820718_INSPECTIONS_20171231

.._ld=
NOHTH CAHOLINA
Department of Environmental Qual

i ype or vrsit: (.@.Zoutine
ante Inspection V Operation Review (,] Structure Evaluation V I�echnical Assistance
Reason for Visit: Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit:] Arrival Time: Departure Time: S County:
Farm Name: I✓� � Scorn LLC— Owner Email:
Owner Name: `{►j4E Phone:
Mailing Address:
Physical Address. -
Facility Contact: CiVyA I i S ISet-c/` w `�� Title:
Onsite Representative: r•
Certified Operator: 1)j C'k'k-.( _Ca o'er
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: l�
Design Cnrrent .
�:.,4 Cattle Capacity op.
U
111
Wean to Finish
Wean to Feeder
Feeder to FinishUairy
Heifer
Farrow to Wean
� - Design Cnrretit
D . P,oul Ca act � P_o P.
Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
`kE'� a
Turkese
�.,�.�
Turkey Poults
Other
ether
]Layer
Non -La er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
mom
air
Cow
airy Calf
❑ Yes [J_Na__❑ NA ❑ NE
❑ Yes [] No �1� ❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 14 NA ❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)? _
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No I3 "A ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes Na ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: � -7 113ate of Inspection: 71cf
Waste Collection & Treatment
4. Is,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Lj] N-o--❑ NA D NE
r
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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
M-Na
DNA
❑ 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
�
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ElA3e-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:LNg
❑ NA
❑ NE
(not applicable to roofed pits. dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2,SIn_
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DJDA &— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S� ' 1ef
/1{t V
13. Soil Type(s): o , D 6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑moo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes 5D No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3,Ncr ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Eg ❑ NA ❑ NE
❑ Yes ©'No ❑ NA ❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes [. No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? I f yes, check ❑ Yes [3'flo ❑ NA ❑ NE
the appropriate box.
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑ Yes CD-l-o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 13' 0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`? El Yes EJ'No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: 77 Xr,,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CSN6- ❑ NA ❑ NE
25.r1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I11-"U ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ej-.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®Tqo_
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
Q T�o-
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Q-lqo--
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑.No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3 110
❑ NA ❑ NE
Comments (refer to question'#>): Ezlilain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better eapfain situationns (use additional pages as necessary,).
3 —/ J
Reviewer/Inspector Name:
Reviewer/lnspector Signatu
Page 3 of 3
Phone:
C II
re: Date:
214 O15

(Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 4P Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ��.Z__Region:
Farm Name: (� s /� ` ��'' Z� Owner Email:
Owner Name: �P 3h Phone:
Mailing Address:
Physical Address:
Facility Contact: X Title: Phone: `
Onsite Representative: Integrator: `[tJG1
Certified Operator: P-iCl/t..P S"4in Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
hr
Swine Capacity Pop. Wet PouitrJ Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oult . Ca aci P,e
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potentiai 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
❑ Yes rnNo
It —
[:]Yes Ep No
NA ❑ NE
❑NA ❑NE
❑ NA [] NE
Page 1 of 3 21412014 Continued

lgacE!Mumber: j Date of Inspection: I 1 70
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 % � �
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 If
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes t No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? IP
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1ONo
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EEviidcnce of ind Dnft❑ Application Outsidee of Approved Area12.
Crop Type(s): C3Q� 6-I C's &��)
Q T
13. Soil Type(s): Wa
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
fo No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1p No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
D No
❑ NA
NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA P, NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stacking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 0!"E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA 9Q NE
Page 2 of 3 21412014 Continued

'acili Number: - Date of Inspection: 1WM
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes [:]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No
❑ NA WE
❑ NA NE
❑ NA riNE
❑ NA TP NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [-]No
❑ NA ® NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes ❑ No
❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
Yes ❑ No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawin as of facility to better exulain situations (use additional oases as necessarv).
14 4;4- &164v re
Reviewer/Inspector Name:
Reviewer/Inspcctor Signature:
Page 3 of 3
Phone:
Date: �7
4/Z 14

type or visn: w e,ompuance tnspecnon- V uperaaon meview v Ntructure tvatuanon U i ecnmcal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: iJ
IL L
Farm Name: rip Sw � �( Owner Email:
Owner Namee:q,.anpS Phone:
Mailing Address:
Physical Address:
Facility Contact: ,?Q.. l V
� u
Onsite Representative.
Certified Operator: �! &rtp-,
Back-up Operator:
Location of Farm:
Title:
Phone:
Region: 4 20
Integrator: /(/�4 q
Certification Number: 91 1 �D
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design Current
�Wet�Poultry- Capacity Pop. �UUL a dA a .:Capacity Pop.
Layer Dairy Cow
Wean to Finish
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Q
- - ` - -- T' x
_- Design - Eurrent
I)r jPault ,Ca acity P,o
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
42
Other'
Other
Turkeys
Turkey Poults
�q.
Other
Discharges and Stream Impacts
1_ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
[:]Yes No
�NA ❑NE
�NA ❑NE
NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page I of 3 21412011 Continued

Facfljty_Nu bcr: ID2te of Inspection:
Waste Collection & Treatment
4. 1s 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
[�JNA
❑ NE
Structures 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
Q�j No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�j No
❑ NA
❑ NE
waste management or closure plan?
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
�j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5 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
r�71 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 M 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 f (` 0 Elw,,��J
nce of Wind Drift
❑Application Outside of Approved Area
Hi -
12. Crop TYpe(s): I�QS`t� ! w,.r,oie " /j - d eCicX--, 6 rt ^c'-✓moo
13. Soil Type(s): Q •�* - (N
L„
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
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes E� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fiS No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
rA No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
Ir
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
ElYes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes EP No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitvto better explain situations (use additional oaQes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: I it 154, Lf
/4/ZOI I

I ype of visit: V Compliance Inspection V Operation Review V Structure Evaluation () Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up p Referral O Emergency 0 Other O Denied Access
Date of Visit: I Arrival Time: Departure Time: - County:, Region:
Farm Name: Stt, Owner Email:
Owner Name: Sk Phone:
Mailing Address:
Physical Address:
Facility Contact: Taqgj i 2i+ftp,�� Title:
G
Onsite Representative:
11
Certified Operator: _12i a ne k i
Back-up Operator:
Location of Farm:
Latitude:
Integrator
Phone:
I • """r `IfzOleiw
Certification Number: zy
Certification Number:
Longitude:
D gn Current
Design
Current
Design Current
Swine
CapacityPop.
W,et. Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
ziejo
17B-W
iry Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oultr,
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoults
Other
I Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes rp No ❑ NA ❑ NE
❑ Yes
❑ No
" NA
❑ NE
❑ Yes
❑ No
fo NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
❑ Yes No
❑ Yes No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 12_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: --
rpNo ❑ NA ❑ NE
❑ No DNA ❑ NE
reStructure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Qff 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
NA
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�j No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cop Window ❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s):YS
13. Soil Type(s): mot' �s-t l t 6� r A4w-aM
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres detennination?
17. Does the facility lack adequate acreage for land application'
❑ Yes
[� No
Tim
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes y No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes 6ja No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: - Date of Inspection: I'j Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes T No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes §g No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
Qj No
❑ NA
❑ NE
[:]Yes
EA No
❑ NA
NE
❑ Yes '[P No
❑ Yes q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes y No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes T No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P
No ❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�51u4y ,f_ dcj, LL� � 2-b Iq li
Reviewer/Inspector Name: a.✓b% Phone:
Reviewer/Inspector Signature: Date: I7 'z-
Page 3 of 3 21412011

r ype or visit: Rp compliance inspection U Uperation Review U Structure Evaluation U 'Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: % Z Arrival Time: Departure Time: ounty: tt eA Region:
I
Farm Name: s W a/ rvl Owner Email:
Owner Name: i W Fq rM S —T�1 C t Phone:
Mailing Address:
Physical Address:
Facility Contact:
To 14 dI k4,v,- Title: Phone:
U
Onsite Representative: Integrator: r100 11
Certification Number:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
-- g ,. off{ °,�>*� P
�R y Des n Current p Design Current
Swine " .,CapacityPop Wet Poultry Capacrtyp.
A
1:
Design Current
Cattle Capacity Pop.
Dai Cow
inis
La er
eede
Non-La cr
Da' Calf
inish
Wean
Feeder
Finish
V
20
Z
=
Current
D P,aul '. Ca acit' P.o
La ers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other
Turkeysmill,
Turkey Poults
Other
In
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes
� No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
FM NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[:]No
NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Ej4 No
❑ NA
❑ NE
Page I of 3 21412011 Continued

7acilih Number: - pate of Inspection: 17
12
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
N No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
IV No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
r Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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 171 � No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
r" 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
[P 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 Win ow ❑Evidence of Wind Drift ❑ Application
Outside of Approved
Area
cil�rt
12. Crop Type(s):
13. Soil Type(s): �1' k 0
14. Do the receiving crops diner from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[� No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
j54�No
TP
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
El NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
TT
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:)Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facilih Number: - Date of Inspection: / JZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1i�[ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [!p No ❑ NA 0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1P
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pates as necessary).
,51e,t '�' C­ ("'41 zo I �'
Reviewer/Inspector Name:
Reviewer/Inspector Signature: ' 1" ► i' 1
Page 3 of 3
Phone: 1 r® 3�-
Date:
21412011

r'q
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �Ij�f 00,
Arrival Time: Departure Time: County: Region:)9_�2)
Farm Name: h 1 rw Owner Email:
Owner Name: l.J�l.fry 5C(, n Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
cr
Certified Operator: PG�j-jQ
Back-up Operator:
Location of Farm:
Title:
Latitude -
Phone:
Integrator: ,p &�tcw
Certification Number: 70 WJC/
Certification Number:
Longitude:
u' Desn�Ce
Swineurrent
p ty DesignCurrent = Design C
) Ca aci PP o M Wet Poultry' Capacity' Pop.. Cattle Capacity Pop.
Wean to Finish Layer Cow
Wean to Feeder
Non -La er
I
—Dairy
Dairy Calf
Feeder to Finish
f ' "' Design *C_ urrent T
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dry P,oultry C•_a aci-- P,o
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
>T
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Dischar es and Stream Im acts
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 IN No ❑ NA ❑ NE
❑ Yes
❑ No
Qg NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[] Yes ❑ No
[] Yes KM No
❑ Yes 0 No
V9 NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

FIftili Rumber: - Date of Inspection: JIM11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O 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:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
[0 No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
`3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks. and/or wet stacks)
T
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?
T
11. Is there evidence of incorrect land application? If yes. check the appropriate box below. ❑ Yes [p No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes[ No
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No
18. Is there a lack of properly operating waste application equipment'? ❑ Yes No
Required Records & Documents
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility faii to install and maintain rainbreakers on irrigation equipment?
❑ Yes
& No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

E cilit • ]kumber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes IO No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CR NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes {71 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. f3
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Q No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Cp No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? [:]Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
S i tkd c Sw / �C2- ,ta , — ,J t ,
,�C_—Ome
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ar:jgLf 3�
Date: Lqt
t
21412011

j
Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit *Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑denied Access
Date of Visit: l l Arrival Time: iB• 0Ot2r�. Departure Tine: � � � County: Sow Region: Ie
Farm Name: 04?:!1nP L7f T17�''1 Z� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: AOU41 P 0 Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:A// ���...
Integrator: � `'jam L(c
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� c F-71 i 0 ti Longitude: = ° = I = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
to Finish
❑ Laer
❑ DairyCow
to Feeder
❑Non -La Non -Layer
❑ Da' Calf j
r to Finish
❑ DairyHeifer
to Wean
Dry Poultry
❑ D Cow
to Feeder
El Non -Dairy
w to Finish
EB30ars
❑ Layers
❑ Beef Stocker
an -a ersPullets❑Beef
Feeder
❑ Beef Brood Co_011❑Turke
s
❑Turke Poults ❑
Number of Structures:
Other
Discharges &Stream Impacts
l . Is any discharge observed from any part of the operation?
El Yes
(]g No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑ Application Field ❑Other
a_ Was the conveyance man-made?
El Yes
❑ No
� NA
❑ NE
b. Did the discharge reach waters of the State? ([f 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)
El Yes
❑ No
y NA
ElN E
2. Is there evidence of a past discharge from any part of the operation'?
❑Yes
'fe No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
J�j No
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

t
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�INo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
qNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
10 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
'M No
❑ NA ❑ NE
maintenance or improvement?
1
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.
El Yes Yes
,
� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13_ Soil type(s)
14. uo the receiving crops ditter from those designated in the CAWMP'I
LI Yes
UN No
L NA
LI NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
py� ►'t P j}QXV�I T Kr CgfJLI _/D Do0
0111 QynOnP1C191!9 �,Cp1vtJ
Reviewer/Ins ector Name r, a�„ r
p _� , IR Phone: ID r m
Reviewer/inspector Signature: Date: �� D
12128104 Continued

t
'Y Facility Number: Ck '— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [d No [INA ❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[)a No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
T No
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
[B No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
( 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
EP 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
fj�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1'_ No
❑ NA
❑ NE
A'ddtkional,CommeAtsAdd/or Drawtngs r „ i ,.a ,;i
a
l2%2&(04

Water Quatit
iFDivision 01K,
y 1/
aeility Number '"�' Division of Soil and Water Conservation
Q Other Agency
-type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 ----1 -- Arrival Time: # `3A Departure Time: �� ounty: Region:
Farm Name: �S— Q -1 � S�O -[ +� Owner Email:
OwnerName: hLalr1Q 5;C1f7,rP1 Phone:
Mailing Address:
Physical Address:
Facility Contact: �l�_ /J ( egoTitle: Phone No:
Onsite Representative: Integrator:
Certified Operator: �� S' sty Operator Certification Number: 230
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E� e ❑' E=] u Longitude: ❑ ° ❑ I =
Swine
Design Current
-Capacity Population
Design Current
Wet Poultry Capacity Population Cattle
Design Current
C►apacity Population
❑ Wean to Finish
Layer
iry Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
Feeder to Finish
o2f6
Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑Non -La ers
El Pullets ❑Beef Feeder
❑Beef Brood Co
❑ Turkeys
❑ Turkey Poults
ther Number of Structures:
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
l . 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
1�NA
[
El NE
El Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
ElYes
No
�NA
❑ NE
❑ Yes
E? No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: w^ r7lp, 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
I [] No ANA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5 Structure
6
Identifier:
Spillway'!:
Designed Freeboard (in):
Observed Freeboard (in): 4f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Wo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
(� No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
iM No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ip 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
[I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[D No ❑ NA
❑ NE
maintenance/improvement?
It. 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 a 10% or l0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence ofWind Drift ❑ Application Outside of
Area
lZ. Crop type(s) CAS muGCR ASS 'V17 dlle I <u, 6.-41^ DI P.[ 5-
ii1
0-aw- r
(/
13. Soil types)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
JP No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
to No
❑ NA
❑ NE
Reviewer/Inspector Name WIRP MUM ( Phone: 110f�33-
ReviewerAnspector Signature: Date: a —I w
Page 2 of 3 12128104 Continued

.. v
Facility Number: —' % a7 Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
the appropriate box. ❑ WUP ElChecklists ElDesign ❑ Maps ElOther
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 l" 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
15 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
V No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 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
Page 3 of 3 12128104

j
Type of Visit w Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other [I Denied Access
Date of Visit. 11 Eat Arrival Time: ��Departure Time: E County: Region:
Farm Name: SK n — Owner Email:
OwnerName: A&awe -5,,A4im Phone:
Mailing Address:
Physical Address:
Facility Contact: u Al,,' atul Title: Phone No:
Onsite Representative: u Integrator:
Certified Operator: ;CLete t � 6i, Operator Certification Number.
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ I =" Longitude: = o = 9 ❑ u
'w• ♦ r� ski dam' ..-
`.1 Des Curp
Mahon
.: j r.
Desig-Cuent
WetatCiiaciPu
�
CatCDaesaigcint PoCuurlaetniotn
te
n P Y P
icush
er
Dairy
❑ Wean to F❑ La
❑ Wean to ❑
Discharges
Feeder Nvn-Laver
&Stream Impacts
Cow
❑
Dairy Calf
❑
❑ Dairy Heifer D Cow
❑
Non -Dairy
❑ Beef Stocker
I. Is any discharge observed from any part of the operation? El Yes (�No ❑ NA ElNE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made? [3 Yes ❑ No � NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No � NA El 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 ,❑Q Na VI NA El NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes W No [I NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than horn a discharge`?
Page l of 3 1l/.i8/04 Continued
&Stream Impacts
Cow
❑
Dairy Calf
❑
❑ Dairy Heifer D Cow
❑
Non -Dairy
❑ Beef Stocker
I. Is any discharge observed from any part of the operation? El Yes (�No ❑ NA ElNE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made? [3 Yes ❑ No � NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No � NA El 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 ,❑Q Na VI NA El NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes W No [I NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than horn a discharge`?
Page l of 3 1l/.i8/04 Continued
I. Is any discharge observed from any part of the operation? El Yes (�No ❑ NA ElNE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made? [3 Yes ❑ No � NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No � NA El 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 ,❑Q Na VI NA El NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes W No [I NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than horn a discharge`?
Page l of 3 1l/.i8/04 Continued

Date of Inspection f t7
Facility Number: -- 7/$ 1
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
[ONA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�%o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[}No
❑ NA ❑ NE
through a waste management or closure plan?
f
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
rANo
T
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[%No
❑ NA ❑ NE
maintenance or improvement?
1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window iin_dow`,!1I❑ Evidence of Wind Drift!! ❑ Applicatioon�n Outside
of Area
12. Crop type(s) ' �L�ItlT`
S4� l fiat r �L1SJ l�1.� f'2+�� �h� . �u;h
--
13. Soil type(s)
- v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
PIo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
fDNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JpNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any ether comments.
13se drawings of facility to better explain situations. (use additional pages as necessary}:
T
Reviewer/Inspector Name Phone: 0a '/33- 33Gp
Reviewer/Inspector Signature: Date: 6 178
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection I1 OS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )DNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P 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?
ElYes
Q 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
$MNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PQNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
#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
6No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
jj��,,
is 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
5,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
C&Nct
❑ NA
❑ NE
Additional ;Comments and/or Drawings:
Page 3 oJ- 9 12128104

• Division of water Quality
Facility Number M
2 0 Division of Soil and Water Conservation
- 0 Other Agency
E
ofVisit 0 Compliance Inspection O Operation Review O Structure Evaluat€on 0 Technical Assistance
on for Visit & Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Aivrrival Time: f;! Departure Time: 1 County: Region:
Farm Name: 1`Q Jw r 7;�M .7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: JA6 ttl�l Aj_le Qs•'+G/ _ Title:
Onsite Representative: w -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
n
Integrator• I r� q4 I
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ e 0 E= u Longitude: ❑ o Q,❑ µ
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layei
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
t)
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
l . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters ofthc 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?
J
❑ Yes L.? No ❑ NA ❑ NE
❑ Yes
❑ No
(9PNA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
f3 No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
12128104 Continued

,a j
I acility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Mo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ffNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
09No
❑ 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
n No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop indow ❑Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s)n
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1 , AL
Reviewer/Inspector Name Phanr W j
:
Reviewer/Inspector Signature: Date: 7 6
12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20- Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ,,��aa
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes t_I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
)Q 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 sludge survey as required by the permit?
❑ Yes
6No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
b No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ 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
F1 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
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

� Division of Water Quality
iFaCility Number S ! r(j)1ivis
ion of Sail and Water Conservation
ber Agency
Type of Visit 0 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: i ,Z i) Arrival Time: lo: S Departure Time: a a... County: 54W"rS0N Region:
Farm Name: W - jDftl Owner Email:
Owner Name: U1 VW S , Phone:
Mailing Address: 3815rt-#ri`i�l�r l�t."!� R�?Ot't A) C— -163 t
Physical Address:
Facility Contact: hoLkq tjiu, O" AA Title: �} Phone No: y
Onsite Representative: �n �e WACnd' _- Integrator:if C�'1'1tc.t►'i"-5tdj'd0,,0( _
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' ❑ Longitude: 0 ° = , =
Y Design Current
:r
Q� r�, f"
{ :
Cu rent
Design Current
Swine Capacity ,P pu ation
.Deign
Wet{'Paultry
s
Capacig P, matron
.)_?r.:
Cattle Capacity Population
Cow
DaCalf
❑ Wean to Finish
❑ Layer
I
I❑Dai
❑ Wean to Feeder ya ❑Nan -La er I I❑
Feeder to Finish
�yre'
K "A
❑ Dairy Heifer
t r'
Dry Po
_�
❑ D Cow
❑ Non -Dairy
El Farrow to Feeder
Farrow to Finish
Discharges &Stream Impacts
I . Is any discharge observed from any part of the operation?
❑Yes
� No
❑ NA
❑ NE
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
[I Yes
❑ Na
[ANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify D41rQ)
❑Yes
❑ No
[S 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
❑ Na
[QNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
Q9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
gNa
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

F.?sility Number: �— 'l
Date of Inspection 1 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 1
❑ Yes V9 No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
I, NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�9 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
W No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�] No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
r4No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[S No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[,] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Rey
a PAS ( �Y1, 4 ef+ RS vwe , [ I �� r Oyz, S
13.
Isr+�•a
Soil type(s) " � t�aqra� L� I�Sb� v Ito t-eSt�+
_
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? ❑ Yes
09 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
® No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Comments (refer.to question :; Explain any YES answers and/or any recommendations or any other comm h
Use drawings of facility to better explain situations (use additional pages as necessary): --F
_._ _.. _ __ _ _ -------,--- _ - - --- -- - - - Phone:
-� y3 3 - 3 Sao
Reviewerllnspector Name
Reviewer/Inspector Signature: fADate: /AIV4
Pate 2 of 12128104 Continued

Faeility Number: Date of Inspection ( r
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'Po ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [ 1 Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[}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
;ENo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ 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
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1p No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D9 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
R9 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
IR No
❑ NA
❑ NE
.r
Additional Com penis and/or Drawings: f i.
Page 3 of 3 I2128104

dr
Type of Visit 411 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: l ! : / d Departure Time: County: -S_► 9soz2 Region: if,?O
Farm Name: t:✓T e S, h1o, _roM Wig_ Owner Email:
Owner Name: Ar Sv75�isn Phone:/b' S`1y-
Mailing Address: .39/ S� o.� �6w,� /Q�[ .,., F ,sy!n AIL _._,29-?`l_l
Physical Address:
Facility Contact: _ 02M /✓•uwd.,r,( Title:
Onsite Representative: doarr,
Certified Operator: ke _ /�1c-L.,Ile.,
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _ /e.-„'��-, S/r,.,.1/o1,1/ _
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = , Longitude: ❑ ° ❑ 1 = u
Design Current' . Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
©'Feeder to Finish I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made?
Design Current
Capacity- Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
DEY Cow
❑
Non-Dai
❑
Beef Stockez
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
Number of Structures: ELI'
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 [' Mo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2'�Ko
❑ NA
❑ NE
❑ Yes
2-Ko
❑ NA
❑ NE
12128104 Continued

r `
Facility Number: Date of Inspection 3 36-of
Waste Collection & Treatment
4.
��,,��
❑
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E3 No
❑ NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: - -
Spillway?: 070
Designed Freeboard (in): o? 0:4.'.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes allo
❑ 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 [20No
❑ 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
QNo
❑ 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. 1s 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
_7s9 or - 901 iOo y-sv
12. Crop type(s) 8er#%11 1.K All
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
D-No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[9-f4o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-] Yes
❑ No
❑ NA DON
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA Q'NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ o
❑ NA ❑ NE
Reviewer/Inspector Name � Gr�► � � Phone: 1/0-YkG - 19y/ e-w7io
Reviewer/Inspector Signature: Date:
IL/irW VT �-VI�i•/aMLM

Facility Number: 9,2 — Date of Inspection 3'Ja-ps
Required Records & Documents ,—,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes !� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D No ❑ NA ❑ NE
the appropirate box.
E1,W16P ❑ Che fists ❑ Dp6 ❑ N�s ❑ 0
21. Does record keeping need improvement? If yes, check the a ropriate box below. B Yes ❑ No ❑ NA ❑ NE
❑ r ❑ ❑ 7�arste-fln�lpsis ❑ fir` ❑ Was#e�m�sfefs-- ❑ 'on
❑-Hain I❑ peeking- rop Yield ❑ 1 a s❑ W athe,�e
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? (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?
Additional Gotnuients audloi V; awin$s_VR- 'k` F- .: 4�'qk" _ . .
y. x W MA r
❑ Yes
[[No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[�'NE
❑ Yes
❑ No
❑ NA
C?IqE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
Ulf o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2 F4E
❑ Yes
2f' o
❑ NA
❑ NE
❑ Yes
Mo
❑ NA
❑ NE
❑ Yes
[r10
❑ NA
❑ NE
❑ Yes
0' o
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
❑ Yes [21�o ❑ NA ❑ NE
, /east •n i tek / Aar /1Toa�i�, O^cl Fitcr i ° CU..7 .'I*15/p•c7el ba,j
rfev.'ewej Cra� I.'e/,/ P"'., f
12128104

. Arvr`� �'- aa�a`� 's- kF -. � �_.T3+'"•rs.4.. � i .2" � �"`rrm..A" a '. ..-�;: rtia�-y e _
Type of Visit C)-C�ompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit outine Q Comptaint O Follow up Q Emergency Ngti�icpt}Qp ,0 Other ❑ C)enied Access
Facilin- :lumber Date of Vicit: Time: —�
rO lint O erational Below Threshold
Erf
ermitted ertiDed Conditiona}l"l"�' Certified ©12egistered Date Last Operated r Above Threshold:
Farm dame: W S.t�n TR�%1` County: q � vHJ
Owner Name: W >'e S s' Phone No:
5
Mailing Address:
Facility Contact: w dik N Title: Phone No:
Onsite Representative: �iGD�I Integrator:
Certified Operator: M' ke 64 1 k4l._ Operator Certification Number:
location of Farm:
Swine ElPoultry ❑ Cattle ❑ Horse Laritude " 4 ^ Longitude ' �• �w
Design Current
Swine C'anarih Pnnntatinn
❑ W o Feeder
[9-5eeder to Finish
I D
❑ Farrow to wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry° Capacity Population Cattle Ca achy Population
❑ Laver I [I Dairy
❑ )von -Laser ❑ )don -Dais
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons i U Subsurface Drains Present 1LJ Lagoon area JLJ Spray Field Area
Holding Ponds f Solid Traps � i,] No Li uid 'Waste Manaagement System
Discharges & Stream Imnacts
1. Is an<< discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ SDrav Field ❑ Other
a. If discharge is obsen-ed was the conveyance man-made?
b- If discharge is obsmed, did it reach Water of the State? (if yes, notifi- DIVQ)
c. if discharge is observed. what is the estimated flow in aallmin?
d. Does discharge bypass a lagoon system? (If yes. notif.- DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ StrillwaY
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): _ --
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
El yes
�Q,�;sdo
N0
ElLtYes
,LET,
114
Structure b
05103101 Continued

Facility Number: 0X — j
Date of Inspecliun O
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ER no
[:]Yes ❑ 46--
❑ Yes 91 0'
8_ Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes o
_Waste ARnlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 3-No'
11. Is there evidence of over application'? rr ❑ Excessive Ponding 0 PAN ❑ hydraulic Overload ❑ Yes No
ir� 12. Crop type d& CV;�'r./! `
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes []-Noi
b) Does the facility need a wettable acre determination? ❑ Yes Q_N0--
c) This facility is pended for a wettable acre determination? ❑ Yes ❑Av-
15_ Does the receiving crop need improvement? ❑ Yes B.N '
lb. Is there a lack of adequate waste application equipment? ❑ Yes L`flvo
RRguired
Records & D_Uuments
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[- +1r-1
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
��
4o
(ie/ WUP, checklists, design, maps, etc.)
ElE Yes
l9.
Does record keeping need improvement? (ie/ irrigation, freeboard. waste analysis & soil sample reports)
❑ Yes
❑fi''o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
G-Ko-
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
LiTVo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes
C No
25.
We"y additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
I�No
ItF7No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations ar any other c
Use drawings of facility to better explain sit ntlons. f oss additional pages as necessary): field Copy ❑ Final Notes
�ooci Claps Gi�ci �S�o[J ilGcal`d� I1
4 . 4:�vvc ` !�[ ors � �u^ i✓l t'�cv— lu�..C,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: zzz3 104
05103101 Continued

Facility Number: 9. — Date of Inspection 3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a p'ermanent/temporary cover?
❑ Yes
❑ Yes LSO
❑ Yes EM--
❑ Yes
No
❑ Yes
o
❑ Yes
�rNo
El Yes
No
05103101

C
Division of Environmental Management
Animal Feedlot Operations Site Visitation Retard
Time: - 00
Seer eral Information:
Farm Name: 'fib N1 .2_ County:
Owner Name: ^ S Phone No:
I
On Site Representative: U00Integrator.T"��p_ _
MaUing Address: 0
Physical Addres&I-ocation: 4, jjG' �►r ! 1 �e
Latitude: :3-5 -_I `i I 2 Longitude- _ 7� //Ej :�J_
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals 7�pe of Cattle No. of Animals
C3 sow ❑ Layer O Dairy
© Ntttsray 0 Non -Layer U Beef
0 Feeder
OtherType of Livestock Erg� -L% ,w , t Number of Animals:� `f 9 0
Number of Lagoons:— - �_ (include in the Drawings and Observations the freeboard of each lagoon)
acili Insecti
Lagoon
Is Iagoon(s) freeboard less than Ifoot + 25 year 24 hoar. storm storage?:
Yes ❑
Now
Is seepage observed from the. lagoon?:
Yes ❑
NgPW,_
Is erosion observed?:
Yew
No ❑
Is any discharge observed?
Yes ❑
Now
0 Man -mode 0 Not Man-made
Cover Crvp
Does the facility need more acreage for spraying7:
Yeses
No 0
Does the cover crisp need improvement?:
Yes ❑
NoQ3
( list the crops which rued improvement)
Crop type:- r - - _ Acreage:
Setback Criteria :. .
Is a dwelling located within 200 feet of waste application? Yes 0 N00.
Is a well located within 100 feet of waste application? Yes © NVQ
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes Q Nee -
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes D Noj-
AOI — January 174996 • ►: r ram'. -. = - .

_._Maintenance
Does the facility maintenance need improvement? Yes ❑ Now
Is there evidence of past discharge from any part of the operation? Yes 0 Nof&-
Does record keeping need improvement? Yes 0 No 0
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 0 No ❑
Explain any Yes answers: s '�
2 5+
ec: Faci7hy Assessment Unit
Drawimp Qr Observatio
0
Daw:
Use Attaeb w= jfNeeded
..--- --- -'— •�C�r..��-.•r..r a��rt:- `!n sr.R1'(��'1} ��.ey �.� s.fr...y���.. �w-tr-v.•+��-�N_- -:^R
AOI — January 17.19%