I . Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes PNo
❑ Yes J.No
❑ Yes
P No
❑ Yes
No
❑ Yes
No
❑ Yes PkNo
❑ Yes 5;No
[,Yes ❑ No
Continued on bark

Facility Number: ... 3d.,,__ —461P..,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes R No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (#l): Structure L Structure 2 Structure 3
15...__. .......... _....... ....
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes &No
❑ Yes E9 No
❑ Yes )i No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack 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)
1. ... ! .. ...............
15. Crop type _.....�ir�, 11►u�...................._... .C.Q]C�.......�_.............
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?
Eor Certified acilitics Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
JU No
❑ Yes
No
CRYes
❑ No
❑ Yes
ELNo
❑ Yes
(;No
K Yes
❑ No
❑ Yes
tR No
❑ Yes
InNo
❑ Yes
INo
❑ Yes
RNo
❑ Yes
K No
❑ Yes IQ No
❑ Yes No
Yes ❑ No
Comments {refer to `question;#} Explain any YES answers'andlor any recommendations'or anyfiother comments.
Use drawings of facility to,better explain situat ons :(use additional=pages as necessary}`
r� f
c� � 11 11 ll� 1
. xmS s:'lovio bQ bvi 1� 4rauj U+1k S ioc v ►�L"e-
lz . �wslor. c v� or, imb- G'VJ OdkV ("Ah- Of (d o . _Sw i be- AlW 04k e ia,� and tnsWed.
�ou-e
ahem s6ula b.e Mf_* eJ, IrUtt" �t ves s kouO be CA"— �- (.5rxn. Co
50 + 4 c�., Wa`6 CovtCe.`rit� +cces or. j
-1 -. CXWAkP.
00eak_ , AxAV w,3 6 6w, s6dMe rLdjej A-
v-tco4v�-, S64 6e� W4v,i` j j%Vntbt v- Aj t + !'f A(^6er. 'Soi q- Nc6 k
la
ox.AlYs;S S 6t 6%- 1c.c ii �k CAWMP
a
Reviewer/Inspector Name°; �' 3
r;
,3 r _
Reviewer/Inspector Signature: ,�j Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. "` . �
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIIViAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �- , 1995
. Time: /0' 4 S
Farm Name/Owner: Pin nl ) J 1'Yi
C7
40
Mailing Address:
County:
Integrator.
On Site Representative:
Phone:
Phone: ICf 1 1 j 1 rrm�`,
Physical Address/Locadon: �+� It�� 4_ jet ol) 5p- nDi o on
Ie4 1n �0/1_- 6W 5M;A alye/ ChUrc-A.
Type of Operation: Swine _�,Z Poultry Cattle f
Design Capacity:
DEM Certification Number: ACE
Number of Animals on Site:
DEM Certification Number: ACNEW
Latitude: Longitude: - ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 67esr No Actual Freeboard: 'Z—Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes r No
Is adequate land available for spray? Yes or No 2 Is the cover crop adequate? Yes or No Z
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oreo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o 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 2
Additional Comments: �'br c n - 1 4.PX,bY 5b pQ5 G-P di LC.
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

! Site Requires Immediate Attention:
Facility No. 3�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: i.�.�
Mailing Address: 2J- r 3 k�, Alr /U --
County: _AA'/L-
Integrator: - 1_dU,2oe/ v Phone: ep G k 7 Ji
On Site Representative: _ 04 le eV P� Phone: s
Physical Address/Location: _ Ali, I 1 Q c, 2n s t usnn - % _e (_fi U" r ? D 5
Type of Operation: Swine Poultry Cattle
Design Capacity: 5-7 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' ) Longitude: ° L( 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: ;)- Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or&)Was any erosion observed? es No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or o
Crop(s) being utilized: i
Does the facility meet SCS mi imam setback criteria? 200 Feet from Dwellings?( �eor No '
100 Feet from Wells? Igor 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 er No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or&i If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes org
Additional Comments: rotm
L 'N
G-�o ^-
Inspecto Name Signa at
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone]
Ju 1 20 ' 95 8 : 4�_ P. 05/ 16
•
Site Requires Immediate Attention
Facility Number: 3 /- ej%
SITE VISITATI0N RECORD)
DATE: 2 i 1 $ 1995
Owner: �' nq Farm Name:
County:
Agent Visiting Site: Phone:
Operator. Phone.
On Site Representative: Phone:
Physical Address:. /1lij
..c/ _S'.�►�/. r/�l
i
Type of Operation: ,Swine PouIt^f -- Cattle
Design Capacity: 7 { 7-- Number of animals on Site: ' �-
Latitude: v Longitude: a '
Type of Inspection: Gzcund _ , Aerial _
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or Actual Freeboard: Feet Inches
For, facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is t-e cover crop adequate? Yes or' No
Additional Comments:
Fax to [phone]
r Sian. ature of Agent

•
0
CJ
Facility No. 3 1 --
DIVISION OF ENVIRONMENTAL MANAGEMENT
AN 4AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Farm Name/Owner. r l
Mailing Address: ;;�-2? 3 /`%2 - Z�f'/ I
County: Do e 1,',1-
Integrator: _: �7�r/2�r a Phone:��-
On Site Representative: Q11C Phone: All i s - {
Physical Address/Location- lv iY 111 Q-r P o s t- P-L) ✓y. I
Type of Operation: Swine L/ Poultry Cattle
Design Capacity: 3 S 7-V Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude: ° _ t ' > 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: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or0o)Was any erosion observed? gr No
Is adequate land available for spray?6)Dr No Is the cover crop adequate? Yes or
A
Crop(s) being utilized:
Does the facility meet SCS rni
setback criteria? 200 Feet from Dwellings?(Yees%r No
,
100 Feet from Wells? Y&s� or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or -No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orG 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 f
Additional Comments: r0flIA f
e��o ^-
Inspecta Name Aka,
AILL,
'
Sign at e
cc: Facility Assessment Unit Use Attachments if Needed.