310445_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qual

(Type of Visit: Q Co�hpliance Inspection p operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up Q Referral p Emergency D Other ❑ Denied Access
Date of Visit: t r Arrival Time: Departure Time: 4 1 S County: DUPLIO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Faculty Contact:
Title:
Phone:
Onsite Representative: C— #& Integrator: .} n
Certification Number: 11 2 L
Phone:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
I
Dairy Cow
Wean to Feeder
Q
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,ouit
Ca acl
Pa
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Puilets
Beef Brood Cow
Turkeys
Other
Turkey Poults
❑ther
Qther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
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 ylio
❑NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

.ti
Facility Number: I -Lig Date of Inspection: 1 t
Waste Collection & Treatment
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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: t AGr0tJ (_A(smot�j �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 41 14 S'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes jZfNo ❑ NA ❑ NE
[� Yes M No ❑ NA ❑ NE
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmenta 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 �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 Q4 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C2(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [24o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window, ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [n o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes wo ❑ NA ❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3"No ❑ NA ❑ NE
acres detenninatiou?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available`! If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes o
❑ Yes 'No
[:]Yes a�ll
❑ Yes ]N0
❑ 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 0 Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F cilit Number: - Date of Inspection:PS I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ 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 structures) 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
1Comments (refer to question #): Explain anyx.YES'answers and/or�any additia
1lise drawings of.facitity to heifer explain'situatioris:(useladditianal;paeesaslni
I
): `V,
❑ Yes [2/No ❑ NA ❑ NE
❑ Yes E2fNo ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes Cj'/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
h n cl nN. of
M/N co ❑ NA ❑ NE
[J'No ❑ NA ❑ NE
[7 /No ❑ NA ❑ NE
n
Reviewer/Inspector Name: Phone: (2l 6�-~ �j�e
ReviewerlInspector Signature: Date: 1 1 11.3
LY
Page 3 of 3 21412014

Type of Visit: JErcompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: eRoutine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: ® Arrival Time: Departure Time: County:
Farm Name: eTPM_V1' ,/ Y1 f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onslte Representative: Integrator: �]
Certified Operator: 7�GCertification Number: )USA
SA
Ej
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design .
Enrrent
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pnp.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder
I jNon-Layer___.
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
b . ►Poultr.
Ca aci
P,o
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPouets
�thcr
Other
Discharaes 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2TNo ❑ 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: WL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r ��
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JEJ'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VTNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes ?'No ❑ NA ❑ NE
maintenance or improvement`?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �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 if 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 PNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil 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 No
R.
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
r
Page 2 of 3 21412011 Continued

Facilit umber: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes A No
❑ Yes 7fNo
❑ Yes Po
❑ Yes 16 No
❑ Yes PI"N❑
❑ Yes g No
❑ NA ❑ NE
❑NA ❑NE
❑NA [a NE
❑ NA ' ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
o
gNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Signature; Date:�4 e!
Page 3 of 3 21412011

Type of Visit: Vz C mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 County: Region:
Farm Name: 77T— t- t4 (L+H. 51 r4,T Owner Email:
Owner Name: ! [—. g Rom[ 6\ ]M1 L. L C` L _ Phone:
Mailing Address: + �C ►l-I�� ► u�� �1�[CH 1'� �~ [�L�41.1 1 CIF 5
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �� -� I v ► I Lj_ER_ Integrator:
1
Certified Operator: F.LZ(L iM i L.LE.CL Cer it fication Number:' �S O
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pnp.
Cattle Capacity Pnp.
Wcan to Finish
La er
Dai Cow
Wcan to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Gurrent
❑ Cow
Farrow to Feeder
Dr. Poultr.
Ea aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
A
❑ 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 the discharge bypass the waste management system? (If yes, notify ❑WQ)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
r 0 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 21412011 Conh'nued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
— 1 =
3Co 99
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes � No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
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 kNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 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); a
13. Soil Type(s):
U
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[] Yes ] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes gNo
❑ NA
❑ NE
the appropriate box.
_
Q WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes XNo
❑ NA
❑ NE
Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis
❑ Waste Transfers
❑ Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections [] Monthly and 1 " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
kNo
❑ NA
❑ NE
Page 2 of 3.
214120II Continued

Facility Number: '3 % - it y _ jDate of Inspection: qi
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo
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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes )6-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
�NA ❑ NE
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
P
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ANo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TO
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
I� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or. any additional recommendationvor<any other, comments,:
yww
Use. drawings of facility to better explain situations (use additional pages as necessary}.:::
',? _' _
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I. S
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Reviewer/Inspector Name: irlaWAIOM 61001 NI
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date: `7
_ZQ ILI 0-
Z/4a011

9
i i ADIvision of Water Quality
Facility Number ©- L y 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Structure Evaluation p Technical Assistance
Reason for Visit: ,Routine ❑ Complaint n Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: // Arrival Time: C D Departure Time: County: Region:
Farm Name: r-- LA M J LLG �L PAZM S 1 *5 kp, Owner Email:
Owner Name: [-9, rn I LC.-e Phone:
co Mailing Address: j�`� R l' a3 i Ltae— &Ltgmcw Vi-Q � GLA.(_,4 UI LLB. >R _L0'4
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1 L-c-c�
Certified Operator: I L.L E V
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
14 Wean to Feeder 0
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Dther
Latitude:
Phone:
Int
egrator:
Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Puults
Design Current
Discharees_and Stream Impacts
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0,,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
[:]Yes [:]No (DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes k
No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: j - q Date of Inspection: 5 ❑ /
Waste Collection & Treatment ]�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 n�
Spillway?: n p
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No [DNA ❑ 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): 12CP s/wIG <fow
13. Soil Type(s):
U+
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
E] WUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N
Q Waste Application [� Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑�aste Transfers
Rainfall ❑ Stocking ❑ Crop Yield El120 Minute inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
o ❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facllit , mber: - Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes I No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ���r❑"``No NA ❑ NE
OtherIssues
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?
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes fiO No
❑ Yes No
❑ Yes [� No
❑ Yes j No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes[No
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
lComments (refer to question #): Explain any YES answers and/or any additional recommendations or any othmcoinn> ents...,'.
use drawings of facility to better explain situations (use additional pages as necessary).AN I
W-� - k Q_
g195/1 r l. g
I I) rVIO
ReviewerlInspector Name:
Reviewer/Inspector Signature'.
Page 3 of 3
Phone:
Date: 5�1 oh1
2142011

Type of Visit Compliance Inspection ❑ Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit xRoutine 0 Complaint D Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 5Q Departure Time: County: (-/ Region:
Farm Name: Tc,e [ r m+i(-LE iz Peafn SI Tcas /,,+ Q Owner Email:
Owner Name: t G2 [tom L, . 1' Il LL _ -__ _ Phone:
Mailing Address: 'T�F]5 ► CH d E L U-E ACIF
Physical Address:
Facility Contact: Title:
� {
Onsite Representative: {,'�(zy I ' j�� ► I LL,E[Z
Certified Operator: �� "� • ,'� l t LL E e
flack -up Operator:
Phone No:
Integrator•
o901c:) j�o�S a�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 6 = Longitude: = e = 1 =
tl
Design Current
Design Current
Design Current
Swine Capacity f �pulation
1Vet Poultry �apaclty Population
Cattle Capacity Population
Finish
❑ La er
❑ Dai Cow
Feeder
a
Non -La er
❑Dai Calf
to Finish
Dai Heifer
to Wean
El D Cow
Non -Dairy
RFarrow
to Feeder
to Finish
❑ La ersEl
❑ Non -La ers
Beef Stocker
❑ Beef Feeder
Pullets
Beef Brood Cow
❑Turkeys
Ot e
❑Other
10 Turkey Poults
Other
Number of Structures:
DischarLes & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
No
,
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
r
a. Was the conveyance man-made?
[:]Yes
❑ N❑
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (Ii'yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128.104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I 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?: r
Designed Freeboard (in):
Observed Freeboard (in): 1 L0 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesX
No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6• Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ 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 j No ❑ NA ❑ NE
maintenance/improvement? 1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ' ❑ Yes �No ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El 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 El Evidence
_of Wind Drift [I Application Outside of Area
12. Crop type(s) L �r� S6 Aq/,U41, 5 l [�
, -
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 7t No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes _NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,KNo
❑ NA
❑ NE
Comments.[refer toquestion #): Explain any YES.answers::and/or any recommendations or; any,;other comments..:...
Use drawings of facillfy. to: better explain . situatlons: (use additlanal pages as necessary): 8
Reviewer/Inspector Name j�[7 `S"=. i "3` 3` p".=_ Phone: lzi)
l'i'�; .^i� J a L i��
Reviewer/Inspector Signature: Date: W pl&nl_-�
Page 2 of 3 12128104 Continued

Farilily Number: 3 1 — Date of Inspection Ib
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [--]Yes ANo ❑ NA ❑ NE
the appropriate box. El WUP ❑ Checklists 0 Design ❑ g Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes k,� No El NA ❑ NE
0 Waste Application 0 Weekly Freeboard El Waste Analysis 0 Soil Analysis El Waste Transfers/ ❑/inual Certification
0 Rainfall [:1 Stocking ❑ Cop Yield ❑ 120 Minute inspections 0 Monthly and 1" Rain Inspections [] Weather Code
22. Did the facility fail to install andmaintaina rain gauge? []Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 ]tours 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?
1 f' 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
_XNo
❑ NA
El NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
No
[INA
ElNE
❑ Yes
❑ No
ANA
❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes , No
❑ NA ❑ NE
❑ Yes] No
❑ NA ❑ NE
❑ Yes ]No
El NA El NE
❑Yes &o
El NA ❑NE
d nal C mtnent .. . y:
!>,d itto o s'andlor. Drawin s: �,.� ;t °.,��='.;d.-.
LANTl L
AL
�I �c-�riwAST� F- w �-S 3 C-_.� 7 at.cT Losi
A • i AAA--1 rF-[?- 5,4mQ cS-: TA V-OW 4 5 EN T y/l4p]'id
a 1 plICE 1
11/6L5)0'� 1- LO 1. `�-
H.,
Page 3 of 3 12/2&04

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: T) y U7 Arrival Time: ®r Departure Time. County: Region:
Farm Name: t � ► ' 1 i LLEX CZM iC':S _!al Owner Email:
Owner Name: +Z G"1? , ,CD,LLq Phone: 29"
Mailing Address: 1 NsruR E A& f_ f/ Ind 1�ElXU9u I u�
Physical Address:
Facility Contact: Title:
Onsite Representative:E���
Certified Operator:
Back-up Operator:
Phone No:
Integrator: C
Operator Certification Number: J
Back-up Certification Number:
Location of Farm: Latitude: 00 = I =" Longitude: 00 01 = {[
s
Sw[n
Design Current Design Current Design Current
,.
Capacity l'opula#ion Wet Poultry Capacity Population Cattle Capacity Popula#ion
❑ can to Finish
❑ La er
❑ Dairy Cow
Wcan to Feeder
er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Dr.y Poultry ❑ Dry Cow
I ❑ Non -Dairy
La ers
❑ Beef Stocker
El ❑ Non-1-a ers
Pullets ❑ Beef Feeder
Turkeys ❑ Beef Brood Co
Turkey Puuets
Other Humber of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Qther
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
)SLNo
❑ 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
XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J ':No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: S1 -t#451
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: _j_AA I TM 9L
Spillway?:
Designed Freeboard (in): 119.5 _ 1 . S
Observed Freeboard (in): ly r ]' S
5, Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes I%No ❑ NA ❑ NE
❑ Yes )gNo ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �!LNo ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste ARRIleation
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes )o ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
of Wind Drift ❑ Application Outsides of Area
12. Crop type(s) ,7G t3s 1��� Q� Sly
13. Soil type(s) f LA—,Q'(_A U ► u_r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,<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
XNo
❑ NA
❑ NE
Coin enr& rr;ejerr to que�stti�on #) Explain any YES answers and/or any recommendations or any other cammenta.
Use'�`drawinl;s of faciiityohetfer explain situations. {use additional pages asp necessary};
rlr i i i at�1 » �9M�_.
LtJ • A �M l tk. 0-
1 '� • 5 .0. S
11
lo"1d$ t .-4- y �'
Slat 1o7 1,9 rt
Reviewer/Inspector Name - j�. s; <' i ` .' Phone: -r�o-
Reviewer/Inspector Signature: Date: L
Page 2 of 3 12128104 Continued

I`
Facility Number: 31�(,�� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �c.,(111 No ❑ NA El NE
the appropirate box. l�
0 WL1P El Checklists ❑Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ko ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑>Vaste Transfers ❑ �r{nual Certification
El Rai nfall 0 Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and l" Rain Inspections I❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ N1?
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JX No
❑ NA
❑ NE
25.
Did the lacility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit ar 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
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
V�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
ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewcr/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
�o
❑ NA
❑ NE
Additional Comments and/or Drawin
Page 3 of 3 12128104

Division of Water Quality .
Facility Number 0' Division of Soil and Water Conservation `=
Q Other Agency ..�, ...
Type of Visit Q Compliance Inspection 0 Operation Review D Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 a Departure Time: r� County: I L-iAl Region:
Farm Narne:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: � y �i I—LF rL
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
=n
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: f �'4 ;9 J Oq
Back-up Certification Number:
Longitude: = o = ` s�
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La er
❑ Wean to Finish
® Wean to Feeder O� 133�
❑ Feeder to Finish j
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Da Cow
❑
Non-Dai
❑
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? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑Yes [INo El NA El NE
12128.104 Continued

Facility Number:
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
• Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 60
Spillway?: �r p
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Og No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 5N No ❑ NA ❑ NE
[]Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes 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 El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes � No ❑ NA ❑ NE
maintenance/improvement?
1 l . 1s there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes N 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
pj No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
kNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation dcsign or wettable acre determination?❑ Yes
DQ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question 4): 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 MAROP G4/NFSPhone:
Reviewer/Inspector Signature: Date:
12128104 Continued

4
Facility Number: 3—9q5j Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ( No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C)�No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 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
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
ElNE
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
P(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t&No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes gNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA El NE
and report the inortaIity rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JP 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
Z 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
t No
❑ NA ❑ NE
12128104

C"afDivision of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Typo of Visit 40 Compliance Inspection D Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit .0 Routine 0 Complaint Q Follow up Q Referral Q Emergency D Other ❑ Denied Access
Date of Visit:"Arrival Time: .' �� eparture Time: Q oUnty: �� Region:Farm Name:`' wn4 r Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative:�—
Certified Operator: / I Jze.—,
Back-up Operator:
Phone No:
Integrator: — , _ oeni !/ r___ A�
Operator Certification Number: _/_ 22-5 2
Back-up Certification Number:
Location of Farm: Latitude: = e 0 ` = " Longitude: = ° ❑ ` ❑
11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
0 O ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design. Current
Cattle Capacity . Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Da Cow
❑
Non-Daity
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:..
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 ILJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
12128104 Continued

- • N.-
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Smart cture 2 Structure 3 Structure 4
Identifier: ,7,, lny
Spillway?: ,VV
Designed Freeboard (in):
Observed Freeboard (in)-
5. Arc there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan'?
❑ Yes ;No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
Cl Yes XNo ❑ NA ❑ NE
❑ Yes/XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONO ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�{
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �C.J No ❑ NA ❑ NE
maintenance/improvement? I Id
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fLl No ❑ NA ❑ NE
El Excessive Ponding [I 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 Windo/w�, ❑ Evidence of Wind riff ❑ Application Outside of Area
12. Crop type(s) � /1� �iQ�1� 11 21,) . �. t�v���
13.
Soil type(s)
J
14•
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
/W(No
❑ Yes PNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes0No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes 2�o
[INA
❑ NE
19.
Is there a lack of properly operating waste application equipment?
ElYes ff No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7" ,�Po�r ' �
fr 6CIVY
Reviewer/Inspector Name r Phone D
Reviewer/Inspector Signature: Date: 0
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available;? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ ether
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
❑ 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 PNo
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes ❑ No
VNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [;T'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 0No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
PNA
❑ 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 concerti? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
N0�s.'
e74 $� to r- 4-3
—e,os-j
7-5--' toe?-0 F� •
12128104

O.Divisian of Water.Quality
Facility Number Q Division of Soil and Water Conservation
Q "Other Agency.
:?
Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:
Arrival Time:``
❑
Departure Time: ! linty:
Farm Name: 1"Aed
Ar��
ll_ /Y]
ef pp
'��� A � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5
Certified Operator -
Back -up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 1
Latitude: = e = ` =" Longitude: = ° = 1 = "
Desi n Current` .. °° `?'11M "
g Design Current Design, rEiirent�V,
,Swine . Capacity Population Wet Poultry Capacity: Population Cattle: .Capacity';:P.opulatlonf
❑ Wean to Finish
Wean to Feeder ©Z)
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish k
❑ Gilts ;
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Puuets
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:..:>©
�Re
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes fid No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Cl No ❑ NA ❑ NE
❑ Yes xNo ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
12128104 Continued

r
N.
Facility ]Number: — Date of Inspection I if7l
Waste Collection & Treatment
4. Is storage capacity (s(ructural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes zNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ON E
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: d d
Designed Freeboard (in):
Observed Freeboard (in): IrZI
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No El NA El NE
through a waste management or closure plan? ///
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X 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 ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 710
❑ 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 Soi.
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
El NA El NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes 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 )ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [No
❑ NA
❑ NE
Comments (refer to question 4): 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):.
21) /i,,� 1-T2
2XL<� z6) ae
Reviewer/Inspector Name 1 '�� rQ I Phone:'
Reviewer/Inspector Signature: Date: L d
Page 2 of 3 12128104 Continued

r
i
Facility Number:, — hate of Inspection I Y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes W(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VrNo ❑ NA ❑ NE
the appropriate box. ❑ wuP ❑ Checklists ❑ Design El ❑ Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. eyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 10
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 P�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor at 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?
❑ Yes ❑ No XNA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes ;�No ❑ NA ❑ NE
❑ Yes ❑ No jpfNA ❑ NE
❑ Yes JCS No ❑ NA ❑ NE
❑ Yes `� No ❑ NA ❑ NE
❑ Yes J[j No ❑ NA ❑ NE
❑ Yes e6 No ❑ NA ❑ N E
❑ Yes fZ(No ❑ NA ❑ NE
Page 3 of 3 12.128104

Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine D Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: d' Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Dnsitc Representative:..
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
((..QI�, �Phone No:
Integrator: ti1'.twl.��s
Operator Certification Number:
Back-up Certification Number:
=0 =` =u =O=A =n
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ ❑ Layer
❑ Non-Layet
JW
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
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
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Neifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: W
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 Vr No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Contdnued

r 4t
4 �
Facility Number: 51 —
Date of Inspection Ias
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -ONo ❑ 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 S Structure 6
Identifier:
Spillway?: N9 Nd
Designed Freeboard (in): 5
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes A 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 7 No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit? []Yes m 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 ;ZfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes JZ No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soii
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i
❑ Yes
[Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)zNo
❑ NA
❑ NE
—4em LoaW G' 0'0 -
- zooV �S� � LSr0-*Rr (JEI9 21ZA� o 5
� �ov�
G
Gov rZ-�-C4 1
Reviewer/Inspector Name.:
Phone:
Reviewer/Inspector Signature:
Date: Jf,�/D 5
I2128104 Continued

I �
� r
Facility Number: ►� — !t% Date elf Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fai I to have al I components of the CA W M P readily available? I f' yes, check ❑ Yes [21 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �Z 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
WNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NF
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1p
�2rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
;XNo
❑ NA
❑ NE
and report the mortality rates that were higher than nornial?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
ONo
❑ 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
9 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
O No
Cl NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ yes
;�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

IType of Visit —0 Compliance Inspection D Operation Review Q Lagoon Evaluation j
Reason for Visit Q/ Routine 0 Complaint Q Follow up a Emergency Notification ❑ Other © Denied Access
Facility Number
[}ate of Visit: Time: ��
I
Q Not Operational Q Below Threshold
Permitted,CertiBed © Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: ...........2...........1................................... County:»..........V�:?P�...... ............. ........
Owner Name:
Phone No:
MailingAddress: ..... ...».......... ..... ....»...... ........... ....... ..... ............................................. »..... ...........................................
FacilityContact:.............................................................................. Title: ........................ .................. „.................... Phone No: ........ ».... ....... ................ ............
Onsite Representative:.............>E-- ............................................ Integrator:......... ............. ..... ............ ..........
Certified Operator:
Location of Farm:
.._......................................................... Operator Certification Number: .......................... I .......... ....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude •
ti Al s nC; ;£urreni� .7:.
eSal ' t "a
a"urlractiotn:;yI
i Cu'rrent
Swine,' :. _ ;:v;.i'CIai_ i'P�Co i:t:; :;iesi '
i�:i .:Pa�iltry G:a ci 9=Pouiations'`CPoulation"Came '
Wean to Feeder Z],,,'erairy
ELa
❑ Feeder to Finish; on -Layer ❑Non -Dairy
I
k
.1" Farrow to can r .,
.. ::11:_..•'.:
: ' -
Farrow to Feeder Othe r y.
Al
4� .., .:::::..
Farrow to Finish - Tatar D6ig Caj4dty i''y
e N� . = i F
- aril .'. :�',"� f�. £. :� .t i� F ,r I :.
�`�_�
❑.. :y
Boars = :�.,..� ': �•,' ' �;-','t otal'SSLW'
i1.�� �."�:'r :.i k{', i ..:,' I .Ili 3 " �.:F, .. y�F�' •1;,
:' ':�ri� ' j ��
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Ye��o
Discharge originated at: [3 Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes 3Ao
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
Identifier: ......... ....L _.............. ........... .............. . ... ........................ ... . ..... ...................... . ... . ...... ...................................
...................................
Freeboard (inches):
12112103
Continued

Facility Number: -- j' Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Y
o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type .9C-(Z M'UDA 6& 11 C-sfj �f�2 L [ -,a_A_-M) OO Cf S Ec 6
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ID No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
ID Yes o
c) This facility is pended for a wettable acre determination?
❑Yes No
15.
Does the receiving crop need improvement?
❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes dNo
Odor Issues
f
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Y No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ YesXNo
Air Quality representative immediately.
////
i "'Cai:Y['a 1 • .. �`:51X': "::. ,.,. : ['.: .: Vlli.. .. " 5f'":... .: F�.:.:.: li :... .: !
s (refer tdque�on #}:=�Expiaaaa agy YGS answers andlar.any:i�ticosnmcridatloiis or.aoy,:otl'�er;carinnaents"�` [��; ` �'
"3, yy.d'ii�.. " ?S3" StiDi.:_ [ip:i' }.,. +_+.-K:, .:��.. ylesa��'^.it'v'1�t"kl`.. „k "j;P�:�;-:lt.'i. .;�`�; idk`I':mi€ a:✓'S3?„ .. ,iww.n ,._.xiw _ .t , €•.•:.. �.�••ii;'i ; �ii
tags of tiacllltyta better: eaplaiii sttirationa:•(use addi#lunal s es as necsa
D Final
CINPv-, '� &U (LDS IJLU- ►AA3�6:rt1b
Reviewer/Inspector Name j{" tE._ : i z j
Reviewer/Inspector Signature:
:I) li'3✓5'MAW
11N:!
Date:
1s.isroa t ummuea

Facility Number: — 4 Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel W[3P, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPI)ES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes �f!No
❑ Yes 7)No
o
ElYes
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

r
Type of Visit Xcompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0-Routine Q Complaint Q Fallow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number + 5 [lute of Visit: � aa� rime: I ❑ t �
ti l 0 Below Threshold
r] Permitted 13 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Form Name: r-✓�Fy 1 + �er �!�►,i ""� �-�Z County: D Ve l i'�
Owner Name: rr M A W- Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator: 13 r& 15- Q iq ro /r nG
Operator Certification Number:
)Zjr5wlne ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 6 u Longitude 0' ' 46
Design Current
SwineC'nnneity . Pnnnlatinn
Wean to Feeder
3 L 00
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
El Farrow to Finish
❑ Gilts
Boars
Resign Current Design Current
Poultry
Capacitv Pa ulation Cattle Capacity Pa ulation
ID Layer
Dai
❑ Non -Layer
LINon-Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of l:a oons �- ❑ Subsurface Drains Present ❑ La oon Area Spray Field Area
Y.
Holding ponds 1 Solid Traps' [] No Licluld Waste Management System
Dl'cbarges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes eNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmiO
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,ONa
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier; 1 Z
Freeboard (inches); 36
65103101 Continued

Facility Number: 31 — LPTL5 1 Date of Inspection .� d
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0 No
❑ Yes 2fNo
❑ Yes 0 No
❑ Yes 21 No
❑ Yes ZNo
W-astLAPPlicatiun
10. Are there any buffers that need maintenancelimprove ment? ❑ Yes ZrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 21 No
12. Crop type 1e ke. 19-51, S4vw-e r.�^'L� G+- � ►•r , CO I- 2-.%f-Le04, ,S11 i'lS -- -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZI No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
�,O No
Relluired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑ Yes
2rNo
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
jZrNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ETNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(iel discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
,ZNo
24, Does facility require a follow-up visit by same agency?
❑ Yes
ZI No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
B No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.... ;:...s.: "a-, • ;u:i;» .:• :-:v,,.�.: ::.:, i '. Sr. -fie: "`zx �'a-.:.':.....:f... .::......:-:Fi °.:: '.::.:..!.: x-. ...-:.w.,-:,�::: {r.:,,:: ... .-.:: .._;..... fi: .:.. : �.�: ..i :.•; +r.;,,"• „
Coo ments (refer to quest[gn #):', Explaii any YES answeff,` dlnr n cnn:m dat[ans or any, other comments;:.::::
..:
use drawings of facility to better explain situhtions, (use additional pages:as necessary]: ❑Field Copy El Final Notes
.. _ "F' Ir".' e
Y'eCnrds nee wen keel.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: .7 19 a Z
05103101 Continued

s Facility Number: Y/ —CrIAf S I)ate of Inspection
Odor JLsM
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ONO'
❑ Yes '[2No
❑ Yes ErNo
❑ Yes _I?rNo
❑ Yes ❑ No
Additional'Commentta and/or Drawings::':':; f: Jk
05103101
05103101

.A6ivision' of Water Quality
Q Division of Soil and Water Conservation
4` . Q Other Agency
Type of Visit 10compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Vlsit Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date. of Visit: fine: �1 IS� Printed on: 7/21/2000
O Not Operational O Below Threshold
© Permitted E] Certified 0 Conditionally Certified 0 Registered
Fartn Name: ............. r A.`r..... j . s �.. 1 ,y...°L r ..es....r�.7f Z.....
Owner Name: .............1�'1........�..".I..� V.........
Facility Contact:
Mailing Address:
'ritie:
Date last Operated or Above Threshold: .......................
County: ....1��',.`.l..'?.....................................................
Phone No:
Phone No:
Onsite Representative:.......J...�'T'�.r.�.....►.....F! +f. r................................................ Integrator: „ ''ai,rn .. f f .!!afo'.I.l.J}.R...........
Certified Operator:
Location of Farm:
Operator Certification Number:
AL
,Ofwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� «
Design Ctirrent
Cainaelty Ponulation
..L
air Wean to Feeder
:?ZPO
'Tli Feeder to Finish
"`nn Farrow to Wean
O�NA�
Farrow to Feeder
'
Farrow to Finish
@ Gilts
'tL' Boars
JZ.
s 1. Solld:Tranps
Design Current Design Cirreat
Poultry Capacity Population Cattle Capiklly -,Population
❑ Layer I I JCI Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
- ❑ Subsurface Drains Present Lagoftn Area JE3 Spray Field Area
�. ❑ No Liquid Waste Management System
Discharees & Stream I_mpacLS
1. Is any discharge observed from any part of the operation? ❑ Yes 0'&o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes'J21No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes /ONo
c. If lischarge is observed. what is the estimated flow in gal/min?71L A
d, [Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes'TzINo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes,0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesEJNo
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier: ............................ ....................Z........................ .... ............................... .................................... .............
........................................................
Freeboard (inches):
5/00 Continued on buck

lFacili Number: 3 1 — S hate of Inspection I I_I �I (i� Printed (in. 7/21/2000
,�5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, 0 Yes 0No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managers through a waste management or
closure plan? ❑Yes P'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 tnaintenancelimproventent?
8. Does any part of the waste management system other than waste structures require main tenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'!
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12, Crop type f5E n eV%UWrt FeN3adee 5;1.tq i W ; O-0, 1114�e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Doctiments
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, Over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.yiolA1Q11S •al- c}enO"' •►sere Tipted• 4Wtog tit s.v 41t; 1'o0 eeeiye no tho
rorres' nndeneta about: this visit.
Comments. (refer.tQ questiozr #}::Explain any YES answers attdlor. any. :recnmfnendatia or. any.: otht
etee ldstaan:Ew:dIse da.ex !"a es, necry')'�spi 8 '+
_r4e FaC ]t f Ceo(s, A► { OVGo•y(-r a'-C LJeI1 kepf
❑ Yes ❑ No
El Yes PfNa
❑ Yes .dNO
❑ Yes ;ff'Nn
❑ Yes 0No
ba4 "
❑ Yes 120&0
❑ Yes )}'No
❑ Yes J;21NO
❑ Yes "Pmo
❑ Yes 9No
❑ Yes ZNo
❑ Yes ZNo
❑ Yes zNo
❑ Yes ,dNo
❑ Yes g No
❑ Yes �ONo
❑ yes ,No
❑ Yes O'No
❑ Yes No
❑ Yes J'No
Reviewer/Inspector Name Gt. ✓ } } [7 ?` F ` IV.' ^� $ ° �
Reviewer/Inspector Signature: f Date: (o 5_1Q'1 ____ 5100

Facilifty Number: Date of Inspection }Tinted an: 7/21/2000
`odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ YesArNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNo
28. Is there any evidence of wind drift during land application? (i.e. residue an neighboring vegetation, asphalt, ❑ YesOo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J, o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ YesA!�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
v:
5/00

ivision of Water Quality
t)Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Outer ❑ Denied Access
Facility Number !late lif Visit: �Ea'irne: ® Printed nn: 7/21/2000
d Not Operational Q Below Threshold
13 Permitted Wertified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
Farm Name: LS`?a-r'....�1 rt.t.,,1.�+.........1 2— County:...... .......................................
Owner Nrtmc:..rf1,.............. I ......... I Phone No: ... C! i..—0....... ........
FacilityContact: ..............................................................................Title:............................................................... Phone No:...................................................
Mailing Address:.. Z. ....... C'.t`ti. Tt..1.t �-......13.:......... .ZC.(J.L—AcU.LL,. --C ....... ae..L,C..... Z..fa.S .GP.
OnsiteRepresentative: ... ....................................................................................................... Integrator:..... 3. v. C� �5.......................................
Certified Operator:.... " }-%�-`-G.................... Operator Certification
Location of Farm:
© V1 t-1 5 L b L a G' S tx- ! of S 3, AV P n L�CJ X 4 L, --t S �-.. L L-C—S •
5 _ - '..�
IgSwlne ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude ' ° 94
Design Current
aw�ue
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I I[] Non -Dairy
❑ Other I I I
Total Design Capacity
Total SSLW
Number of Lagoons 2 ❑ Subsurface Drains Present 110 Lap-onn Area Spray Field Area
HoldingPonds 1 Solid Traps No Liquid Waste Management System OW n C �' 5A'f 5
p ❑ q R Y "o Uri M-r-r--
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, slid it reach Water of the State'? (If yes, notify DWQ)
c. ll'discharge is observed, what is the estimated flow in gal/min'!
d. Does discharge hypass a lagoon system" (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
nf'4-ALt"t5 , CX44--
0 Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freehoard plus storm storage) less than adequate? ❑ Spillway
StruOurc 1 Structure 2 Structure 3 Structure 4 Structure 5
Idcnti ficr' ........, u.................. d'. . fr..........................
.................... ................. ........... ........ ......................
.......
Frechoard (inches):
5100
❑ Yes 9�10
❑ Yes �*o
..A ^
❑ Yes KNo
❑ Yes MNo
❑ Yes �*G
❑ Yes ❑ No
Structure b
Continued on back

Facility Number: Date of inspection 1'rirtted on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed`? (ie/ trees, severe erosion, ❑ Yes P<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 3KNo
(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
8. Does any part of the waste management system other than waste structures require main tenance/improvement? ❑ Yes Mo
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 *0
11. Is there evidence (if over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type e Y ,0, S_T-A L_ V% < m,. tAA 7 r -> A c , I t -•r*4 1!,�L_S�,'1
13. Do the receiving crops differ with those designated in the Certified Animal Waste. Management Plan (CAWMP)? ❑ Yes (kilo
14. a) Does the facility lack adequate acreage for Iand application'? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes ANo
c) This facility is pended for a wettable acre determination? ❑ Yes gNo
15. Does the receiving crop need improvement'? ❑ Yes XIN0
16. Is there a lack of adequate waste application equipment? ❑ Yes ''WNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ;R�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes *0
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes R1 No
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 23�N0
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?
❑ Yes KYo
(ie/ discharge, freeboard problems, over uppl icat ion)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes W40
24. Does facility require a follow-up visit by sarne agency?
❑ Yes PkNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes NNo
U �+i¢iaidos.o1' [11 C�t'11CiiL'S HxHCL' �1[:tL[i (i ll°Illg {�t]5,V�51t= YOj1 wi�� eetriye', iiU• l�u>1'{#1�1', .
COrre5 oIl[ience. a�?out. tFiis .Visit. '
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
Le T�7
L S T-LAA ..-. C_ a �
ReviewerlinspectorName V-�-L Glee,,•_ Sat kL,S M�
Reviewer/Inspector Signature; t'')I- "," I A ?A Date: r { c5i - {�-T� 5100

Facility Number:` —y Date of Inspection �Oc Printer/ on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes gNa
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EM
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes %No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ^E10
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 5j -No
32. ❑o the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 'WNo
Additional Comments and/orDrawings;
cG---�r—�r
P�
?G
LJ
�io
HWIle
�-1 l
.. .... .. .. . .. ... I
J
S/00

Lacroon Dike Inspection Report
Name of Farm/facility
Location of FarrnlFacsliay
Owner's Name. Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH: IV
Names of Inspectot-S
C�[J 7
It
Freeboard,-f s, '�2_0
r
—C�� -- Top Width., Fret /0
-r Downstream Mope, xH: IV --
Embankment Sliding? Yes o
(Check One, Describe if Yes)
Seepage? �4--yes No ►-�
(Cheek One, Describe if Yes) - ee ►-f �
Erosion? Yes _,--'_ No
(Cheek One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? -- Yes � No If Yes, Depth of Overtoppin- Feet
Follow -Up Inspection deeded? —Yes y'"r No
Engineering Study Needed?
Yes v-,—l!So
Is Dam Jurisdivional to the Dam Safety Law of I967?
Other Comments
r
Yes _^L4ff'11'qo

13bivision of Soil and Wate'r Conservation Operation Review
C•Division of•Sciil and Witter Conservation - Compliance Inspection
Division of Water Quality - Coinpliance Inspection
© Other Agency - Operation Review '
11P Routine Q Complaint O hallo.+•-tJr rrf I:IWQ inspection 0 Vollo►r-up of DS1VC review 0 ❑ther
Facility Nrttnher G ")ate of Inspection � 3
I'itjle of Inspection 24 hr. (hh:mm)
© Permitted IM Certified [] Conditionally Certified (3 Registered j] Not C) erational Date UM Operated;
Farm Name: ............ �rVy.... t 4.4.i.�C..... FPi,itlx`......r... _�..... ... 1 C:ottnty:.... ..Dtr{�� yI ...................`........... .............
Owner Name: t'�!I��� i.[.(1 ........, Phone No:.....�glal�....�r�?.'tLi.........................................
Facility Contact: .......................................... .....qq............................... "Title .... I Phone No:
lllailing Address:.. �.a0......ctiL At7lrtu.�...� f�.�r0�1 �.�lR.t... .............. ............................................ ....5?.....
..
Onsite Representative: .......... Tyel....... F'.!X!.lLt ............................ Integrator: ......3mm.g................................ I ....... I ........... .........
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:
Location of Farm -
Latitude Or C�` �•° Longitude � • �' �
Design Current
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JEJ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Z- Subsurface Drains Present ❑ LaFnan Area Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
1)ischatM & Stream Impacts
1. I% any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated al: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-madc''
h. 11' discharge is obscrvcd. did it reach: ❑ Surface Waters ❑ Waters of the State
c. Ii' discharoe is observed. what is the estimaicd flow in gal/min?
d. I)nes discharge: bypass a lagoon syslcm?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the Slate other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 StruCILlre 3 Structure 4 Structure 5
Identifier: 7i
Freehetard{irrchcs): T ............r.................................-...�.....................................................................................................................
❑ Yes j9 No
❑ Yes (A No
❑ Yes 0 No
❑ Yes ® No
❑ Yes ® No
❑ Yes [4 No
❑ Yes 18 No
Structure 6
1 /6/99 Conlrnued on back

Facility Number: 211— K Date of Inspection
5" Aremtliere any immediate threats to the imcgrity of any of the structures observed'? Oe/ trees, severe erosion,
seepage, etc.)
G. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenaatce/improvctncnt'?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
]. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation n1arkings?
Waste Application
10. Are there any buffers That need mainten,,otce/improvement?
��
❑ Yes ® No
❑ Yes M No
❑ Yes ® No
❑ Yes Dfl No
7XIMENO
❑ Yes M No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen y ❑ Yes ® No
12. Crop type t+'mU> .a........ k...................... 1"fl...�Al N..... ..I ......... COY. Wi1j.*
.......................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes ❑ No
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does (lie receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. hoes the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
14. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is Facility not in compliance with any applicable setback criteria in effect al the time of design?
21. Did the facility fail to }cave a certified operator in responsible charge?
22. rail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
5D Yes ❑ No
❑ Yes (k No
❑ Yes 2? No
❑ Yes ftNa
❑ Yes M No
❑ Yes No
❑ Yes { No
❑ Yes CO No
❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes WNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
]VA.vialatioias or. deficienr es .were dated t�tiren s visit:. You va .receive no fiirther
enrr�sporidenee; abbot: this visit/:: ; ; ; ; ................ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.;'
Use `drawings of facility to better explain situations. (use additional pages as necessaCy):i i
IIt LL[t7ti'w r,J �0 - vv o, . WOShDut� �t' C �+� CIOM)I a
W ; MF v aa, �{ S 01� 0 t 46y\ Or lf.F1>N•Ct• [ cvv, ] 1[;w4 U.
wit/ lie rI U r Wa rG4-Lvm+ n host u4gs ` o f IUu�ry Cry- l7t�v! l�t ci �°Y
�
GJU�' �6 {
A mr ���w j � � �r{�S i P1dz L�e5 ;n- hcwes + IAICON
Reviewer/Inspector Name - KA
Reviewer/Inspector Signature: /0,,RJ•. f l — Date:
IVl7L'iM

0 Division of Soil and Water Conservation ❑ ether Agency
Q Division of Water Quality
10 Routine D Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Date of Inspection
Facility Number 3 �[
Time of Inspect inn = 24 hr. (hh;m n)
0 Registered ;Q Certified E3 Applied for Permit © Permitted 13 Not Operational n Date Last Operated:
Farm Name: ...................... .Y.Y .........1:L.4�1.4 ....... rCl:, r^..,......................I................. County: ........ i a. �il�.............,............,....,.....,.....................
OwnerName: ............................. ........................................................... Phone No:...... °.li��.. � `i.: �4! 5........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: .......... tgi A..+.Alw% :....... iou�!5..,....0.:......................... ...... Ety. A :0[ k.ke..t.r��....,................................. .z..MS ........
Onsite Representative:..........! IIft...& t1...... MULU.............. Integrator:......: .......... —................................................
Certified Operator. .................................................. _..._.,.........---.................................---• Operator Certification Number:
Location of Farm:
Latitude « Longitude 0' ' fL
. .
-sign Current Design Current
Swipe, Capacity_'Population Poultry Capacity Population Cattle,. Capacity Population
Wean to Feeder 3 zLo ' zoo ❑ Layer ❑ Dairy
E..
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
..........
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars Total SkW
Numlaer; af;I;aQQtinns 1 Iinldiri :Ponds Suhsurface Drains Present 110I,agoonArea PX Spray Field Area
No Liquid Waste Mang •.;_ _� gement System em
Genera
1. Are there any buffers that need maintenance/improvement? ❑ Yes PNo
2. Is any discharge observed from any part of the operation? ❑ Yes ER No
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -matte? ❑ Yes No
b. If discharge is observed, dies it reach Surface Water? (If yes, notify DWQ) ❑ Yes [P No
c. If discharge is observed, what is the estimated flow in gaUlnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes qNo
3. Is there evidence of past discharge From any part of the operation?
❑ Yes
P No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoon4holding ponds) require
0 Yes
❑ No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P] No
7, Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(P No
7/25/97

Facility Number: 3 — S
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes MNo
�tructures_(I <aeoons.11olding Pond_&-Flush_i'iIs. etc.l
9. Is storage capacity (freeboard plus storm s(orage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �. 2-
................................................................................................................ ......... I.........................
.................................
Freeboard(ft): ............. .a.ii........... .............. L.4.............. ............ i,•....... ..... ,.....,...........................................,........i...................•,................................
10. Is seepage observed from any of the structures? ❑ Yes 9 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12, Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Annlication
14. Is there physical evidence of over application? ❑ Yes M No
(If in excess of WMP, or runoff entering waters of the State, notify `DWQ)
15. Cropa ................
.'C.".U.p-..........;iI. M'.... Mi .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ONo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency`?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Cerlified oEr&rffljjted Faciii fe- Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations:vc deficiencies. wver'enoted-during this,visit., .Yo4.A11 receive;no further:::
corresp06deinO d out this'yiMt:::. -
❑ Yes CgNo
❑ Yes 10 No
❑ Yes P No
❑ Yes No
❑ Yes JN No
150 Yes ❑ No
❑ Yes M No
❑ Yes No
❑ Yes No
+ImmE. t'e. er t .('� .... hn '.,'vEx ialm" :':YES answers rtnd/or- n reeommendati"i orian other commuit9i
3....... .........� i'..'"::: i:.:.�. .. i.� «.��..I.�F>«..�FF4 i3•.;..... ;. y. ... i i. ¢ .. y
.. i. i:.
lY] 6 [lrgwingkof facility ta_hclter; ex lain sft i tiisits: use additiadaI a es as n scessa ')iAM"'.;€ _
.. r:'. k".!r1:i3hF"sir."tirn�,.iiees• �:....:: ..........:.....
5. Ca. Swj be_ CA -(}ow ar' to c�ecr kz uK l co" 6 rtjt5e.fkw,
cxmsed
t'�osgtrl" 6&,k Ve's 1
wcs� C� %is .
7125/97
Reviewerllnspector Name
Reviewer/Inspector Signature: A1-vot,
Date:

►w
------------------------
1[3 Division of Soil and Water Conservation ❑ Other Agency
i �FZ•;� j ��:
',,,,` ,F•-"' �,.� ,;� Division of Water unlit
® Q
.. �... :... ..... wy�n•�e�..s,w.iliEw!'^e!"'.':"'Si`S"'-.ii::,n-�...,.....3�rSv-f:l::�..—...,,
... ......... ... .. .:.....:: ......... .. �. 11,,-w�,,,n*--..+,mww..w�..p...........-..:.!•"lsF4.....in--w�+..eer.....a...�........N :':S '
0 Routine 0 Complaint 0 Follow-up of MV0 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspecdon
L I Facility Number'
Time of Inspection = Db 24 hr. (hlunun)
© Registered ® Certified 13 Applied for Permit [3 Permitted [j Not Operational I Bate Last Operated:
Farm Name:...Y. .!".+r.. !-�1,.t..1.i.t: ..-....,-.s..�,e....�,....a .d..... -..... Cntinty:... .r�. ..k.K,...................................... Ljj.. .
Owner Name: ..............rx.. ......,....... .......... Phone So:.... .....................
FacilityContact:.............................................................................. Title:................,...,....,..,................................... Phone No:...................................................
Mailing Address:......1..7.:7..?—........Pm..S..uric..-..-? ...... ........�?.�.�r�i:..4.�.� 1..[��.�......................... ..�.�. r'..�g...
Onsite Representative:...-x.Ok..I i.Ll ram .......... ................................. integrator:,..... ........................ .-............ ...............
Certified Operator;............................................................. Operator Certification Number...................
Locution of Farm:
..... rx.t .t..t......s...S.p.-l..q.5.9." .... LA. ......�.,.�.�.......sc.�.... i
. :.....:........ .:.�..Lc:......... ,,,,.ti.�-t�,...... ks. ti................................... -................................ ......................-........... ... ....................
Latitude Longitude �• ��"
€ :... es gn' urrent °F, 'st rid. urren Design
Swine :;... • 'Cipacity.. Pnpulption:::, Poultry :;;:; ! Capacity )'upulat'ton : ;.Cattle Gapucily Population' .
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
"JiNu ber;of;L'agarms IHoldin ;I'nnds Subsurface Drains Present Lagoon Area �] Spray Field Area x
.....
F
�., :::� � i:: �: +5':: is l��: �::::. �� "Eli;"i �:.::. se �s t•t.�f'::� .�;. ... i' .. .� ."'I�� "rf:.
'. s ❑ No Liquid uid Waste Management System
e..
(jeneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes j$No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISpray Field [3Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'' (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gallmin?
d. Dons discharge bypass a lagoon systern`' (I17 yes, notify ❑WQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than From a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes
® No
❑ Yes
IN No
�jIA
❑ Yes
No
❑ Yes
No
❑ Yes & No
❑ Yes ® No
❑ Yt~s JR No
❑ Yes kNo
Continued on back

Facility Number:
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures La Loons I lold ing fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3
Identifier: .......,.r...�. +?.-........
Freeboard (ft):
10. is seepage observed from any of the structures?
❑ Yes $j No
❑ Yes U1 No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed"
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify I7WQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
. . . . ...........................
❑ Yes ® No
❑ Yes ® No
Yes ❑ No
❑ Yes RNO
❑ Yes )a No
15. Crop type AIV. .............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)'? ❑ Yes QNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/hispector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement:?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
&No'vialations or deficiencies were noted during this'visit.-.You:will receive no ftirther,
Orrespflridence ahioat thisvisit:•; ;
❑ Yes 10 No
K Yes ❑ No
❑ Yes ® No
❑ Yes lR No
❑ Yes IN No
❑ Yes 54 No
❑ Yes Q No
❑ Yes Eff No
❑ Yes ® No
Comments'(refer,ta question #): Explain any YES answers and/oi• anyrecommendations or any, other..comrnents.
lb drawings of, €facility to better "- Ouin` situations. (use additional pages as necessary)
a,_ a off. VA"— fl+.-.
s, ' -► - L �t ..l .L A-4t �_7
t s a a� }
.,� , �- = f K-L� {f
7/25/97
Reviewer/Inspector Name ,.. ..........
•..., . _
t„
Reviewer/Inspector Signature: ��„ r �17 ,[i a,�, -,,�, Date: to [ 1 � . 1?_.___�►'�

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Site Requires Immediate Attention:
Facility No
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: o--;z-3 _, 1995 -
Time: c7
Farm No
Mailing
County:
Integratc
On Site ]
Physical
Type of Operation: Swine Poultry Cattle r7'7
Design Capacity: , 4, Number of Animals on Site: �el o ❑
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 '�Y ' �-51 ' 4a_" Longitude: 2_' '�',2 Y Elevation: Feet
3 "y 1 3 Circle Y7sZr D'b 34
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: Ft. Inches
Was any seepage observed from th�e-llaagoon(s)? Yes oti Was any era on observed'�Yes or4o
Is adequate land available for spray? rep or No Is the cover crop adequate? es r No
Crop(s) being utilized: �o�'��_ �
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?or No
100 Feet from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o GN
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? gor No
Additional Comments: -Q'9 COLD ^ 1 x 149 00 A LIA c o 1t
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Inspector Name
S ignature
cc: Facility Assessment Unit
Use Attachments if Needed.