310680_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

��le
' i'vi."sip' n f Water Resources
�� Facility Number j - �� Division of Soil and Water Conservation
(Type of Visit: �D`Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance j
Reason for Visit: C--'J'Ro%utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: f O! 3V Departure Time: County: Region: FZ�
Farm Name: p,, Owner Email:
Owner Name: W, j , /6e trs�/f rQ e _ Phone:
Mailing Address:
Physical Address:
Facility Contact: L2 ✓ / , perms _ Title: t`� =fA4Q,­G. Phone:
Onsite Representative: �' _� Integrator: ZZ/
Certified Operator: r` ylz y� ,� $.—�_ Certification Number: 511
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
can to Feeder
4 ciU
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D , P,o_ul Ca acit P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
U_ther
Other I
Pullets
113eef Brood Cow
Turkeys
Turkey Poults
er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E4-No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E2FNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 - 21412015 Continued

Facili Number: - Date of Inspection:
#4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E5No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structur 2 Structure 3 Structure 4
Identifier: 3
Structure 5 Structure 6
nJ
Spillway?:
Designed Freeboard (in): -i---
Observed Freeboard (in):- — 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes WNo
❑ 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 F No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 5a No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [KNo
❑ 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 allo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes 29.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): (�?' /� �1�����.,ryrg-• g
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes nNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
RLNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JZ 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
BNo
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [!3-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: I
lr 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,ZZ[No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �ANo
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 fallo
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
®. No
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
(A 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
Q No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
52 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z�No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑-No
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: ��10 3y15
Date: ,;2w 77
21412015

,-4EMivision of Water Quality
Facility Number Io O Division of Soil and Water Conservation
- O Other Agency
Type of Visit _Q.6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (2 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:/® Departure Time: County: Region:
71r-
Farm Name: V, si .'7f1 /1(LC+V rr" Owner Email: CP
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: (2 lt1Oi�. Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to finish
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 o ❑ ' = Longitude: ❑ o ❑ i = ,S
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
12(029 JLJ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
.❑ No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
V3 No
❑ NA
❑ NE
❑ Yes
iiNo
❑ NA
❑ NE
12128104 Continued

Facility Number: - Date of Ins ection:
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
[6 No
❑ NA
❑ NE
Structur I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EfNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;3 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
PNo
❑ 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
JNo
❑ 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, 21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [;j 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?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�j No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

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 ❑ 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 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I/ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes q 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 Z] 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 [A 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 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
--1
Comments (refer to;guestion #):,Explain any,YES answers and/or any additional recommendations or any other comments. .-
Use drawmes of facility to.;better explain situations (use additional pages as necessarV).
, f,eGt"i✓S'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f
/4 015

Type of Visit: �mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q'IFoutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: rrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: lam. ( A�>4 1 ' g f D
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Pouttry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
D , P,oul
ILayers
I
Design
Ga aci
Current
P,o
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes N
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes N
3, Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �N
of the State other than from a discharge?
Page I of 3
o ❑ NA ❑ NE
o ❑ NA ❑ NE
o ❑ NA. ❑ NE
21412014 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /,❑�. Flo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ErNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �2_�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes -r] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E]�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 '[3'No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes n No ❑ NA ❑ NE ?
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Dodo ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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
k] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
,2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
�' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check
❑ Yes
;2-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 12'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [�o ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Ipme of Inspection: -4,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P, No ❑ NA ❑ NE
25.s the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yeso ❑ 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 oY actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to
lrawings of facility to better explain
Reviewer/Inspector Name:
any YES answers and/or any addt
situations (use additional naQes as
/GO K 15ovp^
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ,j No ❑ NA ❑ NE
❑ Yes J�TNo ❑ NA ❑ NE
❑ Yes .E!j No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
0 Yes Eno ❑ NA ❑ NE
❑ Yes
E'No
❑ NA
❑ NE
[:]Yes
2r�ko
❑ NA
❑ NE
❑ Yes
O�No
❑ NA
❑ NE
or any other comments.
Phone:
Reviewer/inspector Signature
Date:
Page 3 of 3 21412014

Type of Visit: 'Compliance Inspection • 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a jp Departure Time: � County:
Farm Name: �„�.�, / "lc[ #L4 &V1. Owner Email:
Owner Name: 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: V, RQ
Swine
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
[Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
JNon-Layer___j
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
a achy Pao
Layers
Dairy Heifer
pDa Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
VrNo
❑ 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
ff No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VfNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

It
• Facility Number: - Date of inspection:
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 ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Eno ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) r-
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 4No ❑ 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 V2 No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EjNo [DNA ❑ 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 Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X1 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V!fNo ❑ 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?
❑ Yes 0 No
❑ Yes gTNo
❑ Yes WN0
❑ Yes No
❑ Yes No
❑ Yes FNo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vj"No
❑NA
❑NE
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of ins ection: —(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check. ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 10"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ;Z No ❑ NA ❑ NE
[:]Yes F No ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
❑ Yes
VfNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
_7whn Phone: QIX6k 0250
. Date:���
21412011

type of visit: 7 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: 0 Complaint 0 Follow-up' 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time: IIC)= Departure Time: ® County: Ix Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (}R[- E6L Moo,rl-L-_
Certified Operator:
Title:
Phone:
Phone:
integrator:
Certification Number: (Rqv ` `T
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
Wean to Feeder p() 6-6
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
El Yes ❑No ❑NA ❑NE
a. Was the conveyance man-made? ❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 Y;1�0
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[]Yes [o [DNA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 3 IDate of Inspection: jt
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: LA C"6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
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
UNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
E 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
[2/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[Z/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?
0 Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Fo
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
yl�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
DIN",
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes % N l�0 I ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes !,d ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
['No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
u °Vo ❑ NA ❑ NE
Other Issues
29. 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?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] ❑ 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
E21<0 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
d/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
ENo ❑ 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
FIN o [] NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional, recommendations or any other comments.
Use drawines of facility to better explain situations (use additional, pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
jo� Phone, da � 0
Date: 3
2/4 O11

(Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j® Departure Time: f 1 County:
FarmName: �-f +}�WS i_-AaIn S Owner Email:
Owner Name: �]. S MA-L 14E+ti3f, iEALAS iNC.. Phone:
Mailing Address: �� &U-tA Mr7TT lfGt.y S L111 J1Aa r_C- U1 . /It C OR 'SiS
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �Q �2-- fncy— e lnte rator:
Certified Operator
Back-up Operator:
Location of Farm:
Region:
LaLJ 1NSO// Cert�tionNumber: S
�� mc�T ti � �_ v7 C�a 9 � y � 3
Certification Number:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer i Cow
Wean to Feeder
Non -La er
i Calf
fD
Feeder to Finish
i Heifer
Farrow to Wean
jDry Cow
Farrow to Feeder
D , P.oult . @a aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtherI
Other =IL12±er
Turke s
iTurke Poults
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 x No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes 0 No
❑ Yes DkNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - O 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
Structetrg 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L-�0�1/Ij
Spillway?:
Designed Freeboard (in): r ,
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.)
❑ Yes 4No ❑ NA ❑ NE
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? 19
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? T�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XN 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): S es a) ea�_A
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 o ❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
OWUP ❑Checklists 0 Design Q Maps ❑ LeaseAgreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
[] Waste Application ❑ Weekly Freeboard [] Waste Analysis Q Soil Analysis ❑ to Transfers 0 Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield [] 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 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3
21412011 Continued

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 []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
E] NE
❑ Yes
❑ No
XNA
❑ NE
❑ Yes XNo
❑ Yes No
❑ Yes ,I/� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No [DNA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes W No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other�comments ; t
Use drawings of.facility to better explain situations (use additional pages as necessary).
(k�i• n
�1►ate )a/IQ
►bllp]I1 OAT U1,0 ,1Cy1C3
�11C'/ > '� 11 f�Lo y -3/'
�
ON 1►1L_ �C�c
N 'To L
rvlA f
a
�. 01�O�SlG►�A-�1c�� �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1T)D-1e1-
Date: S, dA jj
21412011

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit �C[ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit g _Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: u� Region:
Farm Name:
•� 0174 CLAYS i�g Owner Email:
Owner Name: Vim' 6 wLI - C- Phone: ,A, - -q40-34,0Q
Mailing Address: g35 eIU-L--\+' a-oo�S Lw %VC
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ( i
t I
OperatbF Certification Number:
Back-up Certification Number:
���L19 53
Location of Farm: Latitude: ❑ e 0 6 ❑ p Longitude: = o ❑, ❑ Ed
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
% on-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population_;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
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
No
ElNA
❑ NE
❑ Yes
ANo.
❑ NA
❑ NE
12128104 Continued

Facility- Number: 3 Date of Inspection �---'
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �(
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan? ✓
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VkNo ❑ 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (�f No ❑ NA ❑ NE
maintenance/improvement? /11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElO�No Yes ElNA ❑ NE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy 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) W H it J4-T— �� - Lo" ,fjj lili`- rj
13. Soil type(s) jA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o El NA
El NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yeso
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yesNo
❑ NA
jNo
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ NA
❑ NE
Comments (refer to -=question #) ; Explain any: YES answers and/or any recommendations:or any, ofher comments
Use drawings of facility to better explain situations (use additional pages as necessary):,' -
AL
Reviewer/Inspector Name` ' �""` Phone:
M,4 G 5
Reviewer/Inspector Signature: `" Date:
Page 2 of 3 12128104 Continued

1-11
A
�y
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesTo ❑ NA ❑ NE
the appropriate box.
❑ WUP 0 Checklists 0 Design 0 Maps Cl Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ',A-J�o ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Yl'aste Transfers ❑ A#ual Certification
0 Rainfall ❑ Stocking El Crop Yield El 120 Minute Inspections El Monthly and 1" Rain Inspections ❑� Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes '0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J6 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
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
gNo
❑ 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
ONo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 3& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '� �} 6 Arrival Time: ® Departure Time: County: QU -�V Region:
Farm Name: ��. S _ MA7-TH EwS FA2M_S Owner Email:
Owner Name: LAJ S- MA?-TffEwS FAQ -NHS I�/C. Phone:
Mailing Address: 35 HEWS �-A/ '/(4LL_C;L=1A
Physical Address:
Facility Contact: Title:
Onsite Representative: QEir-� A00 a _ _ _
Certified Operator: 141u �' SAIDOGSoXi-
Back-up Operator:
Location of Farm:
Latitude: EJ o
Phone No:
Integrator:
go 16 r
Operator Certification Number:
Back-up Certification Number:
=" Longitude: =0 0' =
Design Current
Swine C*apacity Population Wet]Poultry
❑ Wean to Finish ❑ Layer
Design Current Design Current
Capacity Population C•at#le C*apacI Population
U.
J.
❑ Dairy Cow
IS Wean to Feeder
JE1 Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
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?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �kNo
❑ Yes t�<No
12128104
❑NA El NE
❑NA ❑NE
Continued

'. f__
Facility Number: — (p Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [I No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J�(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,YNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes J�(No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop El Evidence of Wind Drift ❑ Application Outside of Area
12.
'W.in`dow
Crop type(s) C_jo M4 W q &P4 r
13_
Soil type(s) %�6Q f-QCAIC
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes NNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No ❑ NA
❑ NE
1.7.
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 PeNo ❑ NA
❑ NE
:Comments (refer.to question:#) Egplain;atiy YES answers and/or any recommendations or any�other comments
Use drawings of facilityto betterex lain situations use ailditidnaIl. a es as necessa +�
I 7Jav p)(A G 0010
Reviewer/Inspector Name �(. - Phone: c'11�'jr!a-3a
Reviewer/Inspector Signature:, Date: 3 1q26
12128104 Continued

Facility Number: 71 — Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes K
No
❑ NA
❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check
❑ Yes )� No
❑ NA
❑ NE
the appropriate box. 0 AUp ❑ Checklists ❑ 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 0 Soil Analysis ❑ Yeaste Transfers ❑)dinual Certification
Q Rainfall ❑ Stocking [3 Crop Yield El 120 Minute Inspections El Monthly and V
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes DdNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes KNo
❑ 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 XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes�qNo
❑ 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
Aq
❑ NA
ElNE
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
❑ YesTNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ YesAq No
❑ NA
❑ NE
12178104

E
Division al' Water Quality
cility Number 3 i (��[� Division of Soil and Water Conservation
0 other Agency
Type of Visit `I& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J&Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: %Q 45 Departure Time: County: ';v Region:
Farm Name: w •S m FA TTif F f.y� r^-�i�R tYI� Owner Email:
l—
Owner Name: nS m�#77HEt�J gFq RJA � At C Phone: 9/0 - C1n90 -p39 as
Mailing Address: o9 3 S i?-�1 LL L k IM , , A T` 'q6 r,-15 L'V RZ►CEc�
Physical Address:
Facility Contact:
Title:
Onsite Representative: (,,--qf �Y CLF
Certified Operator: >-4rniC LEE K1-f2
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 9842&
Back-up Certification Number:
Latitude: 0 0 ❑ I Longitude: = ° = ,
Design Current Design
Current
NLDF-ignCurrentine
C+apacity Population Wet Poultry Capacity
Population
C►attle Capacity Population
❑ Wean to Finish 10 Layer
❑ Dairy Cow
Wean to Feeder 00
❑ Non -Layer 1
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish El Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ 13oars ❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other ❑Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

f(
Fla/ cilityAumber: —
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: / V/s
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes '9iNo
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑NA ❑NE
Structure 6
❑ NE
❑ Yes]
No
❑ NA
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2No ❑ 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 lication
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
9[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 ElEvidence of Wind Drift ElApplication Outside of Area
12.
Crop type(s)Cc Q. WN EA T G Q 2( 47;� S is
13.
Soil type(s) NO �
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
tA No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
V§No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
9No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
4,No
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
o
❑ NA ❑ NE
Comments (refer to questionY#) Explain any YES ifii we s anillo`r any recammendatkins or any otherecommenisa„
°UseArawftigs'-,of facility to better explain situations: (use additional pages as necessary
Reviewer/Inspector Name r / j,�/E Phone: 110 �i�o
Reviewer/Inspector Signature:_ Date: l09
Page 2 of 3 12128104 Continued

`f
Facility Number: 3j —&9 j Date of Inspection /Co
Re
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�(No
❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
[�No
❑ NA ❑ NE
the appropirate box. 0 wup 0 Checklists ❑ Design 0 Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�6No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis
❑ /aste Transfers
❑Annual Certification
❑ Rainfall 0 Stocking ❑ Crop Yield El 120 Minute Inspections [] Monthly and 1" Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Dd No
❑ 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
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes]
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J-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 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
0,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
N,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4NO
❑ NA
❑ NE
Addi#ional`CoQtiiiients and/or Drawings:.:
Page 3 of 3 12128104

i o Division of Water Quality
Facility Number O Division of Soil and Water Conservation ✓/
O Other Agency
Type of Visit X Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit h Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Lf '�'/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator: —_� A M 1 C LG6—
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator•
Operator Certification Number: 9 8& y3 (.D
Back-up Certification Number:
Latitude: = o ❑ f 0 « Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
lo0o I ILI Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 M No El NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: Date of Inspection LAIMLOU
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N 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: Sue 'Nae.
Spillway?:
Designed Freeboard (in): )9.5
Observed Freeboard (in): 49
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
Ali
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
q No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
qNo
❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ 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):
Reviewer/Inspector Name m fl f7 A 6-%A Wt S Phone: /Q
Reviewer/Inspector Signature: Date:
12128104 Continued

6
Facility Number: ] — 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 Ej No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ 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 ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 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
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
InLNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(y 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
P�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
Page 3 of 3 12128104

e
Division of Water Quality
Facility Number j� Division of Soil and Water Conservation
- C) Other Agency
Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: rture Time: �ounty: eey & Region: iwO
Farm Name: t/y ..� / J//4'% ��i5y���1.�° A111y1 S Owner Email:
Owner Name: , 6,"— / I.�}��h��a�i S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:��_/�
Certified Operator:
Back-up Operator:
Phone No:
Integrator• "! xe'17'17V
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = =di Longitude: = o = 6 =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
7�[ppt? I ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Cattle
Design Current
Capacity Population:.,.'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes �] No
El NA
El NE
❑ Yes/ No
❑ NA
❑ NE
12128104
Continued

A i
v i
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes No
❑ Yes I ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
/�No
ElYes 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
ElYes YNo
❑ 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?
i 1. 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 WindowsC❑ Evidence of Wind
�Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s) /Up , I J
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 ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes XNo ❑ 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 El NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other
Use drawings of facility to better explain situations. (use additional pages as necessary):
/4(l
1�r /'f P" 7Va /V-5 v,
Reviewer/inspectorName 146kl� Phone: j% ¢�' -}3Z7-
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes JKNo
❑ NA
❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check
❑ Yes ZJ No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesX o
❑ 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 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
PLO-
❑ Yes -No 9/ 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 oNo
❑ NE
26. Did the facility fait to have an actively certified operator in charge?
❑ Yes XNo;K�A
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [:]No
J9NA
❑ 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 reviewlinspection with an on -site representative?
❑ Yes 1LJ No
/
[I NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

0
Type of Visit (5 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: let 13 Q S Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative �r` �3i.A1J�l1S,� Integrator:
Certified Operator: Operator Certilication Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =] o E—_1 _ = Longitude: = ° = t = «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poriltry Capaci -0. ulation
Cattle "Capacity Population
❑ an to Finish
❑ La er
❑ Dai Cow
❑ an to Feeder
ab6c'
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
El Daia Heifer
❑ Farrow to Wean
DrY Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cow
- - -
❑ Turkeys
1
Other
❑ Other
❑ Turkey Points
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,_/
ILI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑,.�/No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
E No
ElNA
❑ NE
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
I No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility`Number: 31 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6r0D� r.J
Spillway?:
Designed Freeboard (in): i� 5
Observed Freeboard (in): C l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Oo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes
No ❑ 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? El Yes
ONo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
,__
L�'No El NA
El 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. El2 Yes
,�,
No ❑ 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) C.,I) s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
El"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
P<o
❑ NA
❑ NE
o-4 of
S6rjp Guf�NGG of OWNJU �� Nct.✓ �U� f3c_r_,.�G �•� crJ.
dt,) v00?11T r✓ao9 wASTC Nl3AL`'S:S
::-a,1C_pDD SkA9e,
Reviewer/inspector Name .To,' j)FAQvi l6�. Phone: (9/0127,-726_1_
Reviewer/Inspector Signature: Date: 11Zt /D.r
12128104 Continued

Facility Number: Date of Inspection I �3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes CJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other � .
21. Does record keeping need improvement? If yes, check a appropriate box below. d Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee 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? [:1 Yes E]'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
El NAElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ElD No
A
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
�
IJ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D No
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
VNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [fo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�
IQ 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
L` I 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?
El2 Yes
�/
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
Additional'Coinments and/or Drawings:
_
12128104

t.
(Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
jd"Permitted Certified 13 Conditionally Certified © Registered
Farm Name: .... L.!�%�'�1 �..+'�Sel _......._._...._...............
Owner Name:
Mailing Address:
40 Time; Q %/
Not Operational O Below Threshold
Date Last Operate Above Threshold: .,
County: 4....................
Phone No: ... . ............... . . ......_.. .
Facility Contact: ... ..._ _. ...... Title:..— ................................._..... ........ ......... Phone No: __ . ._. .. ....._ .....
Onsite Representative: f .. 1� .. _ __ integrator:Glr .........................................
Certified Operator:._................W............_........................................... Operator Certification r:._. .._ .._ .._. _.....
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 'C Longitude • 4 «
s Desrgn
Swe Capacity
can to Feeder
Q
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars
'Ponitr3'. _Ca Wacit :Ponlalioa Cattle Ca acit+
❑ Layer '~❑ Dairy
❑ Non -Layer ❑ Non -Dairy
Other
r '
Total Design Capacity
y i 6k x�
` Toial SSLw
r u _
Discharges & Stream Kris
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes 0<o
❑ Yes 21'go
❑ Yes J2-1Qo
❑ Yes ❑ No
❑ Yes 'ef4o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 214o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .E'1Qo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldemifier: ............ — - ...._ ...—.................................
Freeboard (inches): CR
12112103 Continued

Facility Number:3 /—Z Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P40
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes J:;Mo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 13No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 'L2rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes -2-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes '2090
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2<o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type S,
13. Do the receiving crops differ wi those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes .2 I4o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,0'Ro
b) Does the facility need a wettable acre determination? ❑ Yes ,OT40
c) This facility is pended for a wettable acre determination? ❑ Yes -EI`N�o
15. Does the receiving crop need improvement? ❑ Yes .2'<o
16. Is there a lack of adequate waste application equipment? ❑ Yes -EIINOo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes .IRO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 41p.l'ia
Air Quality representative immediately.
-rm,�,
Comments {refer�to question;#) Explauiu anyYFans�vers and/or aQyomuuendatrons ar any oth_errneients. x
>Use drawrngs'ttf fa�city'tct better ezgluu situiaao�ns(aseadditisi� 1pFa8 p�7'}� Final Notes
Field Co y
rac 1�1 C v4-
T
s r
Reviewer/Inspector Name '`
d uw - ,m .'
Reviewer/Inspector Signature: Date:
12112103 Continued

Ab
Facility Number: 3 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes OT4o
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 ENo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Zj"Ro
❑ 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 J3'&o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ;10
26_ Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 014o
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes O'Ro
28. Does facility require a follow-up visit by same agency?
❑ Yes ETNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,KNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes L IQb
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit: 2 QZ Time: �
10 Not OiDerational 0 Below Threshold
0-Permitted MCertifsed ©Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: e11146,beo County: J,0hA.
Owner Name: Akiiyy I n Phone No:
Mailing Address:
Facility Contact: Title: ��Phone No:
lh Onsite Representative: 2e✓_ Integrator: M'/"✓"J- k
Certified Operator: Operator Certification Number:
Location of Farm:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude • C
Design
Current
Design Current Design Current
Swine Ca aci
P,o uiation Ploultry
Ca acity P.o elation Cattle C►a acity P,o ulation
Wean to Feeder Q
❑ La er I
1 11 JEJ Dairy
ElFeeder to Finish
❑ Non -La er
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of
❑ Subsurface
Present
Drains ❑ La oon Area ❑ S ra Field Area
Holding Ponds/ SOhd T❑
1111
No Li uid Waste Management System
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collecti2n & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches):
05103101
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Jallo
❑ Yes [3 No
❑ Yes [&No
Structure 6
Continued

Facility Number: 3% — ao
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 9 No
❑ Yes ®-No
❑ Yes [&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 n No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RNo
12. Crop type V 4lM eA
11 Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 91 No
b) Does the facility need a wettable acre determination? ❑ Yes Ej No
c) This facility is pended for a wettable acre determination? ❑ Yes Q No
15. Does the receiving crop need improvement? ❑ Yes Q No
16. Is there a lack of adequate waste application equipment? ❑ Yes CBNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
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
B No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ 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
® No
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cotiiments (refer toquestaon #) Erplatn anvYES answers:andlor any recommendattons or any other comments;:;
x � - '4-' a
Usdrawrngs.�{�offacilityto�betteryexplarn srtuahons (use as necessary}'
addrtrnnal pages ❑Field Copy ❑Final Notes
'. ,.i� .'%"-,F,. kY a.`�c. :{ W. :. iz, c-N'. a4.^.^Yi` .-. 9G'.
C`.t
Reviewer/Inspector Name�Q
Reviewer/Inspector Signature: Date:
05103101 C -Y Continued

ti
Facility Number: 3 Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Z; No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
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 06No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Z No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes B No
Additional omments and/orDrawings:
5100

L
f Visit �Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit Amoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Numberer
Date of Visit: 1 � Q Time: _70
�
0 Not Operational O Below Threshold
Permitted [3 Certified L © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .......
COL >/ IT6''z /V Vf Count 41,
Farm Name: ........... y � . U.................................................
Owner Name: ' fin n � r `i Phone No.
............ .... ............in ...........................................................
Facility Contact:
Mailing Address.
OnsiteRepresentative: ^QG� �DY
. ........... .......................... ..
Certified Operator.
Location of Farm:
Title:
PhoneNo:........ ...............................
..............................................................................................................
Integrator: ... u r�........................................................
Operator Certification Number: .........................................
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • i 46 Longitude • 4 '4
Design Current Design Current Design Current
Swine p PoulCattle Ca acity Population
Wean to Feeder 2k,&40 I Layer FE
Dairy
❑ Feeder to Finish ❑Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Desigin Capacity
❑ Gilts
[I wars Total SSM
Numberof Lagoons i - ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
- -
Holding -Ponds 1 Solyd Traps . '` ❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'Ed 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'? 4 l al
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes PfNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes /il _I No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ,TNo
. F7rec
01/01/01 Continued

Facility Number: — O Date of Inspection / O l Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
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 main tenance/improvement?
1 /9/2001
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?
❑ Yes �No
❑ Yes YNO
❑ Yes XNo
❑ Yes PrNo
❑ Yes ,fNo
❑ Yes ,ETNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,fNo
12. Crop type C o r A r k f e-11 ) SO!% bem> i.s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �ffNo
14. a) Does the! facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes j2f4o
c) This facility is pended for a wettable acre determination? ❑ YesIONo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N?-yi0ati0hs'0r deffeiendL,9 -wire nbt;et during th s;A t! - Yo>j� `vial-t; eegiye 06 futftr' -
- correspoiiderne. a1bb6f this visit.. ... ... .... .''
any YES:amwers
❑ Yes Pfgo
❑ Yes JYNo
❑ Yes jgNo
❑ Yes_,EI'No
)Fryes ❑ No
❑ Yes ETNo
❑ Yes _ONO
❑ Yes ',&o
❑ Yes J''No
❑ Yes';;]�No
❑ Yes J2rNo
l�. H'VQ rreeboard records nv,t']a61e � ���joec�:a _ Be sv'44'
Use q t-vRs.J, n ►1 al s � S d44ed w' ` k P) (mod dekfs' ova j'� ��'ck�+'d n e ve4S
6n -the JIF X -Z 1J.
w�1i I<P_ 0 Ajh."4- G,r4P rS 1-r/el1 c:-04 b Ii, el,?t .
r-4
l� T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:4111164 S/qp

Facility Number: 5�1 — Date of Inspection F((//Q_ 1 I Printed on: 7/21/2000
{)dor Issues T
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor helow []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
/11No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes Pl 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 /014
0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100
5100

Dlvlsion of Water
Q Division of Soil and Water Conservation
5.: O Other Agency M s
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit: /_ v C?b Time: , C O t7 Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
13 Permitted 0Certified [] Conditionally Certified ❑ Registered . Date Last Operated or Above Threshold: ................
C� ✓ h /l1c, i� .. County:...P' l� ,�
FarmName:..............................................................r.._................................................. P.............................................I .......................
.�........ v.�..T�`'..................................................... Phone No:...................................................................................... Owner Name: ............�
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: f C�e1o�
p........3.+.................................. ........... Integrator:...........r........................................ ..... ........ .............
Certified Operator: .......................°..— ............................................................. Operator Certification Number:...............
Location of Farm:
AL
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder zc rw JE1 Layer I I ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I I JEJ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ElLagoon ❑ Spray Field ElOther Ir
a. If discharge is observed, was [lie conveyancc nian-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State:! (If yes, notify DWQ) ❑Yes ❑ No
c. II'discharge is ohscrved. what is the estimated flow in gal/thin?
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
Struc;turc I Structure 2 Structure = Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �N0
❑ Yes No
Structure
Identifier:................................. ....................................
Freeboard (inches):
5/00
Continued on back

Fac!Uty Number: r - Date of Inspection Printed on: 7/21/2000
1' 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[] yes
�To
seepage, etc.)
(`
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yeso
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
hIo
12. Crop type o 1, I'\ SJ ` z_-A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
ElfNo
o
b) Does the facility need a wettable acre determination?
El Yes
e) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
o .
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?.
❑ Yes
kNo
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
IrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
'E�No
(ie/ discharge, freeboard problems, over application)
❑ Yes
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
No
0: �1dAblAdiis:oi- iiefici606ii s *ere noised A&ing fhis:visit.- Yoir will reeeiye do l'ui ther
: icorr�oridence. about this.visit_ :: -. • . • . • ...... ...................... .
Comments (refer to.question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�-a ✓ n` �(7v YS �QCs A�
�oGVYc.�s � 5oac:(5 C��Pe�
T
Reviewer/Inspector Name jw S 5 C'_ 14
Reviewer/Inspector Signature: Date: - O --0 5100

F.
Fai4lity Number: Date of I€ispection -2p Printed on: 7/21/2000
r� Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor 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 TO
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 to
o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
°Additional;Uomments'andfor. Drawings:
Mll/]

[3-Division of Soil and Water Consei va oti -'Operation-Review
U Division of Soil and1vater-Conserva on Compliance inspection
' Division of Water Quality Compliance Inspection sr
0 Other A ency - Operahon�Revtew�
1
IRRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-ug of DSWC review 0 Other
Facility Number O Date of Inspection
Time of Inspection © 24 hr. (hh:mm)
0 Permitted Wcertified 0 Conditionally Certified [3 Registered 10 Not O erational Date Last Operated:
Farm Name: -.-..-.. � ....1V�-•�. 2 .` ............................................. County:.... y.. Ax�......................................................
Owner Name: Phone No: a �- `3 � g6I
1............................................................-----..........
Facility Contact: ...... ....... Title: .......... W-.. .. -.P. .................... Phone No-(_9 4P)
MailingAddress:............................................................................................
Onsite Representative :............
.....h.:`�'!
Certified Operator:... ................................................
....................................................................................... ..........................
Integratar:................................. r.............................................
............. Operator Certification Number:..........................................
-2Satipn o' `arm:
A :..... ..........9........is.w.......:.::................................,`...._.......................................................•..........,......-�`�1.. ...-
.. . .. ...1.
�' '.. 1 .......... .........
Latitude • �� Longitude • ��«
Design Current: , Design.. Current Design Current
Swine Capacity Population Poultry "Capacity Population , Cattle Capacity Population,.—
Wean to Feeder
Q(}
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
- �Nurnber, of Lagoons , ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
_Holdtrig Ponds'/Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes %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): ... ........�9............. ........... ...........
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes �§ No
seepage, etc.)
3/23/99 Continued on back

i Facility Number:3k — 6 0 Date of Inspection 0
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? ❑ Yes N[No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? 0 Yes [YNo
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes � No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes O 'No
12. Crop type < 1"i ISSSo -
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?
t5. - Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17- Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23- Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25- Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes OrNo
❑ Yes gNo
❑ Yes f7l(& No
l'U"Ves El No
❑ Yes gNo
❑ Yes IgNo
❑ Yes WNo
❑ Yes ['No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes gNo
.............
P. �1'6Molafidris;oi- deficiencies mere noted d>lrring iris;visit:-YO WRI-feeeiye rro further ; ;
.
correspondence- ah' ' f this visit . . • r . . .
CoEriments'(refer:to-question #)::Explain any_YES answers audlor any reconiinendations or:any°oth_er comments:-M
Use drawings of faciiity.to better explain situations (use additionakpages as necessary) � a
.:._ a
6q, s ��
GCs � t St•=•fir ,
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
M rn
AL
Date:
3/23/99

i
Facility Number: 31 — go 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 9Yes ❑ 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
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 No
M 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 N'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Q'No
itionaComments an or. rawrngs
3123/99

O Division of Soil and Water Conservation ❑ Qther Agency
® Division of Water Quality
4k Routine O Com laint C Follow-up of DWQ inspection 0 Follow-u of I)SWC review 0 Other
Facility Number
Date of Inspection 30
3 � 0
Time of inspection = 3 0 24 hr. (hh:mm)
13 Registered tO Certified [3 Applied for Permit © Permitted 113 Not Operational Date Last Operated:..........
Farm Name: ND ........... P.wste County: ......
\\ 0sN...........................
Owner Name: .............. ................... ........ CtnwA4n ........................................ Phone :Vo:..O.L.64. - '-}%
Facility Contact: .......... nL4....... uaYu or.......-•-•---•-. Title: ........ !!1hmx-9el .............................. Phone No:.�q it?i..z� .:...�{� %......
Mailing Address: .. ...........
�0n._1Lx\........L."..kV ............................. }au aw..t........NL............................... `..........
Onsite Representative :............ 64........&�ua ............ ............... Integrator:�%,k....... .............................................. ........
Certified Operator:............................................................................................................... Operator Certification Number:.....................
Location of Farm:
�s}L....�... ..'S �...Ll.P.. . ......._. rac4.....s'.S...P.1.�.....Jr�.. -----. .... .... .�..�:.......mi.. �.....ft!�..... ......!ate?.1...1121 ......................................................
.. . ••----••.--• •••.-•••............. .- .------..-•-•.••.•.• ••. •...
Latitude Longitude �• �_]' �"
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
2. is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?MIN
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
($ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
LP No
5. Does any part of the waste management system (other than lagoonstholding ponds) require
1� Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

` Facility number:
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons,11olding Ponds, flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stntcture I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ........... :. .................'
10. Is seepage observed from any of the structures'?
11. is erosion, or any other- threats to the integrity of any of the structures observed'?
❑ Yes ikIN, o
❑ Yes W No
Structure 5 Structure 6
❑ Yes 1�5 No
❑ Yes R No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
r
13. Do any of the structures lack adequate minimum or tnaximum liquid level markers? ❑ Yes [Z No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes [[No
(If in excess of WMP, or runoff ientering waters of the State, notify DWQ)
15. Crop type.........C4x.Y1..............lkR4T ........... .SCl'11N......,......
....................................................................................................:.................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 'In 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 M No
20. Does facility require a follow-up visit by same agency? ❑ Yes N No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes CJ No
22. Does record keeping need improvement? K Yes El No
For Certified or Permitted Facilities Only .
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes F No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [A No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes [ANo
:3 No.violations or deficiencies. were noted during this visit.- .Y.ou will receive no farther
correspondence about this visit
Com_ ments.(refer to question #}: Explain any YES answers andlor any recommendations or any other comments
y s I3se drawin s of-facilil to better explatn.sttuatioEts. (use .additional pages'as necessary)
hay? o.rea thG�nrb1d13
1'�.54.-� •
or
1
1�• �-os:o� or. ;n.,r.Y Wall s�wul� be �Ilt,t� p� r[scf�it�,
r
L�� SQL rt toffs 5��1� 6e. 6j eull y- �-tjd Auv%66y
us%h� t`tr+rlrcc�
aL�rc�je i n t C.Mc.
aPe���t `o►� �,a�cu�a ianS. � dvs'�K 4 i rv' LY\ JA&�
- hJ\OUP be, ry
plao .
7/25197
Reviewer/Inspector name
Reviewer/Inspector Signature: -
Date: D

Routine 0 Complaint 0 Follow-up of DW2 inspection 0 Follow-uR of DSNVC review 0 Other
Date of Inspection
Facility Number Ifo 1
Time of Inspection EL�O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 0 Registered F-1 Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
IR Certified [I Permitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated: . .....
Farm Name: County:..D.vl ... L__
. .... . . ..... -W .....
Land Owner Name: . ... . .... Phone No: _CA_LP4_.Z_.qa
Facility Conctact: . ....... . ..... . . ...... . ............. . ...... Phone No: .... . . .... . .... . ........
Mailing Address: .. ...... '±1C . ... . ....
Onsite Representative: .... Integrator:
Certified Operator: .... . .... . ........ . ....... . . ..... . . ..... . ....... . .... . . ..... . . ...... Operator Certification Number:
Location of Farm:
.... kwnx J-0—s f - - ------- -
Latitude F%7710 4 Longitude
,it E�]
Type of Operation and Design Capacity
. .... .... ... . ......
asap ;-
..
UisCUrre t C6rrefifCUReIlt
­
oe
4 gn
Poul
a Oyciiplaio7Cattle
c! P01O.ati6h��
E] EDEa
IN Wean to F 0
La er ❑ Da'
Feeder too
0 [I Feeder to Finish �P)1[1 Non -Layer "":0- ffin-DairvI
0 Farrow to Wean SEE R
FU
.. Farrow to Feeder .T t Design ""',Capacity
l'2�
0 -0 Farrow t Farrow Finish 1`0 SSE
I El Other 0.
Nun INi
fso �� 'Z.
agoon§ ifiMpol NUld — [Ell Subsurfac Drains Present
aTT 411�`
7 7a.❑Lagoon Area 10 Spray Field Area
C leneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field 0 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?
0 Yes [I No
[I Yes El No
0 Yes J@ No
❑ Yes 0 No
&j I A
[I Yes
No
El Yes
NO
0 Yes
10 No
0 yes
0 NO
Continued
on back

Facility Number: 2.1.,..—._4a
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (!Lagoons and/or Holding Ponds) .
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
3..._L.... .._.. ................ _ .... ....... __..... ....... _.
Structure 4
❑ Yes 9[ No
❑ Yes RTNo
❑ Yes IR No
❑ Yes 0 No
Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
INNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type! iaanr �►r� a,.ac 5.. St t,r�!sr. �ttr 1► isct �.1; ............... �.... _� .... _ ....
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
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
A No
Eor
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JKNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
91 No
24: -
Does record keeping need improvement?
❑ Yes
® No
Coftiments (refer tp gitesti' #) Explain ariy YES answers and/or;any recorntnendahans or any other comments` `�
Use drawrngs of factiity to better explain situations, (use addlttonat;pages as necessary)
I. M.1'e- core fo -ee.of Ie-;Lrt ew �e v� Gv be~�
k A% t- a. r e- cL S a rL o. V -& w l( W O a ct 1 K es .
11.1 IZ p! 1 l L.V "ft pVL tv g v.J C• 11 u _
r e v g b cL t o ►�—q t L. e
lam- ocv► wall• V � `J
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: I t
cc: Division of Wafer Oualitv. Water Oualitv Section. Facility Assessment Unit 4/30/97

Site Requires Immediate Attend
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: O , 1995
Time: G1:1
Farm Name/Owner:_ l r [�11%,----
Mailing Address:
Integrator. &dAeAt4 Phone: /Iyy
On Site Representative: ,c t( Y Phone:
Physical Address/Location: AP S A / 1 d-) _ 0.7 S_ ✓in;1e- 1_ Fes/_ u S IQ
Z
w'AfLW. U A-', A/b RA_ S r Lc. dl AIV S ?Z I 10 '7
Type of Operation: Swine Poultry Cattle
Design Capacity: Q (P DU N�� Number of Animals on Site: ^- a (-a 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: $4 " 1-L1 `d " Longitude: �2r° Q ' 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) or No Actual Freeboard: _ Ft. O -Inches
Was any seepage observed from the lagoon(s)? Yes or A Was any erosion observed? e0 I Now
Is adequate land available for spray?)or No Is the cover crop adequate? Yes or No
Crops) being utilized: WO ( ' R. -
Does the facility meet SCS minimum setback criteria? 2 Feet from Dwellingesor
or No
100 Feet from Wells? 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 or Ob 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 r�i'
SUS"
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.