310563_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

rl
Type of Visit: QZoutiane
ce Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint 0 Follow-up . O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I 1 - County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: / G -3
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Ca acity
Wean to Finish
Current Design
Pop. Wet Poultry Capacity
I 11-ayer I
Current Design
Pop. Catlle Capacity
Dai Cow
Current
op.
Wean to Feeder
I jNon-Lner I
Dairy Calf
Fgeder to Finish
Dairy Heifer
arrow to Wean
I Wq Illae--sign
D , P.oul Ca aci
Layers
Dry Cow
io .. Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
O#her
Other
keys
Turkey Poults
Other
Discharges 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)
❑ 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 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 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structu/r�e, 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ i)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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 , notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No A [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No NA
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ❑ Nor-]' NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes <No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes [�]'No u NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ffNo ❑ 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 ❑Check]' is ❑ Design ❑ Maps ❑ Lease Agreements
❑Other
21. Does record keeping need i ovement? if yes, check the appropriate box below.
Yes ❑ No ❑ NA
❑ NE
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather
Code
ludge Survey
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectiWNo
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑40w❑ NA
❑ NE
Page 2 of 3
214,12015 Continued

Facility Number: I -513 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes l4 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E) O NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑<❑ ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
❑ Yes �0[:] NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
rNo ❑ NA ❑ NE
Comments (refer to question #} Explam any YES answers and/or any additional recommendation's or anyother�eominents4i: 14'
Use�dra►nogs of fac�lity�,to better explain situateons (ase=add�t oral pages�as'necemary).
-Net, dalr, P�ntr h,�t�t Can�#A���
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-- n� I,.-�'� � 9 f to / /,S
M
C✓ 4✓kP �sfp r t le!I-+C� i�L !�` i gip, dl6lr4 C�►''�sf,nel-,�L.Sa-�
�d t 5, S Ads d 6p c�a r f
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Reviewer/Inspector Name: 0 I(Vi C o�"`' {�(.�/ Phone: Ito 7 ? 6 73°Y
Reviewer/Inspector Signature: ��Vt Date: 6A;,
Page 3 of 2/4/Z015

type or v isit: Jp compuance inspecnon v iiperatton xeview V structure r vaivanon V i ecnnicai assistance
Reason for Visit: 0 Routine 0 Complaint _CKollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,' t � Departure Time: County: —
Farm Name , -�,�� �� t,( r--� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: Lj, jZ
Design C«urrettt
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pap.
Wean to Finish I
ILayer
I
Dairy Cow
Wean to Feeder I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , luult .
Ca acity
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;3' No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑i No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
f"No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
J�jNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
8 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�fi o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4.. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
LZNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
'�3
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
�] NE
waste management or closure plan?
,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[:]No
❑ NA
J2 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
P 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
maintenance or improvement?
'[2-NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
[;VE
maintenance or improvement?
7
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
gNE
❑ 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
❑ No
❑ NA
❑'NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[] No
❑ NA
❑+NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
.[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
,❑"NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑'NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
[:]No
❑ NA
❑`'NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Page 2 of 3
214120. Co \

Facili Number: Date of Inspection:
24. Didthe facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No ❑ NA Q NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below. /
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑' NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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? ❑ Yes ❑ No ❑ NA jaNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No 13 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes )�o ❑ NA ❑ NE
Comments (refer:to.,question #): Explain. any. YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
` rollov-Lt 1fispeC�loq 4o e-vojua /e- cleg4- up
/rl ollc1ll 4a. vl sf e was
1
❑ Yes ❑ No ❑ NA m NE
❑ Yes [:I No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA aNE
5 o � � o doGt D�dtor X)�X). A.� (Marl � r
0V A)a,5- ;�e�905ed 6j/M el"�_Ifiz2 'i-
O -lc G(i a,s fe hA— elt a
Deal
Reviewer/Inspector Name:
/?/0/-e1l ��. ��IZJttl k S�,/r 0/7
^� Reviewer/Inspector Signature: /
Page 3 of 3
Phone:
Date:
/4/l01

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[lesson for Visit: 0 Routine 0 Complaint 0 Follow-up 0 ReferralA''Emergency 0 Other 0 Denied Access
1 I MSK _ __ _ H 5 9 -t-\ I 1 _
uate of visit: Arnvai time:I �S f rl oeparture iime:I a—Jv rrI county: 1� I II I xegion: N.4
3; 310 orb 1y �*y
Farm Name: Alli -Ir- h e. 4 � � __l� rvvi Owner Email:
Owner Name: !U V ME b90014 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: q Con-c- L N ogai S
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
I ILayer I Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oui Ca act P,o
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Qt
In —Other
Turke s
key Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? m Yes ❑ No [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ® Other: (�f (EAN 0or or- F/UTStVZiX10 P i PW
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)?
151000 .34 f to1LS
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
® Yes
❑ No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[-]Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[30 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ® NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No [g NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [2 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 [Z Yes ❑ No ❑ NA ❑ NE
maintenance or improvement? SMP" Pr'R- ptutJOINq LOA5 &f1-.'5zX'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 ❑ 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): N/G
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [Z NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA W NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑ No ❑ NA [ONE
acres detennination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
❑ No
❑ NA
� NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[a NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check
❑ Yes
❑ No
❑ NA
[j3 NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
® NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
5D NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection: / G
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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ® NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
© NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
® NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes]
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
® Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other,comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
recaiJed. a-- pkoke Ca! corn♦ ;ala04 AJOrrrs a. N 1:4 rt or11n
�I��-y lead a sell • De4N H��► Qi� apt -tue. �r� ref �r{ore�la S�►�e�"'9}
cLr(ivek t;-0 iv,,L s)i.t at 3 30 pH rxKd IrAe wi•ft,, .j'-r_tLae! forr-g,s,
�e_4L NOC4� t" �.Kd -o-t-ker re_ �rQseM$u++ ties w' C1ur phi Z� rawtn . _TkN_
v � oY fi w Sr'ac�iioin we s ass Po ILa,0 5 :
► Y•d dowv+s�f'�+r+� �a� v-)as�'e was bbse-r q&,L '.41 -1 srna�t p°�td
v-a.s b 10 cf t.ad. tc o
2 —� tie f,� 1 re 5 �f : S j�� tt w Os+,
[Cle ►'t ot� r fil"�' �'r'a:`v'> JU a to 't m �ro�r (�lrnbi �9
fesSu st'; P`Pp- I '.� wet E `� vxcow�.l�o��; lal�•, l�t�P� x t`�YG +o/
�} t ors s FVr_ ,9l
�tMu�ecsal � s� �
ferarr� '�
4> St
aA ; A— O `1c pavA desC.ndad..,n 't �-QYn i, o�5nve�.
_ y �v, t �Clit iG wi' - a'
r Q U3 vN .nnn20n dle�. � o P CU ��, (� p e S
tj't 5 , t b seCv a cl rM t rat- ��►�- IT-
S t b [G ,M at 1PL.af 3- t W ac s o V �r u.) o o d2tA_
�. k,,I [J fC. `[n+ (�- v^cLf �Le r \,.a°-S oL 1pQ v4d
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t jORtI&- SEX WCAA -b
Phone: ' 1 o 11 b:1 1 8
Date: Oq I k ct l 2 AI
21412014

Type of Visit: 'Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: /6Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: � County: Region:r21/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: rn&�/f�Q
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:�%�
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
C►attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder I jNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean RM00is ign Current
Farrow to Feeder I) , R,oulta aci l;o
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges 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 16No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes JD No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �no
❑ Yes J:]�o
❑ Yes [KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes',�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E No ❑ NA ❑ NE
Structure 1 Structure
2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
u
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Z/ 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 E:fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,fNo
❑ 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 0No
❑ NA
D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 6No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2J'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?
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.
❑ Yes )EI-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes �ff No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes J�j No ❑ NA ❑ NE
Yes ZNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _L2'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J ' o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0*0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes/0 No [:3NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�TNo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes j:�-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 T2rRo ❑ NA ❑ NE
❑ Yes L2-No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes El -No ❑ NA ❑ NE
❑ Yes Jam-' - [] NA ❑ NE
❑ Yes 2'No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: Y j r/
.3 l�a
Date: 6f
Page 3 of 3 F21412011

c
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: A7ival Time: i' eparture Time: County: `L Region: zzz/_j4_7
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Pjhone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = ` = `. Longitude: = o [= g = it
I tA
Design Current
Design Current
Design Current
Swine Capacity Popnlation
Wet Poultry Capacity Population
Cat#le Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er I
❑ Dairy Calf
❑ Feeder to Finish I
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Stocker
El Gilts
❑Non -La Non -Layers
El
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Co
❑❑Beef
Turke s
Othe
❑ Other
urkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ;�No ❑ NA ❑ NE
❑ Yes ONO ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection c�
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?
Stnic re I St re 2 Structure ? Structure 4
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [a/ o
El Yes {Li No
Structure
❑ NA ❑ NE
El NA El NE
Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes VfNo ❑ 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 7 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P1 No ❑ NA ❑ NE
maintenance/imp'rovement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No El NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZI No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
U] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VINo
❑ 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):
i
Reviewer/Inspector Name el Ad Phone: 7
Reviewer/Inspector Signature: Date: oZ-7
1Zr281V4/ / uonnnued

Facility Number: — Date of Inspection
liequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
❑ Yes
IQ No
❑ NA
❑ NE
❑ Yes
Ef(No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
.❑ 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 Inspectionss E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
Id No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain. rainbreakers; on irrigation equipment? ❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ 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
PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
_
�..
' POD cSu�M��r✓� r
Z
rrn /� rca�S' 16ak
�f0,01r
G, T7
c/
d. Z7
�i�la
Page 3 of 3 12/28104

M
Type of Visit Q"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�+o Kflutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l Arrival Time: /kparture Time: County: Region: �m
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Emaii:
Phone:
Phone No:
Integrator: %/ J
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = f = « Longitude: = ° ❑ 4 = fi
Design Current Design
Swine Capacity Population Wet Poultry Capacity
C►urrent Design Current
Population C•atile Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
ILI Non -Layer I
I ❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
10 Gilts
El Pullets
❑ Boars
❑ Turke s
Other
❑ Other
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
�No
VNo
❑ NA
El NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3 12128104 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?
Struc re i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (nQo`
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 XNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes R(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? [I Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )nNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VI 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
JV
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[INo
❑ NA
❑ NE
Comments (refer to„question #): ,Explain any YESryansweis and/or any recommendations or:any other comments _
Use drawims of facility t0 better explain situations. {use additional pages as necessary};
•
Reviewer/Ins ector Name ':
p .. Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

• Facility Number: — Date of Inspection 1111r111e2
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 VNo ❑ NA ❑ NE
the appropriate box. ❑ VFLp ❑ Checklists ❑ Design El 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
VrNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
UrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes2fNo
ElNA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
R I1No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
14No
❑ 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
dNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
d No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[Z No
❑ NA
❑ NE
Additional Commenis:and/or Drawings: .w'. W ._ :Z 7
ki
Page 3 of 3 12128104

Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up Q Referral P4mergency O Other ❑ Denied Access
De Date of Visit: t ` .Arrival Time: � Departure � Time: County: ' u Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o = , „ Longitude: = o [� , =
64
Design Current
Design
Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity
Population
C►attle Capacity Population
❑ Wean to Finish
ID Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stacker
❑ Farrow to Finish
❑ Non -Layers
❑ Gilts
El Beef Feeder
❑ Pullets
El Boars
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Points
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes &No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

Facility Number:3 Date of Inspection 3 c
4
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: +
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
L/J No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[INo
❑ 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
Vj No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
sNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu,
Zn, te:)
/'
❑ PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments, (refer to_gnestion #) Explain -any YES-ansr.ers and/or any recommendations oranyhercamments.
Use drawings of facility to betfer ex lainwsituatioris. nse=additional a es as necessa "*
{s�c a Cud/ art lsrJ-� /?:r�i� ,5,1P///AL
�2ur��uJ 7—w . 4111,
at 1- '' `'` rlla'`'t l/tJ�p�'L%A,,-, n. o ���` ` Sf� �Gt.s'� 6</� S- zles7/,6,�
lfaCGcrr� �citMors re" �e.s�
oo
eviewer/InspectorName f µ "M Phone. �l/-✓�a?D ��S!��
Reviewer/Inspector Signature: Date: " O
12128104 Continued

Facility Number:, Date of Inspection o cs d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
❑ Yes ❑ No ❑ NA VfNE
❑ Yes ❑ No ❑ NA ZNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA fl NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA XJ E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NANE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA 2NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA &NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
3"N' E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
eE NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
ANE
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
eNE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
EfNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
WE
Additional `C©mmeifs"andlgi= Drawings _
✓l rt.'jlA/ '^f Silk/ vLS/6Ce c.-t ��
ba f _iA.-a be c 7,f
® le Gf t'rrK in
12r28/04

__,Q~ISivision of Water Quality �/ }
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O Arrival Time: 101, �eparture Time: County:
Farm Name: //�r.G��/mil ^� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _e 'L74
Certified Operator:
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = = d = Longitude: = ° [=' =
41
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[]Layer
0 Non -La ei
Dry Poultry
❑ La ers
❑ 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 Heife3
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F__1'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes�o
❑ Yes o
El NA
❑ NE
❑ Yes ,,�No ❑ NA ❑ NE
12128104 Continued

f
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Vo ❑ NA ❑ NE
Structu I S re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
PNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RfNo
❑ 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
[;Y'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
6] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
rq
[INA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
VNo
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
r■
Reviewer/Inspector Name 1 f Phone: l�/ ��—
Reviewer/Inspector Signature: Date: e�=
12/2R. .nntinued

Facility Number: — 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 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
El NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Cl Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
l o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately ?I'.
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application) (r
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 9
4o ❑ NA ❑ NE
Page 3 of 3 12128104

i
Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: h Region:.
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other -
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ O = ❑ Longitude: f= ° ❑ ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
--� LJ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
W
a
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued
r -A

acil.6 Number: — Date of Inspection '7
Waste Collection & Treatment / <
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2No ❑ NA ❑ NE
Strut re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Vio ❑ 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 hTo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [Xio ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '7 "" ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
l3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Xj No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
fNo
❑ 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
[�To
❑ 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):
T
Reviewer/Inspector Name — - Phone:
,/�
~ Reviewer/Inspector Signature: e! _ Date: �a �/
f
Page 2 of 12/2&04 Continued

y Facility Number: f — 6 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Y1 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ["No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No
[I NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P<o
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El 17
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes L No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ffo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 1.2No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes.No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
x
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 ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes P40
❑ NA
❑ NE
Additional Comments and/or Drawings:
re
p6114 J4�4, /
A/
%ate G4 f
Page 3 of 3 12128104

Facility Number
ADIDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit lzompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit,,,ffRoutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: A7rival Time: Departure Time: County: _1 Region: ____, 40
--, -0Ir
-
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
3 Odier,
❑ other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] c [_] Longitude: =1 o = r
Design Current; Design Current Design Current
CapacityP.opulat�on Wet Poultry .,Capacity Population Cattle Capacity >Populahon
❑ Layer
❑ Non -Layer
E Dry Poultry
❑
Layers
❑
Non -La ers
❑
Pullets
s
rTurke
Turkey Poults
Other
Discharp_es & 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 B roodC
0
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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

acility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St ru re 1 Struc re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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):
Reviewer/Inspector Name777 Phone
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

- ...•••uyly�Irrp!nbrrrwrrrrnrrrrr.lrlrlrlr
j
Facility Number: — Date of Inspection
Required Records &_Docu_ments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No Cl 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 [I 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Add►t g al`Gommenii.and/otbrivwings
L a marl arl -0�
I2/28/04

7
IType of Visit goe6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit QoRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: Q Q Ar�riv�al Time: � % Departure Time: �County: k i'C Region: ��
Farm Name: �C�/ Cllir Cl� �GG.�i/.�7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 [ [ Longitude: = ° = 6 = «
Design
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry
Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
arrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
12,1114111-
Other
❑ Turkey Poults
1 1 111,111gurnber of Structures:
L
❑ Other
❑ Other
Discharges & 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 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
Pmo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
<o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�o
❑ NA
❑ NE
other than from a discharge?
12128104
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 l Structure 2 Structure 3 Structure 4
Identifier: A
El Yes 91
❑ Yes ,Y!f No
Structure 5
❑NA ❑NE
El NA El NE
Structure 6
Spillway?:
Designed Freeboard (in): 79=wl— d
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
E�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_�lVo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
V'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
0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �r X " . 47�t4 ,
13. Soil type(s) Z/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Plflo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VINO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (referKto goeshon�#i7 Eyplamiany�YESFanswers�iiii r any►recammendaicans or any other comments.
Use dr �gsAfnac�ty to�he tersegplam sitaat�ons. "(nse addEhonalt ages as necessary)c
vt
e leaSa mow IM S)Ci& %06� c..) all 5
Reviewer/Inspector Name tr �' Phone:
Reviewer/Inspector Signature: Date: 6 G
1212814 Condnued

.♦
Facility hlgmber: a Date of Inspection •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design [I 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 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes P10
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ftz
PNo
❑ 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
P-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PrNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;2rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VfNo
❑ 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
0No
❑ 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
J0,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
( No
❑ NA
❑ NE
Additional Comments and/or Drawings:
161'e-1
G Vew., ie �, A4? 3
12128104

11
Date of Visit: q 0({ Time: Q b '
Facility Number � 5�
O Nat O erational Q Below Threshold
0 Permitted 0 Certified 13 Conditionally Certified [r Registered Date Last Operated or Above Threshold: .........................
FarmName: ..... _............. _............... ............. ................ .._............_._...._... County:
OwnerName: ..... .... . ....................... ....... . ..... ...... .............. ..... .............. ......... ................... Phone No: .... ............... ....................... ...... ..... ._.....................
Mailing Address ..............................
Facility Contact: ..w ..... _ Title:Phone No:
Onsite Representative:.A..,.......- ........................... In ......_............................ . w......._.._� . _ .__
......... Integrator:
Certified Operator: ........................... Operator Certification Number...
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 66 Longitude • ° 4C
„ r Design .current r JJC��gn r l.uri nth
.. _.
t" ` Diiign =Current W
swine
_.s Wr
Ponitr3' Ca seiry
Ca -act Po Cattle =
elation - �.Poiilartoxi: :Ca c� -Po elation
Wean to Feeder
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes [I No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes :5No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1G7 _...._........... _..... !g
� 3...� W_ .. _ �.. _,....
Freeboard (inches): I i
12112103 Continued

Facih'V Number: 31 -- Date of inspection
15. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes /No.
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes�N/o
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 maintenance/iimprovement? 5Kes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �To
11. Is there evidence of over application? If yes, check the appropriate box below. ElYes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C, S LJ eEa&M UDR ( 14 ) S C0
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 Iand 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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately_
UP OATC MOP Y T Ei j C.12.vr\
❑ Yes �Zo
<
❑ Yes ❑ Yes lo
❑ Yes n
❑ YesrN__q�
❑ Yes
❑ Yes To
❑ Yes
❑ Yes [N�o
El Yes No
❑ Field Copy ❑ Final Notes
9.) SOMC A Qt CA5 zj,� rmeLc�. Ir-3 O cCD C-kozrorJ C-pA 13c SgEi i ,
_tJC.4.0D(— t Z-tfA L)1J9 A rr}G�3flMCr�' oP`1�
Reviewer/inspector Name r
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: Date of Inspection
•Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(e/ WUP, checklists, design, maps, etc.) Yes ❑ No
i
23. Does record keeping need improvement? If yes, check the appropriate box below. El Yes o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes zNg/ZO/
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit? VNo
(ie/ discharge, freeboard problems, over application) ❑ Yes27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes ldivo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes INO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall [:]Inspection After V Rain
❑ 120 Minute inspections ❑ Annual Certification Form
[r No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (XRoutine 0 Complaini 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:rO
Not O erational Q Below Threshold
® Permitted ® CertifiedD Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: &-l-d e IDir Sr✓ dli:�fi _ County: --- Atobli
Owner Name: ma( h S i5o'lo Phone No:
Mailing Address:
Facility Contact: Title:
I A
Onsite Representative: 1rIrl1i'j
Certified Operator:
Location of Farm:
Phone No:
Integrator: Mgr !�.
Operatof Certification Number:
91 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 6 Du Longitude * 4 C�K
Design Current Design Eurrent Design
Current
Swine, �.MCa aci P,o ulation. P,.ouI Ga aei P,o ulation Cattle Ga aci
Po ulation
❑ Wean to Feeder ❑ Layer ❑ airy
❑ Feeder to Finish
❑ Non -Layer
❑Non -Dal
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
L�
❑ Subsurface Drams Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes 93 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes X[No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): / "
05103101 Z, if Continued

4
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes C No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 91No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 141 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IM No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type ft4y , ,5,ru/l art i pk , / `fl,rt Gtl/IQ�-5cr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
&No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15,
Does the receiving crop need improvement?
❑ Yes
FlNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Pallo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other 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
&No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
K:[No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
91 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ko No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer to questlo© #): 'Eaplam any YES answers and/or anyrecommendattons or any otiier,comments"
s
Use drawi6gsg6f1aci1ity to better explain -situations. (use adiitional pages as nece ry) [] Field Copy ❑Final Notes
ND : p� Piro oK Mein ZA jb0A he4 -b � e4PAAe�
r f'tY)YAPF t h ! / dd 7 4 le, h %'i� �! 1K- t`�{/ �'I�l-/ /V� ■ 5y5 ! r �/C1
k1 ky r,e pikted totA Cen*Y pi'u s y Orpri so -A, �'�e ►s h f ��rro�A�
Y C D
Mid � Via!
Reviewer/Inspector Name g�, 7
Reviewer/inspector Signature: Date:
05103101 /
Continued

Facility Number: 31 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 159 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gl No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes %No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes $a 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 F.No
3 I . Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9I No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes O No
Additional Comments and/or prawings: ,
05103101

Type of Visit >6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Sfla Date of Visit: Timt: 3 i$ O 1 �'f
10 Not Operational Q Below Threshold
Permitted [3 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
�°l.�.C�12 �,L r ,��.w..F� `.'.'.'a............ .......... County:..` .V .�.1.YL........................ Farm Name: ............ ................ .......... ..............................
r'
Owner Name: Phone No;
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:..........................................................................................................................................................................................�....+.......s..... ......................•...
PIA Representative: .�...G �.f..................................... Integrator: ... n.y.�.+.......................
Certified Operator:
Location of Farm:
... .-....I .......... I .............. Operator Certification Number:.............................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� ���
Design Current
Swine -Capacity.Population
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
ZQ 35
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design. -.Current Design : r Curiient°
Poultry Capacitv Poulation - , Cattle Ca aci _ =P60ul 661
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other "
Total Design Capacity
Total SSL- w
Nunther.of.Lagoons `: 2—Subsurface Drains Present ❑ Lagoon Area Spray Field Area
:Holding Ponds / Sold'Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes O No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gallmin? hIr
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 Y No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentifierId e Uj ........................................................................................................................................................................................................................
Freeboard (inches): , 2-:3� 35
5100 Continued on back

Facility Number: 31 Date of Inspection 1 Printed on: 1/9/2001
5. ,Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes OfNo
(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 JjNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type lose r"4-v Olaf. . 4y ct y0. J>4Q f t Gra+ W%
13. Do the receiving crops differ with those designated in the Cert fed Animal Waste Management Plan (CAWMP)? ❑ Yes NrNo
14. a) Does the- facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes KNo
16. Is there a lack of adequate waste application equipment? ❑ Yes j4No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 0 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes fidNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ;9No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a actively certified operator in charge?
D Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
ElYes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ( No
24. Does facility require a follow-up visit by same agency?
❑ Yes] No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
Nq•yiol"al[iQris;or• aefciend' v re ote� daring this:vis�ti Yop wii ree�iye no further
' cor'res • Bence. aibaut� this .visit • . • ..... ..... .... ..........
Comarents (refer to question #) Exphufo any YES answers and/or any recommendations or any otl
_ Y
Else dfia of to ' to`better eg lain situations {use adi3tUaa1
__._ vnngs:: �h' ._ P _ _ . P
F�aL a�� fr'ecl"rds cre f vey` Dell ke&.
Reviewer/inspector Name li'�t �! �._.3 �5�«
ReviewerlInspector Signature: Date: V f
of 5/00 '

Facility Number: 3) —S6 Date of inspection 1$ Q Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below [:]Yes )�No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JA No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a pei•manent/temporary cover? ❑ Yes ❑ No
5100

D><vLston of Wester Quality
Q Dtnsion of Soil an Water Conservation i_7 s
s1.rr•s'-
Type of Visit IWCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: io Z n� 'time: © Printed on: 7/21/2000
NNot Operational Q Below Threshold
Jff Permitted E3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: }- 1....................................................
............. G'le. nlr'.......Fe.*'^�......................... Countv:.....--.V .IAkt....
Owner Name:.....11 awt wed Phone No
Facility Contact:..............................................................................Title:.............. Phone No:
MailingAddress: ................................... ........-.........- .................._............................................................... .
Onsite Representative: -- Integrator:.LGl' �.... f
........
Certified Operator: ................... Operator Certification Number:,,,,,,,,,,,,,,
Location of Farm:
,Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 -' Longitude ' C�' cc
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Iff Farrow to Wean a0 5
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ ]Boars Total SSLW
Number of Lagoons Z ❑ Subsurface Drains Present ❑ Lagnnn Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Disebar2es & 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-rnade'.'
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any.adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I St>-u - urc2 Structure 3 Structure 4 Structure 5
Identifier: .........old-- ....... �
Freeboard (inches): so 40
5100
❑ Yes *0 No
❑ Yes J.No
❑ Yes IN No
1 a
❑ Yes XNo
❑ Yes R No
❑ Yes KNo
❑ Yes VfNo
Structure 6
Continued on back

Facility Number: 3I -57e3 Date of inspection D Z LtD printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [:]Yes 29 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closureplan? ❑ Yes FfNo
(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 0No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 10No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Jd No
12. Crop type 4qef"Vlt� I1 -S-' rX i h.1.Mft4yai
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,gNo
b) Does the facility need a wettable acre determination? ❑ Yes B No
c) This facility is pended for a wettable acre determination? ❑ Yes R No
15. Does the receiving crop need improvement? ❑ Yes P§No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ElYes 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 XrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes .8No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,� No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes B1 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 14No
24. Does facility require a follow-up visit by same agency? ❑ Yes )9 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PtNo
E1: No violatforis:oi iteficier�cies were hated during 4his:visit: • :Y:ou will •t•&6*cy iio: rurther .:.: •
corres onc><eRce:abotitthis: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):
ICJ . i,�JOrk �� jwcp!'Oflela ltil �grt�QS ►n �`; el�( � . �G+'�;hVe e��U!`f S -�a `
r rn D,r-al/'e• G o 1��� 1 "1 �' I G �� �.-` ,p
M . Be S U fB fa Use pea aJ,,^I d4cd �-dg�e a n ci S l ,f 0 ti .1- A � ` Z : r
c
f3. Kbvild d� a.-o�n�t yr��uw� C r rej�t �p
teaa'e 1U d ��� ,

Facility Number: jl Date of inspection 1 rJ O(! Printed can: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes gNo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes 54-No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 99No
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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JUNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional omments and/orDrawings:
5100
5100

Div'*sibn of Soil 'and "W" OpeiationReHew ;,-
-t [3 Division dMil"arid -�Vat&-Con�iivatioli-,- kn�eJnspec:ti on
­.A.-tbii4sion- ofWaterWateedalityQ ompliaiai�el nsp&tionjf�� .-
Othei A w. e
g
16[Routine OComplaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 00ther
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:m
Permitted [3 Certified 13 Conditionally Certified 13 Registered JE3 Not OperaEtionial Date Last Operated: - L 1�1 k I, ..........................
FarmName. ............ ...... ....... County . .......... ....... Ic ............. ......................... .......................
OwnerName: ................................ ................................
Phone No: ..................................................................................... -
FacilityContact: .......... ................................................................... Title: ................................................................
�?-k
Phone No:.. ... ...................... . .. ........... _iCA�
Mailing Address . .........................
K `� . ......................... .................... * ............
Onsite Representative: ..... .............................
........................ " * ... .............. .... ..........................
....................
............ * ........ .............. ......... .
integrator: .............. .................................................
CertifiedOperator: ......... ..................................... .............................................................
Operator Certification Number:..........................................
Location of Farm:
............... ........................................................ .......... .................................................................................... ........
Latitude Longitude
-,es,gn Design. Currieht­
D_ Curre
nt
Design Current
SwineCapacity _.,qU1try,,-Capacity .:Population: Cattle Capacity Population-;-'
"' Population A Cattle
X[Wean to Feeder e2035 ELI Dairy ayer I I
[j Feeder to Finish ❑ Non -Layer ELI Non -Dairy
❑ Farrow to Wean
❑
Other
"J' El Farrow to Feeder
E] Farrow to Finish
T6tal-DeMgr! Capacity
❑Gilts,
F1 Boars
X&MSSLW
Area JE1 Spray Field Area
s Present ui1Aei;of-Lago'ons
Subsurface DrainDE =-n t
7,HoldiiiiPaiid�[Sbfid.Tra -10 No Liquid Waste Management System
�,ps;
Discharg & Stream Impacts
I- Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: El Lagoon [:] Spray Field [:1 Other
a. If discharge is observed, was the conveyance man-made? El Yes 0 No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [:]No
c- If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ............. k..7
............................................................................................................................. .... * .................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
0 Yes D No
E] Yes .,RNO
Cl Yes �No
Yes fk No
Structure 6
E] Yes XNo
Continued on back
3/23/99

..,ility-Number:I — 3 t)ate cif Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
b!o
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
N?'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
r�RrNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidenc of over application? ❑Excessive Ponding El PAN
❑YesNo
12. Crop type �L 51�)
f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
09No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
MNo
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
D�No
15. Does the receiving crop need improvement?
❑ Yes
N(No
.16. Is there a lack of adequate waste application equipment?
❑ Yes
X No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes VNo
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 VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �(No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Z�(No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0: NO M61hiid is or• deficiencies -were noted• during thi ... !sit. •You will fe, b, iye ...nlruii-theri
corresp ondence. about this visit. .... .. .
Corninents (refer to:'question #) EXplain any, YES answers and/or anyrecornmendations or any other conin►ents:_ F
Use,drawings of facility to better explain situations (use.additional .pages:as necessary)
- d.
— - y
Cl-
Reviewer/Inspector Name
� � f
Reviewer/Inspector Signature �_ Date:
3/23/99

FacilityNttmber: Date oi' Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes -XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�'f�T0
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 N0
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 (X'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes�qNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes�(No
3/23/99

'A [3Division of Soil and -Water Gonseivatton Qperation•Review
c`' 13 Division of Soil and Water Conservat,on `GompGance Inspeetso e _ -
® DlvisiOII of Water Quality _Compliance Inspection -`�
:Other Agency - Operatiort-RevEew, "
I® Routine Q Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Oder
Facility Number j Date of Inspection 1
Time of Inspection i'i 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified © Registered10 Not Operational I Date Last Operated:
�-- .............
Farm Name: .......................................... .r.....fo.t !... `rr.................................... County:...----•Vvo/;^
OwnerName: ... ._.._...M.U. �...........5^qJ..........r`.tY.V%_5............................. Phone No: .......................................................................................
Facility Contact: ......................... ..........I.............................. .... Title: .---. Phone No:
MailingAddress: ......................................................... ........... ..... ....... .......................................................................................................................... ..........................
Onsite Representative:......!.`.+!�l!. .....YIIE'r�1BK....................................... Inte;rator:.......�.r..W 4...................................................................
Certified Operator:...... ........................................
Location of Farm:
........ Operator Certification Number: ..............
....................................... .............. .................................... .......................................... ...................................................... .......•-••.............. ......... ..................... .................. I....... .
Latitude ' 1 •6 Longitude * 6 69
Design Current:
CaDaeitV Paoulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
F�
Ilfnmberof Lagoons_ ❑ Subsurface Drains Present ❑ LagooR Area ©Spray Field Area
��
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a ❑
a. If discharge is observed, was the conveyance man-made! Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min"?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure t Structure 2 Structure 3 Structure 4 StruCLurC 5 Structure 6
Identifier: 1 Z
Freeboard (inches): ,3 / z .................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

acility=Number : — b 3 Date of Inspection
6. Are.€hose 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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 & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ief 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?
0: Rio yiolafitjns;or defieieacies mere noted Boring #his;visit.... will ..... R.....
correspondence_ about. this visit.. • .. _
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JgNo
❑ Yes ❑ No
Cl Yes ❑ No
r
Comments {refer td: questipn #): Explaiin.;any YES answers and/or any recommendations or,any oilier comments
Use drawings of facility T better explain situatiar use additional pages as necessary)
1) 1
j<cs on,4L i -fie l8 U-eSf Td 1 ris eL� �� 00►-) Lq 6Qhs
� � QI� �n-�RG7•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3I23/99

:'� ❑ DSWC Animal Feedlot Operation Review
V.
E.DWQ Animal Feedlot Operation Site Inspection f
® 1loutine 0 Complaint 0 Follow-up of D-%V!2 inspection 0 Follow-up of DSwC review 0 Other
Date of Inspection I t L—;-U.iT
Facility Number S S
Time of Inspect ion 24 hr. (hh:mm}
0 Registered [3 Certified [3 Applied for Permit 0 Permitted JCI Not Operational I Date Last Operated:.,
Farm Name: .-t4.-i:5 kit t-o..,c--.....S.4:.,.1...�............................................. County:.. ?�x�.� x.,k.................................... AA.i...� �
Owner Name: '
...1-��..,r..�.... ..�:.w...�: �..�,: .....�rt,.n. rv:.^..�.................................... Phone No: �I f.17 ..... .... `..
yt
2-111
Facility Contact: �. !�?.1. ..... .�.4 ..[:i-.L. ....................... Title:................................................................ Phone No:..1..9.. .
Mailing Address:.P.o.....�.Q. t:......�..5.q.....................................................................
Qnsite Representative:.. -- .,r..r..res,� /--P.c�t.v.&...G4_�./5;,��.e,"+
Certified Operator:--•l'a..C' ..................r.. t)'0..u.Lx-xP_ .f-.�, **-----
Location of Farm: jj
�.�....H=..±.!.;..�..�- ... ........................... ...? g .... ..;
lntegrator:..P,.u..r.�..........................................................
Operator Certification umber:..-.1-7..1.I... Z................
� ....W.ts.f.....S..t.... *.... 3.,r�-e.w... o.'.as . 1.... o..r...tar_..a .....i.+ —
S:t . i.D.K.....1N..4. ......1'�H?......... ..�.'................ __......... ......................................... ......... ......... .-........ ....................................... I ......... ............... Y
Latitude Longitude E!�•
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
E[Farrow to Wean
Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design' - Current
Poultry Capacity Population Cattle Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity Zp
Total SSLW �S
Number of Lagoons 1 Holding Ponds JE1 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2- Is any discharge observed from any part of the operation?
Dischari>e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach Surfaco Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes r1RNo
❑ Yes E� No
❑ Yes .g No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes t_No
19 Yes ❑ No
❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes allo
Continued on back

1)
Facility Number: Z) — S 2j ,
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes RLNo
Structures f Lagoons.Ilolding Ponds, Flush Pits, etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):..............:...3.......................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ONo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ENNo
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 KNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes N No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ... ..... c!4_......................q.�.:......................................
1.6. Do the receiving crops differ with those designated'in the Animal Waste Management Plan (AWMP)? ❑ Yes Er NO
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Pennitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, Noviolationsor. deficiencies. we're noted during this" visit. .You.will receive no ftirther
correspotidence ahoiit this.. visit::.:
❑ Yes CR No
®.Yes ❑ No
❑ Yes ® No
19 Yes ❑ No
❑ Yes EtNo
® Yes ❑ No
❑ Yes IR No
9,Yes ❑ No
❑ Yes [KNo
. T
6ii i6ents (refer to question #): Explain any YES answers andlorany recommendattons'or any other comments
Use"drawings of facility to<hetter explain situations. (use addi.tonal:pxges a5necessary} W u y
'L (r 0. L _ cc rr t c env o 3 i 0 0 3 to e
4 . Ld �q] o a la ..� e.{ t Y� fl �J �[ { 0 +A- S,-
tZ - fir+ C tt t d w 0 ti �n .ties— vs 0. t k 4 do alkf a C 4 ,4 .}
i- C � j L4-`� &tV(_ S dUd a S i ✓LCR �t. 6
IA�. Stre�• 1
2. &C-{ .M9 S t r e_ Gvv,_ f
l.a-- - 4) 4 6-0 � j
S L✓i: Uliz 1 V
yr��{�p�� n r� [w�' (� �L � � 6 1 `7/25/97
A- 91 t't: 1 rF A-P i7a �--4 r.r 9_,V .a- ■,, t t (a je- _(T___� � kV1S ') Y� r.r 4.rnT }-Y'-'�1L4rA M�GL . C.-, ✓�i.., �, 2A.i u1 o,e 7
iReviewer/Inspector Name {
Reviewer/InspectorSignature.-_n,,d „ wJ' Date: Z6 q7

Site Requires Immediate Attenti _
' Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ 1995
Time:
Farm Name/Owner:J,_714T
Mailing Address:
r
County: ��Oli `7`J -G7t-��-'StJ �/l� �7<-
Integrator �l?/1 L�„�-iJ� Phone:
On Site Representative: fJ%i ver �e0IL2j-A1 Phone:
Physical Address/Location:
Type of Operation: Swine.' Poultry Cattle
Design Capacity: Number of Animals on Site: cQ -6 (S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' ' 12 Longitude: ° 5: ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: -3_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (e or No
100 Feet from Wells? 6e or. 'No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(N
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(B 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)? Desor No
Additional Comments:
•
Inspector Naq Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS STTE VISITATION RECORD
. DATE: i '7 , 1995
,, . +' Time:
Farm Name/Owner: P'14T(: �1'09n Gw
Mailing Address: —)?ir I ' & Y l Zq P )ton 7.wso ll AJ(_ 2,F54j?
County: Dup I Ln
Integrator. /�'ifl _ _ _ Phone:
On Site Representative: L �i'!C-e T(Jr� �r j Phone: 91U�
Physical Address/Location: q03 -(�pn1 JCS2>+5W4 �� !2f4 4n 15IG
Type of Operation: Swine Poultry. Cattle t9I sh
Design Capacity: 15cty5 Number of Animals on Site: 100�) SCW
DEM Certification Number: ACE _ DEM Certification Number: ACNEW
Latitude s ° CO ' s5w[" Longitude: —11 SS Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard. Ft. __ Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes o No
Is adequate land available for spray? 6es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
M
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oCR
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o oNo If Yes, Please ExpIain.
b:
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop .. Yes r No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

o, OPERATIONS BRANCH - WO Fax:[phone] Fug 1 '95 9:58 R.14/17
U4 IV too LO U_
SiteequirCs.Timmediate-Attention,
Fac.ility Number'
SITE VISITATION RECORD
DATE: ... 1993
(3wner. w F,�.3 Farm Name: &rCjEaZP- f -
County: u►
Agent Visiting Site: Phone:
Operator: _- _ _ Phone:
On Site Representative: ..Phone:
Physical Address: [ C'16
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Aaimals on Site:
Latitude: o Longitude: o
Type of Inspection: Ground Aerial -
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or Q Actual Freeboard: Feet _ Inches
For faeilides with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oWas there erosion of the dam?: Yc,s or.No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: I
j
aX to 919 7 - 559 Signarure of Agent
F ( ) 153 a

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