820538_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
O)N

W1
Division f Water Resources
Facility Number rN= 3 O Division of Soil and Water Conservation
t Q Other Agency
Type of visit: Frompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: O Routine O'Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:I�l V i County: 314M'CIIr) Region: FI �D
Farm Name: 12 - V1,d& (1 Fa e-1 Owner Email:
Owner Name: go,F r�G ll Phone:
Mailing Address:
Physical Address:
Facility Contact: C,,w q �a✓w�cA Title: Phone:
Onsite Representative:
It
Certified Operator: ay*A I V0 Obt-0
Back-up Operator:
Integrator:
W t3 S
Certification Number: r SY
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3 -No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
a Current
❑ No
Design
Current
Design C►nrrent
Swine
Capacity Pop.
k Yr
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[3"9-A
La er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dai Cow
Wean to Feeder
v0 iib
Non -La er
❑ Yes
Dai Calf
Feeder to Finish
❑ NE
of the State other than from a discharge?
Dai Heifer.
Farrow to Wean
Design
Current D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
��° ;���
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3 -No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
[-]Yes
❑ No
D -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
[3"9-A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[,1446
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
O K
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2015 Continued

Facility Dumber: 97 - S33 jDate of Inspection:
Waste Collection & Treatment
❑ Yes
Q o
[: NA
❑ NE
4fls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ea-Ner❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
D Yes
❑ No
Q-347V- ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Spillway?:
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Required Records & Documents
Observed Freeboard (in): -- 7-
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�o
❑ NA
❑ NE
large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[911G
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health: or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[! No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z],IQo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any pan of the waste management system other than the waste structures require
❑ Yes
bto
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑�N-o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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 Windrow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 5 "f'"I S & Z)
13. Soil Type(s):Wtti � l�i/l''�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
[: NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ED;V°
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2-90
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[EJ�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[-fj`No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes ellro
❑ 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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes O'No
❑ Yes dNo
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Wacift Number: Z- S 3 Date of inspection: 4V S '-J-2s Ae
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []�o ❑ NA ❑ NE
r
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑-34o' ❑ 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 E=1 1 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Io ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes Fa ❑ NA ❑ NE
❑ Yes BNO ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency`? ❑ Yes FNo ❑ 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).
ra,� S'- �-3- t6 5'ly� 5��j �f_(, --r7
'q3'7 -a
Reviewerllnspector Name: k� i 1 I U U 4,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ,()_q3J_ 33 z f
Date: J rE K ,101
2141201S

ivision ufWater Resources
Facility Number - O Divfsiouof Soil and Water Conservation
`© Other Agency -
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: t!rRoutine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit:7_nau Arrival Time: r(�D Departure Time: County: {l� Regiowi ff
Farm Name: J``�'--
Owner Name:
Mailing Address:
Phvsical Address:
Owner Email:
Phone:
Facility Contact: CU u4 Uefdldt _ Title: Phone:
Onsite Representative: Integrator:
S
Certified Operator: - AltCertification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Im acts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [E !Vc' ❑ NA ❑ NE
a. Was the conveyance man-made.' ❑ Yes ❑ No ff NA ❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWR) [:]Yes No [n -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (II'yes. notify DWR) ❑ Yes ❑ No eNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued
Design Current
-llesign
Current-+
Design Current
Swine = Capacity Pop.
WetPoattry Capacity
Pap.
Gattfe r Cagaeit�° Pop.
Wean to Finish
La cr
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Y
�
Dairy Heifer
Farrow to Wean
Desi h
Current
Dry Cow
Farrow to Feederl)r}
l Dolt Ca act
P,,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
(3ther
Turkey Poults
01 Other
Other
.•...mow
�.�--�.�..-�...�,,.��::;-�
., '" ...
Discharges and Stream Im acts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [E !Vc' ❑ NA ❑ NE
a. Was the conveyance man-made.' ❑ Yes ❑ No ff NA ❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWR) [:]Yes No [n -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (II'yes. notify DWR) ❑ Yes ❑ No eNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Fac' ' Number: ML Q 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3'K-oo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
g:;XA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .7j -.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑e .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
�To
❑ 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
[2,f4o
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EBI�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑'1Go
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2No ❑ NA ONE
❑ 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): Gt/ty t jj f, C>
13. Soil Type(s): � t�� i6 b
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LaNo ❑ 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 UNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. 1s there a lack of properly operating waste application equipment?
❑ Yes ❑"'No ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [.,Ado ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Wo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 110
❑ 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 w No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[:INA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facil' Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'1`10 ❑ 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)
3 i . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
CD'No
❑ NA
❑ NE
❑ Yes
[ f' o
❑ NA
❑ NE
❑ Yes
E:�No
[DNA
❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes E2'No ❑ NA ❑ NE
❑ Yes [;]-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[IFNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
[Et No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[�!rNo
❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
c�( filo- 30$-6�51
Phoncq1p—'(33- 333f
Date:
2/4/2015

AIKs r
Type of Visit: Q Com fiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Gf Routine 0 Complaint 0 Follow-up Q Referral d Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 7 County. Region:
Farm Name:
I I d� rR-�M Owner Email:
Owner Name: I�.cdGVy,�% Phone:
Mailing Address:
Physical Address:
Facility Contact: !9 [ur1V4 Title: Phone:
Onsite Representative: Integrator: A ( J
Certified Operator: EV" &OtA Certification Number: t ftp J
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude: /b / /y
�9
Swine
Desrgn Current
CapacityPop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Cerrrent
Gsttle Capacity Pop.
Wean to Finish
I
La er
INon-Layer
I
Dairy Cow
Wean to Feeder
Feeder to Finish
Daily Calf
D . i'ottltry
Layers
r
Design
G$ aci
-
Current
I;o .
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
rrow to Feeder
rrow to Finish
lts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
ars
W_Turke
IV
..�
s
Turke Poults
Other
BMW -
her
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation? [:]Yes [1f No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No �NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No E SNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [21No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [J'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412015 Continued

Facili Number: - Date of Inspection: •-w
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J'No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes EE No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '-f3-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C3114o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 2�4o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes gr% ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes eNo ❑ NA 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes N"o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [allo [DNA ❑ 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): P er.�--V ( J -
13_ Soil Typc(s):
14: Do the receiving crops differ 06m those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
[:]Yes
[2fo
❑ NA
❑ NE
❑ YesI7fo
! No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
! No
❑ NA
❑ NE
[:]Yes
2-90
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EJONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check [:]Yes [; No ❑ NA ❑ NE
the appropriate box.
❑VIWUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes Er'�o
❑ 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 [1 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes WNo
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

1Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 2-11*7 ❑ 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 o ❑ 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
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)
❑ Yes [2'No
❑ Yes EJ/No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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
ER<D
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
C244o
❑ NA
❑ NE
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �31
Date: I/*
2/4/2011

I •
type or visit:[(�ptiance inspection V operation Review U Structure Evaluation U leehnical Assistance
Reason for Visit: 04outine O Complaint 0 Follow-up 0 Referral C) Emergency 0 Other O Denied Access
Date of Visit: Arrival Time:SI"1 p ]Ir I Departure Time: County: Region�t�
Farm Name_ [� �+�� Owner Email:
Owner Name: Phone:
f l �/ (� Phone:
Mailing Address:
Physical Address:
Facility Contact: a V�(� ' VCS.. &e Title:
Onsite Representative: 1(
Phone:
Integrator: A43
Certified Operator: Q.,A Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
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?
Page I of 3
E] Yes N A F] NE
❑ Yes ❑ No aNA- ❑ NE
❑ Yes [:]No []-N* ❑ NE
[:]Yes [] No
❑ Yes G -No
❑ Yes 4E] No
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued
Current
Design
Current
Design
Design Curren#
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
airy Cow
Wean to Feeder
lglco I
Y so
Non -La er
Da' Calf
Feeder to Finish
= ---_ _ -
- : _ _ . .:.. -,
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
b = 1?oult .
Ca aci
P,o -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
IPUIlets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [❑ Structure ❑ Application Field ❑ Other:
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?
Page I of 3
E] Yes N A F] NE
❑ Yes ❑ No aNA- ❑ NE
❑ Yes [:]No []-N* ❑ NE
[:]Yes [] No
❑ Yes G -No
❑ Yes 4E] No
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

4P 4 14
Factli ]Number: jDate of Inspection: �
Waste Collection & Treatment
4. Is storage capacity (structural plus'storm storage plus heavy rainfall) less than adequate? ❑ Yes Z3_Ne--[jNA ❑ NE
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 (Zj_b1u' ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 0 --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
Z;446'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E ,40
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
Ofi%
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Bio
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
0-
❑ NA
❑ NE
Waste Application
[] Yes
Q No
[] NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[10
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
hTo
❑
❑
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cl VLCt4 S l!7�(7 _
13. Soil Type(s): - C)�g j] ( b6
14. Do the receiving crops differ from thosVdesignated in the CAWMP?
❑ Yes
Z3 ,15 -o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3'<io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ofi%
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0-
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
Q No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have Certificate
NA
NE
the of Coverage & Permit readily available?
❑ Yes
hTo
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑`1Qo
❑ 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 13"�o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall E] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

LFadliq Number: r ' - Date of Inspection: u
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0t5 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D-N'o— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 O 171 [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ej< 0 NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 10 ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes [!] N ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ YesdNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes %[ No ❑ NA ❑ NE
( zany additional recommendations onany othericornmemtsk.
omments refer to question:#): Explain any YES answers and/o
rse dram of `fkcditv.'to better'mlain situations (use additionai'naQes as necessarv).
S«yeS� is ti��t uKs P,�,s �F��O
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3E3!
Date: U
& (I
214/1014

(Mk 17 W_._lU fid l)
Type of Visit: B Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other, O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regio
Farm Name_RLA (LJ iL Owner Email:
Owner Name: T� Phone:
Mailing Address:
Physical Address:
Facility Contact: ��`� r�) 3, trC4 cl� Title: Phone:
Onsite Representative: G a+A 00 ' utU Integrator: 01-S -S J 4?6
Certified Operator: Certification Number: 19 7 S(
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
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)?
❑ Yes [ ❑ NA ONE
[:]Yes ❑No [E -KA ❑ NE
t
❑ Yes [:]No [B NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No [4 'NA J_j NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yeso ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Derr Current, I�nCurrent ' Desr'p7y Current
Swine
Caparrty- Po',et.Poultry
Capacti} Pop'
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
tp Non La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Weanr
k
-u e
Design Currents
Dry Caw
Farrow to FeederDPo"
uZJ
aci Po s�
-Dairy
,Ca
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkey Poults
Other
Jig, 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)?
❑ Yes [ ❑ NA ONE
[:]Yes ❑No [E -KA ❑ NE
t
❑ Yes [:]No [B NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No [4 'NA J_j NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yeso ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is s4brage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-1' r' o NA ❑ NE
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 ED -N" ❑ 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 C2173-'[] 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 �3Qo �❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [—]Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a'1 =o NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ Vo— ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff o `❑ NA ❑ NE
Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate ManwWSludge into Bare Soil
❑ Outside of Acceptable Crop Window �j❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Sail Type(s):
14. Da the receiving craps differ from t9se designated in the CAWMP?
❑Yes
o [] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3"No
❑ NA'
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
02rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesrN
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
❑ 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 p Weather Code
[—]Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes [' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I o ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

FaciliNumber:Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes �[3 NA 0 NE
25. Is i{lte facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 -No —Q NA E] NE
the appropriate box(es) below.
EJ 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 �o f ] NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes 3-lga [] NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document'
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application. Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
t t(t+,, Cul
B Y�,6
i q. C(
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 Yes QI-No ❑ NA [] NE
C] Yes ['No [] NA ❑ NE
E] Yes �o ❑ NA ❑ NE
❑ Yes Cj-lq° [DNA Ej NE
❑ Yes
allo
❑ NA
[—] NE
[] Yes
Q o
NA
❑ NE
❑ Yes
[g'<Io
[] NA
❑ NE
Pholn ( 4� � � �3
Date:
1./4/201

.. . 61VAS 1) mot) 13
Type of Visit: OCom fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: C outine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: 1POV Arrival Time: l• 00 Departure Time: County: { S1W Region:fZ
Farm Name: Rot it, V, Aw Owner Email:
Owner Name: Phone:(r.ci
Mailing Address: Qj
Physical Address:
Facility Contact: jZa _ Title: Phone:
Onsite Representative: t Integrator: rk � _T^1 3 O 17
Certified Operator: << Certification Number: 176 S
Back-up Operator:.
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation?
Design Current
Design Current
Design Current
❑ NE
Swine
Capac ty 'o
Wit Poultry
Capacity Pop
@attie Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
[JNA
k H
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Wean to Finish
' .a
La er - _
c. What is the estimated volume that reached waters of the State (gallons)?
Dai Cow
Wean to Feeder
,..�
Non -La er
❑ Yes
Dai Calf
k�]_NA
❑ NE
Feeder to Finish :, .
;.
��,�� �,� � .
Dai Heifer
Farrow to Wean
❑ NA
k'A�Y,.
i4`Y M M Mv'
Design Current
D Cow
[!(No., y
Farrow to Feeder
❑ NE
D I'oult .
Ca ac`i 'P,O "y
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
`r
Qiher,.
Turke Poults
Other
Other
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Ia1O
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[JNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[5**NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
k�]_NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Rio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!(No., y
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

s
Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
IJ' -Ko ❑ NA ❑ NE
0.�4 ❑ NA ❑ NE
structure 6
❑ Yes �Noo ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[
EINA
❑ 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?
; 'es
Jaglr-
FU
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;>1o'
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q°
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
l I?""
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
[9 -Ko
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[3 PAN ❑ PAN > l0% or 10 lbs_ [] Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Rare Soil
❑ Outside of Acceptable Crop Window E]Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): _Gje A®
13. Soil Type(s):
14. Do the receiving crops differ from thok designated in the CAWMP?
❑ Yes
Ejl o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
+❑- No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eg- o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1g'""
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
Cgn<o❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D. No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWW readily available? if yes, check
❑ Yes
[cJ-M
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield [:]120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q`No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 11412011 Continued

Facili Number: - 5 1 & I jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [B4 -o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F:34o ❑ 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 � <` r NA [—]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q-1'�o ❑ NA ❑ NE
❑ Yes No C] NA ❑ NE
❑ Yes El ❑ NA ❑ NE
❑ Yes t ZjA ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes l [J' ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E3Xo [:INA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes O -14o ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.21412011

I-$tv
Type of Visit: (D Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (j Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:$$ t��� Arrival Time: -I ; p Departure Time: County:
Farm Name:RpNO'' �na�j� jig Y�1 Owner Email:
Owner Name: Phone:
Mailing Address:
Region: M
Physical Address:
Facility Contact: %4%^D�,ti TVNd2\1 —Title: C3 W {t Phone:
Onsite Representative: RgvOV 7-3 C"%N Integrator: ML1!&D�a Raw t�
Certified Operator: _ ��M�, Certification Number: VT 6,51
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design CurrentW
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
C+apacity
Current
Pop.
❑ Yes
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder '-JV
Non -La er
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
—4...
D . P,oul
Design
Ca aei
Current
l?o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey PoultsEl
Other
Beef Brood Cow
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 [9No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [—]No
[:]Yes
❑No
❑ Yes
No
❑ Yes
[ No
[31NA ❑ NE
g NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/412011 Continued

it/
Facility Number: - V6 jDat6 of Inspection: S1131 I
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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 01
Spillway?:
Designed Freeboard (in): ct
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
01lvo .❑ NA ❑ NE
a o ❑NA ❑NE
Structure 6
[:]Yes MAO ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes [3o�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes L3'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures
require ❑ Yes Q No
❑ NA
❑ NE
maintenance or improvement?
ES?lNo
❑ NA
❑ NE
Waste Application
❑ Yes
[Rf No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ey o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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):
i- 1 Sn.. b4 a ya-s
13. Soil Type(s): U ¢t
Z7 r J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes Ey"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ES?lNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Rf No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes E� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo ❑ NA ❑ NE
Page 2 of 3 214/1011 Continued

Facility Number: `b'3. - cv-3 Date of Inspection: 13 ��--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J]�fNo ❑ 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 [yNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [ No ❑ NA ONE
❑ Yes [ rNo ❑ NA ❑ NE
[:]Yes [vKNo ❑ NA ❑ NE
[:]Yes C!rNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[E�No
❑ NA
❑ NE
33. Did the ReviewcrAnspector fail to discuss review/inspection with an on-site representative? [:]Yes
[j] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes
[ZoNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or:ady additional recommendations or any other ca nmeuts.
Use drawings of facility to better explain situations (use.additional pages as necessary). _ a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Q�����o�
Phone: Glb'30$-1<�sSl
Date: 13 4 j at
2/412011

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Cr / Arrival Time: r�U Departure Time: County • Region: ]C�
Farm Name: 90,01 Owner Email:
Owner Name:/�� 7 ��y�� Phone:
Mailing Address:
Physical Address:
Facility Contact: RTitle: _ e9jorI6,,,- Phone:
Onsite Representative: 1511;? �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impact
I. 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 10 No ❑ NA ❑ NE
❑Yes
n Current-
Design
Current
Design Current
SwineMC-icity
Pop. Wet Po�ryCapacity
..::.
❑ NE
Pop.
Capacity Pop.
Cattle
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
' `
Dai Heifer
Farrow to Wean
Design
Current '
D Cow
Farrow to Feeder
D .°$oultrv"
Ca ac
P,a P.
Non -Dai
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other ___:
Turkey Poults
Other
Other
- I.:,.Y
Discharges and Stream Impact
I. 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 10 No ❑ NA ❑ NE
❑Yes
E] No
E] NA
❑N
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
E] Yes
®No
E] NA
❑NE
Yes
N No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Z12=- Date of Inspection:
Waste Collection & Treatment
a�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,[!�LNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 716
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 jNo ❑ 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 C,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �S_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 [aNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �4 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes La No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift/ ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _.
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 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 r—_1 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Re uired 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 [g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ig No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Faciti Number: - Ds ection: 7—
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ NA ❑ NE
4 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Dg 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
[a No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
63 No
❑ NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes g, No ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Dater
214/2011

E
Type of Visit B-Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �.��U Departure Time: �3a County: Region: ✓�`'
Farm Name: 1 Yf� +���j� Owner Email:
Owner Name: '�1/J%aX.0 Phone:
Mailing Address:
Physical Address:
Facility Contact: g / 7--V- 7 o/1 Title: x1 -J'_ Phone No:
Onsite Representative: Integrator w'
Certified Operator: Operator Certiiicatton Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ 1 = Longitude: ❑ ° 0 i 0
64
Design Current
04_016
Design
Current DesCurrent
Swine Capacity Population
Wet Poultry -Capacity Population Cattle apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
can to Feeder
❑Non -La er
❑ Daia Calf
❑ Feeder to Finish
❑ No
❑ Daia Heifer
❑ Farrow to Wean
, �;
Dry P
❑ Dry Cow
❑ Farrow to Feeder
-try
w.4 El Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Q ❑ Beef Feeder
❑
❑ Pullets ullets
❑ Beef Brood Co
- -El
Turkeys-
❑ Yes
Qther
❑ Other
❑ Turkey Poults
i ❑ Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Di.No
Discharsies & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
UNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Di.No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/2$/04
Continued

f=acility Number: 92Date of Inspection
I Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0-No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA EINE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '7110 4-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J&No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
' No
tN
[INA ❑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
[9 No
❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R1 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑/ Application Outside of Area
12. Crop type(s)
13. Soil type(s) '4ejz -7 T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F'U'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
0,N0
❑ NA ❑ NE
Comments (re er to question #): Explain any YES answers and/or any recommendatiuns or any other comments r
"-better.esasr Use drawngsof facility to ex lain situations. use additional eca es as nyd�
�`.
"
r .-z �z G ^•— /ll�rkrq/ GCrJ°j
G'i1` /v/C'�"e�
•►
Reviewer/lnspectar Name Phone:
Reviewer/Inspector Signature:
Date: /1;7
%3
D
Page 2 of 3
12128104
Continued

,t
Facility Number: —,� Date of Inspection 14
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LE No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ W -Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[,No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
X 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
5d 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
RI No
❑ NA
EINE
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
allo
❑ NA
❑ NE
Addition al- Comments and/or Drawings:
W u waa Oij O ✓+r P . I fG/��jX�P� �^ iS ` yD GC �'` s�l� fFr!"
5p ; L
.t<7� ���w-� �.ce� ~,/`�i`S w Z- to r� r ��L,•'��-y / yl�s � 1 ��r�o %'`� y�7c< d-"
-6v ,
Page 3 of 3 12/28/04
j.

Type of Visit Wcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other El Denied Access
Date of Visit: I 15-Pt
%f Arrival Time:,Q: �!7 Departure Time: .��� County: Region:
Farm Name: ��nQN ��_� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:�d�.�`1i?A' Title://%A�'/`� _ Phone No:
Onsite Representative: �4fIntegrator: pel'
Certified Operator:. ---�t� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1
= Longitude: a ° =
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [NNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No [INA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes CR No ❑ NA ❑ NE
other than from a discharge?
12/28/04 Continued
Design Current
Design Current
Design Current
SR�ne
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
Ej Wean to Feeder
ZV OP
❑ Non -Layer
❑ Da Calf
❑ Feeder to Finish
❑ Dai heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-La Non -Layer
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Outer
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [NNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No [INA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes CR No ❑ NA ❑ NE
other than from a discharge?
12/28/04 Continued

Facility Number:— Date of Inspection
e� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2,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?:
Designed Freeboard (in): '74 -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
CR -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? P.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
allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
allo ❑ NA ❑ NE
maintenance/improvement?
H. . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
19 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) �d18 f
14. Do the receiving crops differ from those designated in the CAWMb ? ❑ Yes
[&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
L.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
f &No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
54 -No ❑ NA ❑ NE
comments (refer to gtiest�an #): Explain any YES answers and/or any°recommendations or any other comments. ,
Use drawings,offacility Wo better explain situations.. (use additionil'pages as-necessary)':r �
{
Reviewer/Inspector Name L.� Phone: 2Z22�e ?--733Ae:'.;'
Reviewer/inspector Signature: Date: U�
12128/04 Continued

Facility Number: — Date of Inspection —p
•` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M—No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
❑ 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
(BNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E9 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
IN 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
5�.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
[ANo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
12128104

FacilitylVurnber � szj
I
0rivision of`Water't
,Q Division,of Sorl'anc
.0 Other,Agencj'
.�..
iality 5 s
Nater Conservation °I� 1� A:,
Type of Visit�,ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
tB�"Fco`utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: — Arrival Time: �� Departure Time: County: Region:
Farm Name:_ > fin Owner Email:
Owner Name:._ �z rt �C _ ,14_60 Phone:
Mailing Address:
Physical Address:
Facility Contact: cz.r __ T AIJa-_Title:
Onsite Representative:
Certified Operator:s4�.
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
PhoneNo:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
❑ I Longitude: =o=, o=,
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
❑ La er
27M I❑ Non -Layer
Other
❑ Other _
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
E]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 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 EN No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
3No
❑ NA
❑ NE
12/28/04 Continued

12. Crop type(s)
Facility Number: Date of Inspection
Waste Collection & Treatment
13. Soil type(s) Z
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:
❑ No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in): 737
❑ Yes
[RNo
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
[& No [INA ❑NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
11
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?
4yes
CANo [:INA ❑NE
S. Do any of the stuctures lack adequate markers as required by the permit?
j$Yes
R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
-
9. Does any part of the waste management system other than the waste structures require
❑ yes
[,SNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlleation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo ❑ NA ❑ NE
mai ntenance/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)
�Comments�(refe to queshnn #) Explain aay OYES ans e s ad�d/or any` cou mendat<ons ar any otter cammen#s.
a ewe .
[Ise tlrawrngsfrfaciltr to lietter tipLatn situations {use_addtbona! pages�as necessary)
/—B4Or: r—
l.J !lb,, A- ``r &ez sGl Orra_ o F ,/Jur b,�lw&oL ,
Reviewer/inspector Name Phone: / 33t�
Reviewer/Inspector Signature: Date: /U~ 3,/—
Page 2 of 3 12/28/04 Continued
13. Soil type(s) Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[a:Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ NA
❑ NE
�Comments�(refe to queshnn #) Explain aay OYES ans e s ad�d/or any` cou mendat<ons ar any otter cammen#s.
a ewe .
[Ise tlrawrngsfrfaciltr to lietter tipLatn situations {use_addtbona! pages�as necessary)
/—B4Or: r—
l.J !lb,, A- ``r &ez sGl Orra_ o F ,/Jur b,�lw&oL ,
Reviewer/inspector Name Phone: / 33t�
Reviewer/Inspector Signature: Date: /U~ 3,/—
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection D—'
�t Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes JR.No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C3.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
E3,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
g,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
J.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eallo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
19 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
AddrhonailCommeatssiodLor Drawurgs `i jAbet& .:Ue
U
Page 3 of 3 12/28/04

Division of Water Quality %/_ —gam
Facility Plumber 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (?'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: . �jz Departure Time.r !i County: Region:
Farm Name: ,�-lrs��— / Owner Email:
Owner Name: �yT �[,r� %/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=i
=, Longitude: =0=1 = "
Design Current Design Current
Cspacity Population Wet Poultry Capacity Population
❑ Layer
o I ❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
�.=•: _; ,
Design: : �� Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Com
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E[No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
12/28/04 Continued

R
Facility Number: —,53 Date of Inspection �J
® No
❑ NA
❑ NE
Waste Collection & Treatment
JZNo
❑ NA
EINE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
J[ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[S No
[INA ❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) Lzmaja
13. Soil type(s) Lid23
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0 No ❑ NA EINE
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
JZNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CgNo
❑ NA
EINE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name _57e—ye EteAiPhone:
Reviewer/Inspector Signature: - Date:
12/28/04 Continued

Facility Number: 5?_ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM€' readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ W ­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:1 Yes R] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NtNo
[INA
❑ 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
0 N
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EX No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
5d 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
0 No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
nal Comments and/or
12128104

L-� Division of Water Anality
JEaE#y Number i� - 33 0 Division of Soil and Water Conservation
� Other Agency
Type of Visit ()-C� m��pHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �Koutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
p'""
Date of Visit: Arrival Time: �,�3D Departure Time: 3 County: ty Region: g'on: EZQ
Farm Name.-x":'_"1'Q/ Owner Email:
Owner Name y�Y_T�p l� Phone:
Mailing Address:
Physical Address:
Facility Contact: _-• Title:
Onsite Representative:
Certified Operator: ,s1 -j-"
Back-up Operator:
Phone No:
Integrator: amu4gff Z
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =I ="
Longitude: = o =
"WEAR-gTatft
Current
Swine Capacity Population
Wet Poultry
Design Current
Capacity Population
Design Current
CattlelM' Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
® Wean to Feeder �O UO('%
❑ Non -La er
❑ Dai Calf
❑ Feeder to Finish
-
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Non -Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ $eef Brood Co
❑ Yes
❑ Turkeys
—_-",;-::•:. �� , .a::
Other
❑ Turke Poults
❑ Yes
❑ Other
❑Other
I.6mtea Structures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
®No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
W No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
(& No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
K No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

a
I
Facility Number: 492 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes 2LNo ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): /51
Observed Freeboard (in): e5? Z_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JO 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 OZ 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? J4 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes t4 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 J3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J9 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) �yfm u �cs /.j
13. Soil type(s)-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IV 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 Eallo ❑ NA ❑ NE
Corn neents (refer to question ft Explai6.auy'`YES answers and/or any recommendations or. asy other comments.`URI
;UseNMI
drawtngs:of facility to better explain situations. (use additional pages as necessary)
a=. ,
AL
Af4woot
0 1, k -n , -T. L t—n,,�
Reviewer/Inspector Name Phone:�3`�c3.�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128/04 Continued

Facility Number: !VL —,53St Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes DtNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes f4 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p El 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes it No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JK No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[9 No
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additio'A Comments and/or Drawings:
S We Lv; f / br Cern vr/tof e -W rni
Page 3 of 3 12/28/04

Division of water Quality ,3
�Fvid i k,lumber Sa_� S 3 O Division,,of Soil and Water Conservationff
Q Otber�;Agency ,�'�.
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:-• o� Arrival Time: 8; D Departure Time: County: _�
5; ,,q Region: jrero_
Farm Name: _,_61 ,4, %, �� Fctr,,, Owner Email:
Owner Name: IQ/ane,, Phone: 911y- SG`L'G_71.2
Flailing Address: %9.? �ue,�Q.at.-� �� ����.]�oa t�NG � .7Q3'2R
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number -
Back -up Certification ,Number:
Location of Farm: Latitude: = 0 =I 0 11 Longitude: =0=,
o=,
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
g'Tpa ❑ Laver
C?7DD ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ Turkev Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed frorn 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
❑ Daity Heifer
❑ Diy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (11 -yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L,N1Vo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
EINE
❑ Yes
[--]No
❑ Yes
VNo
❑ NA
EINE
❑ Yes [?No [:INA ❑ NE
12/28/04 Continued

}
f
Facility Number: —� Date of Inspection 7�8os
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EKo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I _
Spillway?: /?n
Designed Freeboard (in): /!I 'v .
Observed Freeboard (in): -F j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ['io ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes Pfgo ❑ 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 EK ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
DoNO
❑ 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
2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2,&o
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[moo
❑ 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
iO� ✓rD
12. Croptype(s)167
13. Soil type(s) �/o� I/dA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[a'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9'fio
❑ 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 D`&E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑-o
❑ NA ❑ NE
Comments (iefer to question-##} E- daiiii ny�YESiinswei and/or y r omuxendations or any other comments.
-s <; 14
Use drawings of+facilrty to Better e>t fainxsetuahonx. (use additional pagessknecessary .
Nal Try Camel}:,ti Re:a.�a� /¢q/`G/ID+►��'b�
Tr Hall— 1/0_3.2q-rfc,21
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: ^/ B • ds
12/28104 Continued

Facility Number:g2 _�� Date of Inspection 17-8-09—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [gKo ❑ NA ❑ NE
the appropirate box. ❑Jam' " C fists ❑ Deign ❑, rJ ❑9tWr
21 _ Does record keeping need improvement? If yes, check the appropriate box below. es ❑ No ❑ NA ❑ NE
,_..,� 1 �) /,1 g41s--7,. �7 � -19-V'?Eln El eekly Freeboard ❑ Soil Analysis ❑ e
[9<infall ❑Stuckiag [ rop Yield [Monthly and I" Rain Inspections ❑ wea#�ier-cede.
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
2$. 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?
❑ Yes
2f -;o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
QNE
ElYes
ElNo
ElNA
2' E
❑ Yes
❑ No
❑ NA
QN/E
❑ Yes
P14o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[91NE
❑ Yes [3No ❑ NA EINE
❑ Yes E!rNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes O No El NA El NE
El Yes No ❑ NA ❑ NE
Af dditiortal Comlments and/or Drawings:
! �� �►l�cxa r
!.v � I� I'16ti � R
CoP�. 07 T� C +1Bw p�rw, r � Gi1� �L'r F i f caTC � �O�Prp�
il, 7 ��uClr S ���lf%ir9 a,eGk1Y
uPjdre�l.�i fdrn,,s , %,j�ase kcw re
G�e r cor s on
ray
y rU %ecar� Grafi /h. 1�q j �
y
J ✓� 10'_adur0r'
GJr�s
12rz8,1oa

J
\vj
` Facility- Number Date of Visit: J—/�1 Time:
} —
=Not Operational 0 Selo- Threshold
❑ Permitted © Certified 0 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: _ Y- 8�_ /.�✓1+/� County Sd/"1D�rys2
Owner Name: ud�l �_- — — --- Phone No: I �[f —�� 41, / 9.-z
Aanine Address: in
Facility Contact: j Title:
Onsite Representative: km a, Tim! 'a
Certified Operator:
Location of Farm:
Phone No:
integrator- _A&O—A—i I
Operator Certification Number:
J&5Wit1t E3 Poultry ❑Cattle ❑Horse Latitude Longitude �� �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
)Wean to Feeder 700 10 Lava I I I ID Darr
Feeder to Finish7 JEI Non -Layer I 1 10 Non -Dairy
❑ Farrow to l can
❑ Farrow tc Feeder mei
❑ Farrow to Finish Total Design Capacity
Gilts
Boars Total SSLW
Number of Lagoons
Holding Ponds I Solid Traps
Rischarees R Stream Impacts
1. Is any discharge observed from any pan of the operation?
Subsurface Drains Present
No Liquid Waste
Discharge orizinated at: ❑ La2oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notif}- DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there ev-idtuce of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impactS to the Waters of the State other than from a discharge?
Waste CollgStion g Treatment
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes P No
4. Is storage capacity (freeboard plus storm storsee) less than adequate? ❑ Spillwav ❑ Yes $. No
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier
Freeboard (inches): _ aq _
05103101 Continued
❑ Yes
VNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes P No
4. Is storage capacity (freeboard plus storm storsee) less than adequate? ❑ Spillwav ❑ Yes $. No
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier
Freeboard (inches): _ aq _
05103101 Continued

Facility Number: a —53_9 1 Date of Inspection 'Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [] Yes No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®No
I I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes EN No
12. Crop type / r py v Q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JZNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes W No
e) This facility is pended fora wettable acre determination? ❑ Yes Pa No
15. Does the receiving crop need improvement? ❑ Yes O No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ER No
required
Records & Documents
❑ Yes
No
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
5UNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
Q3 No
25.
(ic/ X", checklists, design, maps, etc_)
❑ Yes
[Z No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes'
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Q3 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
®
No violations or deficiencies were noted during this visit You will receive no further correspondence about this
visit
Reviewer/Inspector Name I.
Reviewer/Inspector Signature:
ageS a5 necessary) Field COPY
Date:
Final Notes
05/03/01 eContinued

Farm Ni
-Mailing
County:
Integrator: Cq� Phone:
'On Site Representative: led 5 Phc
Physical Address/Location: Sof 13c\, 1 / ,n,k Sajo
Site Requires Immediate Att72E
:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:.1995
Time: //.'M
Type of Operation: Swine X
Design amity:
DEM Certification Number:
Latitude: 3 S C c—a ' jam"
Poultry Cattle
Number of Animals on Site: a 884_ _
ACE DEM Certification Number: ACNEW
Longitude: o �Z
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)e�j or No Actual Freeboard: Q Ft. Inches
'Was any seepage observed from the lagoon(s)? Yes at�&_Was any erosion observed? Yes 040
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No-�
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? t4por No
100 Feet from Wells? fji>or No
Is the animal waste stockpiled within 200 Feet of USGS Blue Line Stream? Yes or Pd@-
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No "C�e.44,.�,j
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or No If Yes, Please Explain_
Uses the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No s —* - -_t
Additional Comments:
urcc
�. 1-409.j
J
Inspector Nam' 'DEw` o axe Signature
5v; Fc. Tri Wact.o.,:a Btck.
T-�Y tI-k,,;(fe nuc 3a3o I
cc: Facility Assessment Unit Use Attachments if Needed.