240095_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qual

:/
e
Type of Visit: (!) 70utine
Hance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 j7_� Arrival Time: Departure Time: County:Co(LWt&jj Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: &EWu L-0/06pO Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: a o4a a
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design
Cattle Capacity
airy Cow
Current
Pop.
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish J�
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D�, P,ault�. Ca aci_ P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar es 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
[:]Yes ❑ o
❑ Yes Wo
❑ Yes fA No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3
21412011 Continued

[FacilityNumber: - Date of Inspection: 5- 43
Waste Collection & Treatment 0.6
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EX No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 E� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
O Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
01
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
do
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�dNo
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: le
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f=J y
❑ 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

FF-acility Number: - qS Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? I 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 to provide documentation of an actively certified operator in charge? ❑ Yes E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [`I No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E✓(No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [�J/No ❑ NA ❑ NE
❑ Yes K�fNo
❑ Yes dNo
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
dr) RrCt(-- FT&L9 -Co CoMAAW 13c4MlljDA , WXLL.
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OLD 6C-rt-wl OVA tjC-E.DS WCE9 COIsPapL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Rya)
Date: Jc- 3
21412011

(Type of Visit: Q Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L4
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: �3 5� County: ebU4"WS` Region:
Facility Contact: ? Title:
Onsite Representative: �,jf kA.`s'v1QA)SPw GFAuo k6MA40Y
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
integrator:
Certification Number:
Certification Number:
Longitude:
r1Design
Finish
Current
Capaci
Design Current Design Current
La er Dai Cow
Feeder
Non -La er
Da' Calf
eedero Finish
7.do2100
Dairy Heifer
arrow to Wean
Design C►urrent Cow
D , P,oultr, Ca aci_ Pao , Non -Dairy
La ers Beef Stocker
arrow to Feeder
to Finish
ilts
Non -La ers
Beef Feeder
!Farrow
oars
Pullets
Beef Brood Cow
ther I I
Turke s
Turke Poults
Other
Discharues and Stream Imaacts
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 n/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ 4o ❑ NA ❑ NE
❑ Yes �No
o ❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility t mber: -
Ts -[Date of Inspection: ts
Waste$ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L jA &4p pJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ENo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [(Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA FINE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes dNo
❑ Yes dNo
❑ Yes 7No
X
[:]Yes
[:]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 �/N)
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE

Facility Ngmber: 2 q - jDate of Inspection: (,
24. Didihe facility fail to calibrate waste application equipment as required by the perm; ? ❑ Yes No ❑ NA ❑ NE
yr
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? 0 Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes TNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [7/No
[:]Yes dNo
❑NA ❑NE
❑ NA ❑ NE
❑ Yes O No ❑ NA 0 NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
WN
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.-,-,_.
Use drawings of facility,to better explain situations (use additional p g !La nesiry)•
K'.) ,vE Eq ! o A Td Fit p zLeD f'E sc t,E
Cu fl o L aril B 40C r__rELD t5 ✓r1 IvE w r^ by �6dL
(1-4P�uJ f'
GRa� % Y'P£ WNE� '�ESG✓E , ES +�C,�St� W�1J�'EiL— r✓KoP Fox V L-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C*01U " 73KY'
Date: It /11
4/ 011

A
lfakffity:Num er
I
Division.of Water Quality: x
Q Division of Soil and^Water Conseivateon r "��
O#her�Agency. � �m
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation Zo echnical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergencyer ❑ Denied Access
Date of Visit: Arrival Time: ih Departure Time: County: CALL) Ml3US Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:.
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 6 Longitude: = o
%,Z �aLL
Design Current'
r
�Destgn
Current yDes�gn Currents
Swtne Capactty.Population
W Wet Poultry.. -Capacity, `Population Cattle �" a ty P pulahon
:.NCap
El
Wean to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
❑ Layer El Dairy Cow
Calf
Beef Brood Co
ID Dairy Heifer
El D Cow
El Non -Dairy
El Beef Stocker
El Beef Feeder
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?
El Yes 2 No El NA [I NE
❑Yes El No El NA ❑NE
El Yes ❑ No El NA El NE
❑Yes ❑N El NA ❑NE
❑ Yes LJ o El NA El NE
El Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued
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?
El Yes 2 No El NA [I NE
❑Yes El No El NA ❑NE
El Yes ❑ No El NA El NE
❑Yes ❑N El NA ❑NE
❑ Yes LJ o El NA El NE
El Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued
Page I of 3 12128104 Continued

Facility Number: 95 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Stnrcture 2 Structure 3 Structure 4
Identifier: {A(rlu r)
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in): 9-0
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes I_I No ❑ NA ❑ NE
❑ 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? El Yes l� NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 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 El2 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement? El"
11. Is the E evidence of incorrect application? If yes, check the appropriate box below. Yes El No El NA [I NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?.
ErYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ YesL'-�/No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
Yes
El,
f,�, NNoo
El NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
l.d'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
-Use drawings of facility to better explain situations. (nse additional pages as necessary):
1I, L6vJ ARC -AS aO 6f--&w.v0A FZc-LE) I..11YA ?6W=4JC- wAS D=R -tJ A ff-U OF'
T{4E 1461EA5 STXLL- SU6WtV,3 _ SO,�InE LjACT4.. DXRX RC_C£.NTL_Y 0T TNE.�..
's,) �E�-w►��A ���.�n GRpua� s�c�. Nas �,�� gcEr.� AoosRcssEv, i�CcowtmCNo
&j.0AT;Z0G- �= DuE To C,avAPk1(-TIo#J ,
Reviewer/Inspector Name i.T r a* J(-_l _ Phone: w- 7�6...
Reviewer/Inspector Signature: Date: U
11/z8/04 Continued

Facility Number: y — Date of Inspection 8+q fi
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA PINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 2 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
QAE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ENE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
MIN
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
C3'NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑'&E
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:3 Yes
El No
El NA
9NENPE
f
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
CZ 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
��
L1 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?
E�11
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
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G ��1'�i \l
;W
Page 3 of 3 12128104

5f..;
Facility Number
V:Uivision of Water Quality
Q=Division of Soil andWater Conservation
04Other.-AgencyF
Type of Visit
V:Uivision of Water Quality
Q=Division of Soil andWater Conservation
04Other.-AgencyF
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
6Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: 1! b Arrival Time: Departure Time- County: COL44418t'l Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title.
Onsite Representative: G ( ivo b 0S-6
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = I = 11 Longitude: =
Design Current; Design ,._ Current `
Capacity Population we
Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ❑ Non -Layer
© Feeder to Finish l a6
❑ Farrow to Wean
m Dry
[] Farrow to Feeder
� ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Hole
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cowl
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 [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 4
❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility dumber: — Date of Inspection Ll o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (&-aaa)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes U 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 El 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 environmentalth
El❑ Eleat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ,�/No NA NE
LJ
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 [4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Y s
❑ No
El NA
El NE
l5. Does the receiving crop and/or land application site need improvement?VYes
❑ 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
E No
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Commetits {refer to queshonm#) Explain any YES. answers and/or any r"ecomrtiendations orsany otl ertcomments�-.
Use drawings of facility to better explain situations (use additional pages as necessary)n14
lS�,� L6►,� Ari.C4S jrr/ aE12k-LvDA
Cays o d Caws KjEe4s 7o BE ADD2Ene $
AM(L- VCPr g Er-0 eEfCA CE,9
IV"AL), L), Gr Zto o #-J-_U DD
ReviewerlInspector Name
"„�� �` Phone: d T g�
Reviewer/Inspector Signature:
Date: 11 O
Page 2 of 3 + 12128104 Continued

Facility"Number: 124 Date of Inspection ti
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
LINE
❑ 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
UNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LL No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EZ(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CNo
❑ 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
ENo
❑ 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
,
LL No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings: ^-
Page 3 of 3 12128104

Facility Number a �5
V Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Revi7/Referral
0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11 l • 0 Arrival Time: Departure Time: County: ULu M )S Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ,C-ex_,, ko NoE.Dt?_ _
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 1 = Longitude: = ° = I = it
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
10 Feeder to Finish 3 7 a b 6
[--]Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ZApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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?
0/yes ❑ No ❑ NA ❑ NE
❑ Yes �rNo
Ko ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA El NE
El Yes E_d No El ❑ NE
12128104 Continued

Facility Number: Date of Inspection tl ID IU
W smote Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G-o o
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [`f 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 EdNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes ClNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
L Is there evidence of incorrect application? If yes, check the appropriate box below. CJ Yes ❑ No ❑ NA ❑ NE
E Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑'fes
[I No
ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0NoNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L7 No
❑ NA
❑ NE
4018.
Is there a lack of properly operating waste application equipment?
[a'Yes
❑ No
❑ NA
❑ NE
.Comments (refer to, question #) ; Explain any.YES,answers-and/6r any,ree minendati6ns or_Fany 6therfcommenls
»- �. -, - -
Use dra��ng3 6f facility to better explain situations {use additional pages as necessary) k 6
d
I•� DT-SCNA&GE rrtQAA gtt "&) A2RVENT LJQAlC6D ZtWrO �CLD DZrLb{AL
►�,) ExcESS.1;V _ pf,tj�� L.) A S7E - Lau/ A+�-E.as of rSc2 w►unfi C.ZcLb -Fort- nnort£
T N A ki Ll 14 mS , E o -to 4 A V6 ? 2c�GR- 1:6VE ILA G-E rib 4 LLo +,/ Su F �Z C ZCN7"
FScure �ZC� fpa-
ur-ZLz-e.ATxud. A&&.WorXST 00POR-1 IM191K-CA) 5�1� 1Q�bv37 Zo, Zoa9011100 �.
LB.ft5C_4Ap � +4A LCAKXJJ&- Alf. WOW WAA?PE6 ZN Cw-1'�,
Reviewer/Inspector Name " + q ._ �MMrG 4 ` � ` Phone: 0 �� -75
PtrnA
Reviewer/Inspector Signature: � ` Date: u f Y140
Page 2 of 9 icicoivls a.unur#ucu

F9615; Number: al — Date of Inspection t► ►o tD
Retjuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design [I maps El Other
❑ Yes
❑ No
❑ NA
PNE
❑ Yes
❑ No
❑ NA
VNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
dNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
EJ E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
EJ E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
dNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
❑ NA
EJNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
FN
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�/
L�J No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6No
❑ 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
PVo
❑ 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
ErYes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
0 es
[:]No
❑ NA
❑ NE
Additional Comments andlor Drawings: g
3L) �ARSD to A *TT-(Y 4' D_r5"Ap,&-E tb 0jT(-4A AS aIQL117ED. ���0jDTi1G Also
h
33,) Vauww UPDoti ' 00wwV-WW aVxti 'w � �jtlsP�cr,7An� �RT� Cowl�►tJG,
32� GEnla kENW�D`. CRtLCD 6rw ff�- w1ly ►�EJE�e S1io1JE9 n+Q, kENDJboY ►✓4S ZNI-a�-+ri�D of �CSStl6�.
tjo v AN o U rb jLa tAt & `f 'A
jUotr SfAIC VU T° m K tpe A Z•' `� o�wr , aB o uF 3 DFf10 rV
' L0/ �° f>lYoltAnr7'
J N ��'C�V T�KfAl Rr 4SdUr 50w,t
1SAUitl fir f r(i i�f/+�. 5CI-VA65 TAKE 0 PT Q-T-F f EfZ 6 T A 9-Ea S
T
Page 3 of 3 12128104

91'
IType of Visit of Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: co�'vw1f3U3 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e = g 0 « Longitude: E_—] o E_-1 ' =
Design W@urrent
CitPlation
Design Current Design Current
Wet Poultry Capacity Populationan
to Finish
r
❑ La er
❑ Dai Cow
an to Feeder
❑ Non -La er
❑ Dai Calf
der to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PCIGilts
Boars
Dry Poultry
❑ Layers
ElNon-La ersEl Pullets
❑ Turkeys
10 Turkey Poults
❑ Other
❑ D Cow
❑ Non -Dairy
❑ Beef Stacker
❑Beef Feeder
❑ Beef Brood Cow
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?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑l No
❑ Yes
E No
❑ NA
❑ NE
❑ Yes [�No ❑ NA ❑ NE
12128104 Continued

Fdcility Number: 7-4 Date of Inspection h O
) aste Collection & Treatment ,_,(
4. 'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? j� 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: LAG—pr)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 "7
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes ' No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [;No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? t@ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes BNo ❑ NA Cl NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes E2'fio ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
Comments (refer to question #)..-Explain any YES answers and/or any„recommendations or any other comments -
Use drawings of facility to better explain situations: (use additional pages as necessary):
%y.l 4U11 h�GS �1ti� rlb bn WAI/601 W's VA RV EWA� .
ISM) Fesw-t�a jds 6ok bl. j54 d SL^ft IJAVt R,`(,1t, More a,5 AJ41UA }e S+-s, ,t 4vev-% e.0l60e7i to-r
. ,
RA ?Qsy bl�. rJv� Qx S�ap.e_ 6� t'�SGu'{ bkk.d 6h
d•� e,k t tLf did -e4c e_4 cry 41244, 4Lf . (rI Wa ,
Reviewer/inspector Name Jo �1ar r ,(� h Phone: (_� 7�t6 "-7!�r
Reviewer/Inspector Signature: Date: 11
12128104 Continued

Facility Number: 2y -- 4S Date of Inspection t+
R�auired Records & Documents f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No [I NA [� J NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA dNE
the appropriate box. ❑ WIJp ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA EI'NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA dNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA e(�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ No
❑ NA
LEI NE
❑ Yes
❑ No
❑ NA
E I NE
❑ Yes
❑ No
❑ NA
d
❑ Yes
❑ No
❑ NA
7NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 l . Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA Ef NE
❑ Yes ❑ No ❑ NA EfNE
❑ Yes ❑ No ❑ NA ENE
❑ Yes ❑ No ❑ NA EJ NE
❑ Yes ❑ No ❑ NA
❑ Yes '❑ No ❑ NA NE
12128104

Type of Visit Acompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency Other ❑ Denied Access
Date of Visit: r)JSjnj ` Arrival Time: 4 Departure Time: County:Region:
Farm Name: J IEM=tA _� 0411y5Qvk/ Owner Email:
Owner Name: �o �vsoN Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I Longitude: = ° = ` =
" Design
Current." Designer urrent
PRCattle Swine Ca a_ci Po ulation Wet Poult Ca aci �Po iilahon^
P:. p P,.: tY
µ .<> _
.
❑ Wean to Finish
n ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Nan -La er
I
I
❑ Dairy Calf
n ❑ Feeder to Finish
w ".'
❑ Dairy Heifer
❑ Farrow to Wean
�Dry;Poultry��.
El Dry Caw
El Farrow to Feeder`
El Non -Dairy
❑ Farrow to Finish
ElLa Layers
; ❑ Beef Stocker
El Gilts
� ElNon-Layers
El Beef Feeder
❑ Boars
❑ Pullets
' ❑ Beef Brood
❑ Turkeys
Other El Turkey Poults
..
Number of E
❑ Other ❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IxNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

acility Number: L -1r5 Date of Inspection 11141109
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 JNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:/ A-&Y f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Yt' No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence -of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA X NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑'FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? XYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ No ❑ NA 0 NE
❑No El NA El NE
❑ No ❑ NA V NE
❑ No ❑ NA NE
❑ No ❑ NA NE
Comments (refer to question #): Explain any YES answers and/or any;recommendations or any other comments u
Use drawings of facility to better explain situations. (use additional pages as necessary)'
�. �ESC cAE F IEt<DS )tilF�b To BE ��XEc� !�► cts�i%�- x At T serr mucH cdniu6
N k I 0-)q . SotIN Sow � Mfit S ►IqT � fAE l-�A� CEa10
Sejy� Q� - C� q-'A wAS SuBm i --rELk-1 W aLh 2 NCO
F44w
ReviewerlInspeetor Name I q 7 l . Phone• C11b 9� �
Reviewer/Inspector Signature: Date:f 0 l09
12IZ8104 Continued

Facility Number: -- 1 Date of Inspection 61
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA XNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA (ANE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[:]No
❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis Cl 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?
❑ 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 KNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA KNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA [ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA 1XNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA 5q' 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 X 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 NNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA �j NE
12128104

- °Division of Wate]
FaciliWNumber a S 0 Dtviston of Sotl`ai
- Other Agency,'_
Type of Visit 0 Co pliance inspection Q Operation Revlev�y 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outing O Complaint O Follow up Referral O Emergency O Other ❑ Denied Access
Date of l'isil: ,� c�6 Arrival Time: , 3 d Departure Time: County: Region:
Farm Name: Owner Email:
Owner ,`arne: Phone:
Mailing Address:
t hyNical Address:
FacilityContact: Title: Phone No:
Onsitc Representative. _ _Cr(wo _ _ki A oro !J Integrator:
Certified Operator: Operator Certification Nurnber:
Back-up Operator:
Location cif Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ ° =1 u Longitude: ° ` ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daig Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
Discharges 14 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 & ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
C1 No
❑ Yes
dP 0
El NA
El NE'
El Yes
L" 1 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 2, — ,�' Date of Inspection of
Wnste 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 Stnucture 2 Structure 3 Structure 4
Identifier: LA GOW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes n/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1; Structure 6
❑ Yes
o
❑ NA
❑ NE
eyes
TNo
❑ 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? ElYes 2No
o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Oycs L:! No ❑ NA ❑ NE
maintenance or improvement?
!'Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
JNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2(No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
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? ZYes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
2(No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
L No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
C2(No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
W47E1Z09W ANO I► RZA j t 04WA66 OXT(W T*1 gCgmW'q r6Lnf NEEDS ()
� E
•
Z•61 .tb AD,oR_ES.f, 024xN rrLE &ok, W.4-TH2_./Ay to YJtTLN NE.t'oS
rG et
GLEAAIEJ.
IS ){(-St1vE FXELD 3TrkL• (7vLL. 4 Si2AK�tta. TL,(ASE Da d67_kazlr AND
YAW
Reviewer/Inspector Name c% N 4i_ [6 Phone: q,E` %f
— 1d
Reviewer/Inspector Signature: Date:
0
12129104 - Continued

Facility Number: Z — 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 [No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design Maps Other-
21. Does record keeping need improvement? If yes, check the appropriate box below. GYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil El Analysis Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections LI Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA-
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
7wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VXo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E/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?
El Yes
vl o
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
es
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
7Yes
Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
t S j MWO60fift gc,It-wwo4 rx,4 co sTxc( 14Af A for a f P-r6- SEE o,
SfMY ANb C 1VT AWE CU=PfTtiG- WrNda Uo w6T AU-O&J C6 Z60
00' om(—e SPR-66OS Sc E,�lai►,,�.
ALL �CDs NEE4 )7'ycao+J 1�1(-k IAn,&,rr 'E*a-'to,M EfJV A7-4,6
FeUfA 21009
t) (t o ►, P&fj
33.) pW CCU 0 5 wG &,t cc Xf, - c=Nf C k 51TC ter✓ A16
IZ2VO4

IType of Visit X Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Od Departure Time: County: (20( 4EAU S Region:
Farm Name:
Owner Name: _ CO 4A SW
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Owner Email:
Phone:
Title: Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o= f 0 Longitude: = o== u
Design C►urrent
Design Current
ItPoultry
Design Current
Swine Capacity Population
Capacity Population
Cattle Capacti ity Populaon
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dat Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑Turkey Poults
❑ Other
❑ Other
Number of Structures: a
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA XNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[]No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
%NE
12128104 Continued

i
t
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA G CCYV
❑ Yes 'No
❑ Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tANo ❑ 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 ElNA 0 NE
through a waste management or closure plan? -
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement? ' 1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA P NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) !
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA J� NE
,CKNE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA 1 NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA WNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA XNE
UISITGZD 1 HC-- SI i E w f -\OHN CO LS( E CS` "W To C C-r-K Pfi_e@0A06LEt_yF
FOLLOw11#6 SCvfZALj'Rk:�S Orr
U4CO0/V WRS W COmPLARx/cz-@ ay''
Reviewer/InspectorName I 1Pm14XoA 105 Phone: —1 -:4y(' 3a-4
Reviewer/Inspector Signature: Date: S/ foal I C9
Page 2 of 3 12128104 Continued

{
Facility Number: a y —g rj Date of Inspection S 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA V NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA KNE
❑ 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 ONE
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 [gNE
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
❑ NA
NNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
NNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NNE
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
0 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
NNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
1XNA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0&
❑ NA
❑ NE
Additional Comments and/or Drawings: -
ss
Page 3 of 3 12128104

Faciiity`Number
Type of Visit 0 Compliance Inspection 0 Operation Review Structure Evaluation Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency (other ❑ Denied Access
late or Visit: C Arrival Time: Departure Time: � County: r,�,$�$ Region:
Farm Name: Owner Email:
Owner Name -
Address:
Physical Address:
Phone:
Facility Contact: 'Title: Phone No:
Onsite Representative: 66 Integrator:
Certified Operator: Operator Certification Humber:
Back-up Operator:
Location (of Farm:
Swine
Wean to Finish
Back-up Certification Number:
Latitude: =0
4 Lon„itudc: ❑ ° ❑ 1 = U
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ _ ❑ Layer
❑ Non -Layer
ICU Feeder to I mash U j,*V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkFX Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F1
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 L"I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No
El NA El NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

I
Facility Number: A— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If ves, is waste level into the structural freeboard?
Structure, I Stnteture 2 Structure 3 Structure 4
Identifier: �.t.5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
Yes ❑ No
❑ Yes ONo
Structure z
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes Li 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes :yNoD
NNA El 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 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
maintenance/imp�ovemenV
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA INE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
C No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
❑ No
El NANE
L'1
17. Does the facility lack adequate acreage for land application?
18. Is there a lack equipment?
❑ Yes
❑
❑ No
❑ No
❑ NA
❑
of properly operating waste application
Yes
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):
41 J 1 F-A t„` 2( z uPDot _- ?oA �. cL 3 o OAvf , H EAR Y t24X*J F tjuk_ Fr , %k A1k, S d&t—
%dOIJ °VI 6C FT"L_TVA_AL_ ARD.
Reviewer/Inspector Name 14M 3 Phone: I VQ = 13 T6
Reviewer/Inspector Signature: Date: o
12128104 Continued

Facility Number: L4 — Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA 7NE
❑ Yes ❑ No ❑ NA 2NE
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA Q
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No ❑ NA rNE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes [I No ❑ NA
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
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
�o
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
12 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
C2 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?
I Y
El No
❑ NA El NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA ❑ NE
Comments and/or
3z� J � H o Cd u� G-6 C A uk_ � �GIt1Z-� ,,. C { % S ,c � h A.T S c} AND D LJaS?
W-a,,ha (�C E ss-�E �-' rh . LOT Z3Sd06cT_:j-jJ 9,6N(CT
AT V'A5V'V •.
p L E� CO AfC C-1- 5-5.A A_,�
udTC, 2 .Si T'c U.iSMT c' ub Vt-t�.+�' +.1_.T41 '_� H f1 c tL E ("C (j; + 0
I2/28/04

Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint 'OFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: UAWaA S Region:
Farm Name:
Owner Email:
Owner Name: HA/5 A Phone:
Mailing Address:
Physical Address:
Facility Contact: \ITitle:
A Phone No:
Onsite Representative: �ew Ul 6 leFIIVGJ�� Integrator: Jv�
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = n =] I 0 Longitude: = ° =
Swine
Design
Capacity
Current
Population
Design
Wet Poultry C«apacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
IEJ Layer
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
Cb
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Dry Poultry
La ers❑
Non -La ers Pullets
f[D
❑ Turkeys
❑ © Cow
❑ Non -Dairy
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes At No [INA ElNE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 9 No [DNA ❑ NE
12128104 Continued

I
Facility. Number: — Date of Inspection '�,/g
1'
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?
El NA El NE
❑ NA ❑ NE
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LaGocvy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 14 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 V No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes %NO
❑ Yes ❑ No
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 1A No 0 NA ❑ NE
R. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '�� No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes to No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t2. Crop type(s)
t 3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
% Yes
❑ No
❑ NA
,❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
%y �gC�ti rtEc c._� Nln�auf�/� Get Nis 5,�w LAN co �� �G E� j q szn�raw�t s �- AL
�Y.SERtZuJ,ol��vso�c/%c�,yvk) magi (g) -
�A�'TC� utiSCUSS �LFL� c/� I7l wVS 00W 10t�E ES�46usc+ CrEscu�
-4 cuEE�, C0r'( QJZL- ON r��1�! &LpS
Reviewer/Inspector Name �L MA�[JJ NE$ Phone:�lO=�364SFs
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: y — 95 Date of Inspectiion
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes "QkNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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?
❑ 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
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
TANo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�1 ClC ��R j5 W� $�N� N1 s Q�C�MEN�TI DNS !1J �E.Ti�f� T4
"� FGZMEQ • 1 a S 7 f�� i R wlu �A i C C n /v9 ��S 1 v `3E rat ow c
r- p1�10E A 70 -5--E EQ �i6wEE��-GZor� SE�D�avC CLt' AC-0rE
p�aEECZcaAAMENDR) 1cvUs
PPTEp oJYp��ESS t3J �Cu�CnElllT�l'rio1�i
✓a FAQ -NEB y
".Vo(L'r Fa � �DDI oN4 L COn�MC-mot
jqrj
Page 3 of 3 12128104

Type of Visit fig Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine X Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: CC)[" M&A-S Region:
Farm Name: ��CQ�1-t Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:. o l A Title:
Onsite Representative: i ETEl2 1utC]S� �l m``w�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = ; = Longitude: = ° = 4 = u
Design Current
ine Capacity PopulatiJEOLlayer
oulPINsiglWarentl
Design Current
acity Population Cattle Capacity Population
❑ Wean to Finish
I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish _Sq Oa
❑ Dairy_Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA _
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
VNo
El NA
El NE
❑ Yes
XNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

t
FFacility Number: q — 951 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: Liii'�.dCJCJ,71/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p(Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
W 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
V�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
1;9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
MNo
❑ 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
,,**��
l No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA [4 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA NNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
[A NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[4 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
W NE
pV5?eC7)(3Aj CONyuC-71E1-.. w) 014A/ COLLE66 F(1.oO.I.- Sow
16, C(Lpp 15 In/GONYSITICvV LA31 TN UO'T S Or WEE33.
'�$UJ6 1,-) lLL CAN 7PGT 4 )'>Iq IE(.% CONDi l I axiS 4 CAGCcW UFE UGLS
Reviewer/Inspector Name fn4AfQA a4ilveS bmx (tny C. C 1 Phone:
Reviewer/Inspector Signature Date: �a-VOF�
n ,.,, I _f 2 F I I7/2RAM Canlinuvd

Facility Number: Q Lf —rj Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
❑ Yes IN No ❑ NA K NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA VNE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
v
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. ,Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El NA joNE
El NA WNE
❑ NA NE
El NA NE
El NA NE
❑ NA PINE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA [Q NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes UQNo TA NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
Additional Comments'and/or Drawings..
E7Et2 Ii�S S �Qs� W� cWS 1 rC - S,� Lk-) '+ J-!�.,)SCuSS ixG F 1 r 011-3
6.OND1T)&VS -4, 1 yAt )bu3Q "io_ 66 CfJ/VTPC11,VC,) o'R IR MCR- I C-D1SCuS S
I" I C- cDS
Page 3 of 3 12128104

❑ DSWC Animal Feedlot Operation Review
[� DWQ Animal Feedlot Operation Site Inspection
0 Routine 0 Complaint.0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection !r k
Facility Number qS
Time of Inspection ib` 24 hr. (hh:mm)
© Registered 19 Certified 13 Applied for Permit [3 Permitted E3 Not Operational Date Last Operated
Farm Name: �Yf1 j21tt.Yi,S.�i`......F!fx. ............................................................. County:.:.L,dtutl-.6.r.........................................................
Owner Name• _.JP..tCi` A6-vp..................................................... Phone No: ..C�.W.I.A .,3.$.7n............................................
Facility Contact: ................................................ :............................. Title:
Mailing Address:.. i<.Iy..............................................................
Onsite Representative: ........V.iX!�1..... J.06yspz................................................
JCertified Operator :..........4yi �.►�- .......... 1..:.......... ... .� 4n-.a.t...--.-•---.--..---....
Location of Farm:
Phone No: .............
......................... .................... _Z*(.� j..........
... Integrator: ......&l7"A'A....................................
Operator Certification Number,...... �1.Zv
L�nr�.......s9!...... 5...1i...
.......... ....................... ........ ..........:....................................
Latitude Longitude �• �° <
M
Jwme
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design
uapacay
Design Current Design Current -
Poultry Capacity Population Cattle Capacity.; Population
❑ Layer ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity ; j Lv,c'
Total SSLW I q 3 Z
Number of Lagoons / Holding Ponds e Drains Present ❑ Lagoon Area 111 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ 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 gallmiO
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
El Yes
❑ No
3. is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
4- Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97
Continued on back

Facility Number: 7,1,E
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.liolding Ponds, Flush fits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ............1 ... ........................
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?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
❑ No
❑ Yes
® No
Structure 5 Structure b
........................ I... ............. ..._..................
.................................................................
❑ Yes
❑ No ,
❑ Yes
W No
Pfl Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
15. Crop type..................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0; No.vitilitions.or deficiencies were.inotM-during this.visit.:You.'wifi receive:nio' St ri er,::
tirresp ndence about this'.visit.: :: :: ... . ... :
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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11 &0� Mccc) r►1:rter (iYas:ah— Q.rtkt . c,cc.: Skovkj Ve, MSc J
I ii r� 1_ � ] i
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�c sC ��G�.. G� Evrrtc - 1
7/25/97
Reviewer/Inspector Name
s
Reviewer/Inspector Signature:
; �
Date: l &In

Routine 0 Complaint Q Follow-ug of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 3
Facility Number2�
Time of Inspection 3. 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:l 25 for 1 hr 15 min)) Spent an Review
[� Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:.........1C�alr} ^._...._ ...._ .... ....._ .. County: . �Q [J.�?1aLl ..........._ ........., »»......... .
Land Owner Name:.. 3f��iih .... ... _ Phone No:
Facility Conctact:.... a,1.�..Y. .aIC�,!!�if]�li....... _....__..... _.. Title: _...dv..X! Z....../.�..�................. Phone No: .._......
Mailing Address:_ ..SZ'�5....�i�..iR _.��lailf..� ... __...................!4?'..�.1� ....�g�.�....... �.... _ ......_
Onsite Representative:
p .............. ................... ,........ Integrator:. t!Oln?a.S_............................
Certified Operator: ........._....... ...... .......... ......... ... ....... ......_..... »....._......__......»... Operator Certification Number: _ .....__..... ........ _...
Location of Farm:
Latitude ' 4 " Longitude ' • 0 k
Type of Operation and Design Capacity
wS
wDesrgn Current , Design 'CurrentDes�gn Current
Swine fig, �uCa aci •Po iil`ation . Poultry h 'Ca W aci P.o i lation Cattle CaP ad Pv ulat!on" R.
❑ Wean to Feeder ❑ Layer ❑ Da'
IN Feeder to Finish ❑Non La er ❑ Non
Farrow to Wean m fi
A
Farrow to Feeder T tal L"cat Capacity 3 oa
h
Farrow to Finish F�
❑ OthVI `4�..� ,� ,i+�_TVta1FSSLW
Number of Lagooas_f HiSldingPa�nds# ❑ Subsurface Drains Present _ .z
r� w , � ❑ Lagaan Area ❑Spray Field Area �
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0a No
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes allo
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?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes f@ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [ANo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes UrNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 5U No
4/30/97 maintenance/improvement? Continued on back

Facility Number: ...2...._. •-- ..... .Q
6.,Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,tio
7. Did the facility fail to have a certified operator in responsible charge? 09 Yes ❑ No
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes R No
Structures_([^agoons and/or I491ding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [ONO
Freeboard (fl): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 .
10.
Is seepage observed from any of the structures?
❑ Yes
ONo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
[AYes
❑ 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
(allo
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 _.... 5 1. &1 .... ............... rLsi I&............ ...._ —_... .......... ,....._
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
JU 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
® No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24.
Does record keeping need improvement?
❑ Yes
No
Comments.,(;efer to question #f) Explatri any YES 'answersYand/or,any recomrirneridations or any other comments
Use draunngs of facility to bettei explain situations: (use acldttionai pages as necessary)
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wLe� 4,-6 b i�tsa e
IL. Feswe_ y �n,� 5 }� b� I1ir►�►�t� sl�t,yl� be vtdica4d AWAP. CW6f. -<x4tr
Ja6,_O% .
cc: Lywiston of water vuatity, water Vitality 3ectton, ractttty Assessment unit 4/. U/9l