670082_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q Co fiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: + Q2 ii Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 19(wo MASC Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i
Design Current
Swine C►apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dair Cow
Wean to Feeder
Non -La er
El
DairyCalf
Feeder to Finish
Farrow to Wean
Design Current
DairyHeifer
D Cow
Farrow to Feeder
Dr, P,oultr, Ca acit P,o ,
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
7 urke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ o
❑ Yes yo
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

19L
t
Number: - Date of Inspection:
to Collection & Treatment
4: �, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32/
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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2No ❑ 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 CNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �lo
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
do
❑ NA
❑ NE
❑ Yes
[`'No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [;�K) ❑ NA ❑ NE
❑ Yes 540 ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

y7
4
A ill Number: - ,� Date of inspection; S /
Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [ ❑ NA ❑ NE
T
2 . is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N ❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No ❑ NA
❑ NE
Other Issues
/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z ❑ 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
c2ZO
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
FN
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments,(refer, to,questior :#) Explain;any�YES.answerss`and/or iinyiadditionaifiecommendations or any4'other comments .1 4 S
i f A=t; erg,,. e a + t,txsA c 'V'Ta� Ir i;3x '�..-�:i;tr<t.o. -: i �ti. ,iT- s.i �kj°"'.Tis.a
Use°drawrnss:offacilltytobetter,explain,situattons(use-additional�pages;as: necessary;;,�-
E ("�a.
r
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 17
Date: /l A
21412

Type of Visit: Q) 911outine
mpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l I Arrival Time: Departure Time: Fl= County: 01V,5L4ol~% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: j{� [ Integrator:
Certified Operator: Certification Number: Sje)_
Back-up Operator:
Location of Farm:
Wean to Finish
er
Wean to Feeder
ELa
Non-L
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry
Layers
Gilts
Boars
Other I I I®I I Other
Latitude:
Poults
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cow
ow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E] No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ ❑ NA ❑ NE
❑ Yes N [DNA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - / Date of Inspection: li Ij
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA ❑ 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 Ej 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 hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LA 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 N2o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L'J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FA`No
I —] NA❑
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ 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 t e 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
d
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -9 7 Date of inspection: 11
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Nan -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 VN
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes <o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes 2<0
❑ Yes PNo
[:]Yes
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any
Use drawings of facility to better explain situations (use additional pages as necessary).
Lk
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
comments.
rda., AV, bj+r RRAtE �Al 69-of
Phone' 1Io •-
Date: X I (,.�
21412014

Type of Visit: 0 Coptpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: . ,Routine O Complaint Q Follow-up () Referral O Emergency 0 Other O Denied Access
�-! -
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: Departure Time: jj County: 6A)SL„6 / Region;
Title:
Owner Email:
Phone:
Onsite Representative; t C' M& Integrator:
r
Certification Number:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Longitude:
Design
Current
Design
C*urrent
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle II
Capacity Pop.
Wean to Finish
"Layer
Dai Cow
Wean to Feeder
I
INon-Layer
I I
Calf
Feeder to Finish
T,;d
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P.oulti.
Ga aci
Po P.
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkex Poults
Other
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 DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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 o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: -
Date of Inspection: Sp, jl�
Waste Collection & Treatment
4. Is s6fage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes Eo
❑ 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 hreat,
notify DWQ
7. Do any of the structures need maintenance or improvement? '
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes VNo
❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA
7",/
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift, ❑ Application Outside of Approved Area
12. Crop Type(s):
❑ NE
❑ NE
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 ❑ Yes PINo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 Ngo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
a 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
� o ❑ 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 L N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ' Xo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: 3 2t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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 Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0--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:
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [2 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [q'NO ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []�Xo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes fo ❑ 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 Dages as necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
(late:

Type of Visit: U C_o7pliance Inspection V Operation Review U Structure Evaluation (_-)Technical Assistance
Reason for Visit: (YRoutine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: S Arrival Time: ® Departure Time: 1 =County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 13 G—U N 04 $ E, Integrator:
Certified Operator: Certification Number: ar] ZZy
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Curro
ent
Design Carreut
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
�7_,b �
La er
Non -La er
Dai Cow
Dai Calf
Dai Heifer
a(
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1) . P,ouIt
Ga aci
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef feeder
Boars
IPUIlets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes O/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes ❑/No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ❑
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
LAt,Q,)
Z2---.
Structure 3 Structure 4 Structure 5 Structure 6
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 [f/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes jfNo ❑ NA [3 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E�`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �Noo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2 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 E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Zo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other: .
21. Does record keeping need improvement? If yes, check the appropriate box belo . es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑Waste Transfers ❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections []Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [✓f ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: q
24, Did the1facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E� o ❑ 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 YNo ❑ 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 [ l 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 [4No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments,(refer to question #): Explain any YES a:nswers�and/or.any additional,,recommendations or any other comments
Use drawings of facility to better explain situations (use additional -.pages as.necessary):
G f (6&c -2A t-e✓
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �
Date:
14/2orr

Type of Visit: 0 C pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Timer County:j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number: C;6�9
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C•apaeity Pop. Cattle
La er Dai Cow
Design
Capacity
' ent
Pop.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
'L.o
Dai Heifer
Design Current D Cow
D R P■oultr, Ga aci P■a . Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
—M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes �j`N ❑ NA ❑ NE
❑ Yes 6;��
❑ NA ❑ NE
Page I of 3 21412011 Continued

r
Facility Number: f,. - Date of Inspection: T-�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C24o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are. not properly addressed and/or managed through a
❑ Yes
o
❑ 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 environment
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
ElYes
'NNo
❑ 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
dNo
❑ NA
❑ NE
maintenance or improvement?
/No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E2
❑ 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
tj No
❑ NA
❑ NE
[Yes
[:]No
❑ NA
❑ NE
❑ Yes
[](No
❑ NA
❑ NE
❑ Yes dNo
❑ Yes E(No
❑ Yes YNo
❑ Yes [:;Y<o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP El Checklists [3 Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 15 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [7No
� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA [] NE
Page 2 of 3 21412011 Continued

Faciii Number: - Date of Inspection:
24..5id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 64o ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]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 ❑ 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
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
9XIC [3 NA ❑NE
Cj,? No o [3 NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other, comments , ,5�+
t� .+
Use drawings of facility to better explain situations (use additional pages -as necessary):,
i S .� W �E� c.o►�Tj2.o t� �s� ,
Reviewer/Inspector Name: .
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �V ( w-'13
Date:
21412011

RS _F'���k
Divisiot Water Quality
-
t
OgqDtvlsion of Sotl and Water Conseryatton,n �
f `� ' � �
�,,
l. =0.
!-s�
Q Othei `A([��enc t5. s t ¢
QWiV11% ;:i
Type of Visit mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine
0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3b I
Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative:
,/� l-
1)("V-k Chas( Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: = o = 4 = is Longitude: = °
=
1
0
1t
:Factltty�Number�
Y s Design Current ,.i,,bxry� t
Des n Current 13esjgn Current x A
Swine `@ Ca sett t.Po ulation , o-�Wet-Poultry Ca acit `ikP,o elation kxCattic � Ca acRt Po ulalion
l?; y 1? 3. .:,r ,P <hY yapa�1FP.e,�hy$�
❑ Layer
❑ -Layer
7,0 K ` E
DryPpultry s_t -
.�r,�� .x�.:... � � ire . „�,
l
=t
p �
a't ❑
Other Nuinbe�"of3Structures
4 k."r,�-'...#'
Boars ❑ Layers
❑
i
n
Wean to Finish
Wean to Feeder
Feeder to Finish
.
Farrow to Wean
Farrow to Feeder
El
Farrow to Finish
Gilts
t
'
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dai !-Leifer
❑ D Cow
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 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
❑ N
❑ NA
❑ NE
2. Is -there evidence of a past discharge from any part of the operation?'
❑ Yes
ICI
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: (p — Date of Inspection
S
Waste Collection & Treatment
4. Is'torage capacity,(structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11A
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes ONo ❑ NA ❑ NE
(ic/ 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 environmentalthr at, notify DWQ
El Excessive Ponding El Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
7. Do any of the structures need maintenance or improvement? El Yes N ❑ NA El
NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
U �Q [I NA
ElNE
(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
El Yes
,,,.,
!�'No ❑ NA
ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No ❑ NA
❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
No El NA
El NE
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21 --//No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes Ej No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes El No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Io ElNA ElNE
18, Is there a lack of properly operating waste application equipment? ❑ Yes !4❑ NA ❑ NE
Comments (refer to question°#): Explain any YES. answers and/or anyrccommendatigns or;any other;,comments ` � Y
Use drawings of facility to better explain situations. (U*additional pages':as necessaryjc ;�
7j SOVAf OXICZ W00,,l(_ rtr-00 Nzfi IV -,
;L,) VAT4ER_ CODE 1 tU t--WsA c.-(Zt6AJI 1'/RPJ{4u- xk-40 ra 'd.t: Flu- 0 dvT,
Reviewer/Inspector Name
l�!':. 9a `* k, Phone:
�.. _ 1 .,
ft)
Reviewer/Inspector Signature:
Date:
D It t
Page 2 of 3 IL/1co/V4 4unrinuea

Facility Number: (,I — X dt
I Date of Inspection
Reg
uired Records & Documents ME
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
d No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
�es
❑ No
❑ NA
❑ NE
lalysis ❑ Waste Transfers ❑ An al Certification
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ S�Imlonthly
❑ Rainfall ❑ Stocking ❑ Crop Yield �120 Minute Inspections and 1"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ia
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
No
[]NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes�No
❑ NA
❑ NE
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
L N ❑ NA
❑ NE
❑ Yes
No ❑ NA
ONE
❑ Yes
Ld'No ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes❑
7Noj NA
❑ NE
El Yes
o ❑NA
[I NE
Additignal Comment s andlnr Drawin s:
.a �.
Page 3 of 3
12128104

Type of Visit M Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit x Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Li j Q Arrival Time: © Departure Time: County: Q SLQ w Region:
Farm Name: 1C>K FA2(ns Owner Email:
Owner Name: 't�,pJVW> �R1AA/ CNASC Phone: q/ -9139-95-4Cc
Mailing Address: I G /+' C) I I1_:� CH f BARN, NO— 9 g D 1 ^�
Physical Address:
Facility Contact: /� _ (� Title/
Onsite Representative: Cka i N � 014W tGG Z�Q-tW `_NASIc
Certified Operator: ) OlQNA t -t� `Z>• C 14 A S C
Back-up Operator:
Location of Farm:
, �Phone No:
Integrator:
p-perator Certification Number: =9 1
Back-up Certification Number:
Latitude: = o =' = Longitude: = c =' =
Design Current
Design
Current Design
Current
Swine C•apacily Population
Wet Poultry
Capacity
Population Cattle Capacity
Population
❑ Wean to Finish
ElLayer
❑ Dairy Cow
ElWean to Feeder
❑Non -Layer
El Dairy Calf
Feeder to Finish
1 L/3 VO 1 a
❑ Dairy Heifer
El Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish El Layers
El Beef Stocker
❑ Gilts Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ 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?
❑ Yes x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
No
❑ Yes )q No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection I u I I d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L4r'oow
❑ Yes )4No
❑ Yes ❑ No
Structure 5
❑NA [I NE
El NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
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 property 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 [IN I,
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 [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J ] No ❑ NA ❑ NE
maintenance/improvement?
11_
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo ❑ 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) 9C>6-7-- 5G COLV U--� 0647- 5'i3�
13.
Soil type(s) Fcwto74A1 �Q(p/,ycxy✓
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
PNo ❑ NA
ElNE
15.
Does the receiving crop and/or land application site need improvement? ElYes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ElNA
ElNE
17.
Does the facility lack adequate acreage for land application? ElIN
o ❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment? , El Yeso
❑ NA
❑ NE
:a�. .. LL kEti 1.: .9N�tk `5. ,d�.�L��� Comments refer tii uestion # Ex lain an YES answers and/ar an ,:recommendations or,an other comments �
®Use drawIngs�of facility to better'ext) situations_(use- -add ittFioyn��a��l•page#,As as n&esps�a+ry)
i i4 '4. Y.#Y.
ReviewerAns ector Name
P �
' "�� � "� ` '
� � a� `'�l• t E:S,
Phone: CI K) - 19 (a" a�
Reviewer[Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

`S
.ya
Facility Number: --3 Date of Inspection
Required Records&-12ocuments n�
19. Did the facility fail to have Certificate of Coverage,& Permit,readily available? ❑ YesjZfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes XNo ❑ NA ❑ NE
the appropriate box.
3WUP 0 Checklists,. O±Design ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check theappropriatebox below. ElYes No ❑ NA ❑ NE
0 Waste Application ❑Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ )/aste Transfers ❑ linual Certification
0 Rainfall 0 Stocking [] Crop Yield ❑ 120 Minute Inspections
22, Did the facility fail to install and maintain a rain gauge?
❑ Monthly and I" Rain Inspections ❑ Weather Code
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
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments andlor .Drawings:
j/ lrji� G•�1-�
s r uWT��0�3
cPuUAiIoN Q) aCjlc�
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[:3NA
❑ NE
❑ Yes&No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes ANo
❑ Yes KNo
❑ Yes �No
❑ Yes fl�o
❑ Yes No
ElYes INO
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
i �-Q,GU�L'C7 LA Fd0?v
01.4CC-- 5WLE 1c, G
cca�xt�f�-� �R LoP� � /o��r�`• <,�G-ci�clwS
Page 3 of 3 12128104

Type of Visit ACompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: (2WSeOCAI Region:
Farm Name: Owner Email:
Owner Name: __ lYf�1C� Q�e tf��l�SC- �P/hone: 1a'o�9Q'ys (p
Mailing Address: i 14� A C � 4 4 S Cfz//v`Lu A )N . I C 92aQ l
Physical Address:
Facility Contact: (� �, r, /� Title: (� _ _ Phone No:
Onsite Representative:..t; 11L1�1-/y C�-�G 1 <ie 13 W1C1C Integrator:
Certified Operator: I�QWALh S• CHA $ r Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = ` = `d Longitude: = o =1 ` = t1
11110,
►,
vva Dest n Current
Design C>urrent
Design Current
Swine
Capacity P`o}{s�ulation
6 aNl.. fMP S' L
Wet Ynultry Capacity Population
Cattle
@opacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
Non -Daily
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
II
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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)
Cl Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�s No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W—No
❑ NA
❑ NE
other than from a discharge?
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? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 111❑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`?
❑ Yes
1P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0,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
RNo
❑ 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
`❑
�L
12. Crop type(s) � E\T�,
_
13. Soil type(s) ��Q-�S j�% L)�Dbwta Tmo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�§LNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`?
❑ Yes
XNo
❑ 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
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DkNo
❑ NA ❑ NE
.`X aiaE r.l '9? i .
;Comments (refer to,yuestinn #) Expia�n' any,YE.Stansw,e�rs and/or<an y recommendat ons-or any other Comments.:;
: � � ..
Use�drawmgs of facility to betterexlams:tuations {use;addthonal pageslas necessary,): 4�r
c,3�-�'v2.�`:e.�i.a� Tat,r,tMvl'jlgg'1�.."+.
PU" AS6 ts (-.47f-_ I/V 'o g 107 sd) L- 5j4Atpt_ `S
,Dla�l > ).9 104 SGIL4;14M pL e SEA,r 0 F F 4cR-E a-'
GA-uJ?>6-0T1CW )'�sCAE 1,�! /09
Reviewer/Inspector Name F _ - i-A' 6R S 1 Phone: q10 — l&'�
Reviewer/inspector Signature: Date: -ab6
Page 2 of 3 .12128104 Continued

Facility Number: —caorl Date of Inspection d
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1kNo ❑ NA ❑ NE
the appropirate box. 21 WUP ❑ Checklists 0 ❑ Design maps
g p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑/nual Certification
0 Rainfall 0 Stocking El Crop Yield Q 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes VrNo
❑ 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 XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes &No ANA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ 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
P�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
BNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
ElNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VWO
❑ NA
❑ NE
Page 3 of 3 12128104

`L�a:c
0 Division of Water Quality
ility Number LQJ 0 Division of Soil and Water Conservation
Q' Other Agency,
h
Type of VisitC pliance 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 ElDenied Access
Date of Visit: C 0 Arrival Tirne: Z-"*G 1 Departure Time: County: Sg_/f 610j-1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = I = Longitude: = ° 0 1 = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
RI Feeder to Finish lA3110
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other ,
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current I
Capacity: Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood"
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
Ely/ ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
VN
❑ NE
❑ Yes❑
NA
❑ NE
12128104 Continued

Fa.,ih y Number: O — S;J, Date of Inspection 5
i
WA-te Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
940 ❑ 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
0"T o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
L�J 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
LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
d No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Er/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?
El Yes
l j/ 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):
��"; ] �S E C�J '1.0 Cod �'.��41J � tJrr E ►J �olN fi� V
Reviewer/Inspector Name 0 Phone• 7 3 TP
Reviewer/Inspector Signature: Date:
1 12128104 Continued

Facility Number: — Date of Inspection a
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other —41"
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes L' I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes E J No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ��To ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I_I Ng ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ['JZ
El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues
N
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
L'J 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
CJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
L7 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
lr==Numbe., ision of Soil and Water Conservation
0 Other Agency EVI
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g 0 Arrival Time: Departure Time: County: 0NSL.6LJ
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 3eko-k"
Certified Operator:
Back-up Operator:
Location of Farm:
r''lsTe'k CU,
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
r
Back-up Certification Number:
Latitude: o = ' F_--] Longitude:
Region:
Design Current
Design Current
Design Current
Swine C«opacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
❑ Feeder to Finish 7.0
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
El Non-Layers
El Pullets
❑ Turke s
El Beef Feeder
❑Beef Brood Cow
❑ Boars
Other
❑Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
"No
1. Is any discharge observed from any part of the operation?
❑ Yes
El
❑ NA
FINE
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
11No
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
d NN
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: k7 Date of Inspection 3 4
i/
Waste Collection & Treatment
JNo
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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: CA b_mfld
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �✓�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes LJ 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? I ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Oi No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
do
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI No
[1 NA
❑ NE
Reviewer/Inspector Name - ] Phone: 10qt-13r
Reviewer/Inspector Signature: Date: U
pnno 2 of i 12/2A/Ad rant Load

1•
)Facility Number: (r7� — to Date of Inspection
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 El Other
❑ Yes �No ❑ NA ❑ NE
l?`Yes ❑ No ❑ NA ❑ NE
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 V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EKo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
�es
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
� o
ElNA
ElNE
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 ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;[INo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E?t o_
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;kr,4o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
R o
❑ 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
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division U. Water Quality.
Division ofk oi[ and Water Conservation
Dther Agency,'`
Type of Visit (3'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: JJ';I $- Departure Time: County: d&14k Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: eAAMPAL .. rg"t A.tW I integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = I = {I Longitude: = c =' = {I
Designs Current
Swine. Capacity .population. `t >wet Poultry
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder jE1 Non -Layer
® Feeder to Finish L)3U
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
I
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other—-
❑ Other
gn, Current d; r ':,
city Population `` Cattle
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
[I NA
El NE
❑Yes ❑N
❑ Yes L"JZo
El NA
❑ NE
El Yes L�
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection U
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Lmoopi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
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 IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0No ❑ NA ❑ NE
❑ Yes [J'Nlo ❑ 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,-'J NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there'any required buffers, setbacks, or compliance alternatives that need ❑ Yes E(No ❑ NA ❑ NE
maintenance/improvement?
]I. 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) C S 6 0 CWS
13. Soil type(s) Foxe sToP woo mto&-ro -- -- -- - - i
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ElNo El NA ❑NE
l[J No ❑ NA ❑ NE
EfNo ❑ NA ❑ NE
9❑ NA ❑ NE
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):..'..
LI ,) UPOAM 60-
?(IT D 0'&S
Reviewer/Inspector Name a a riJ(L( L., — — i Phone: qIQ
Reviewer/Inspector Signature: Date: 11
Page 2 of 3 I 12128104 Continued

cility Number: —g Date of Inspection 4 li
fa Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E► No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Ld Yes
❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking 12/crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/, ❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
VNp❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
�No❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[] No ❑ NA
❑ NI?
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Io ❑ 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
ffNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElL7No Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

LReasonforVisit
Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
O Routine O Complaint O Follow up O Referral OEmergency O Other ❑ Denied Access
Date of Visit: // /!p D Arriral'fYme: 2`�D Departure Time: r ounty: Region: 7'S v
� il�(SGD
Farm Name: l Owner Email:
OwnerName: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �&E62�2&.a
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 = A Longitude: 0 ° 0 i = fl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I E]Y.Non_La er
Dry Poultry
❑ Layer's
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey eFaults
❑ 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: EM
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 9No ' ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
Oyes
❑ No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Z, Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
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 ;ZNo
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes ZNo
❑ Yes 9No ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 El ElNA ElNE
maintenance or improvement?
Waste ApDlication
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 XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA 1ZNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes ❑ No
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
❑ NA ;2`NE
❑NA)2rNE
❑ NA ;2"NE
❑ NA E 'NE
��O L��l�'p �.NO C��S�F �Gl�''y L/,� �.✓ `�. �7��1s � . Q.i�`2 ��rSST
Reviewer/Inspector Name: {`` `,��';° Phone: /a Z
Reviewer/Inspector Signature: Date: /
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 7 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA VNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
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
NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
VNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
( NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
VNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA 9NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
2(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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
tVNo
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
OvNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�,20.rt171V us,14-� Ash_ �+h0 FTcciE�nJ
�c
rwz'< Re-e— AV'oe- 1�40 &"w
,2,ti/Z�✓� /�`A�i��Io
e1 FARE A!!94
/� �
C�Eu�`'4R
�- -r e7W G��►J �/�2.�zrJ�O,
/eEPooe r ai " 1141O Of_i� /¢i✓D �r✓y/ �/CTZL)wJS �i}Yf.✓ /v
&0'g4kM'
12128104

G-7 R. gok
Type of Visit O C,00 Pliance Inspection 0 Operation Revlew 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: r 7 S Arrival Time: /Z 3C+ Departure Time: County: OVSI.0 q Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: CaAiJDV1U_ �'# VNTA.D,1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = p =1 Longitude: [= o = & ❑ 1I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 3 U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
� I
❑Non -La er I
Dry Poultry
❑ Layers
❑ Non -La' ers
❑ 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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

4
Hacility Number: RIX Date of Inspection r17 d�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA 61 d 1
Spillway?:
Designed Freeboard (in): Zb
Observed Freeboard (in): ^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Zj"'No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
o ❑ 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
WN, ❑ 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RfNo ❑ NA ❑ NE
maintenance/improvement?
l1. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
ZNo❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) gran l VOA t H ) S & O CA.-)5
13. Soil type(s)
U10
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D/NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
[5/Ni�No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
93 o
❑ NA
❑ NE
')a.) UPDATC w vP ,
Reviewer/Inspector Name p� tJ, it p,Q I�j 4 L� ��` wa; � , x rT , Phone: MOP ffs ~~ 0 0
Reviewer/Inspector Signature: Date: syj 7 ra J'
12128104 Continued

acility Number: 7 — } Date of Inspection 7 JS
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. 2rWUP ❑ Checklists ❑ Design
g El Maps El Other
❑ Yes 2 No ❑ NA ❑ NE
Wyes ❑ No ❑ NA ❑ NE
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 V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
, �El
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NJo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,2
L�No
❑ 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
G? No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Z 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
VN'o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,��//
12No
❑ 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
Ekf o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,��
L2No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E; o
❑ NA
❑ NE
Additio'niU Coin ments,andlor. Drawin s:
12128104
12128104

Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notffication O Other ❑ Denied Access
Facility Number Date of Visit: ENot
une: / 20
eratiotW O Below Threshold
Permitted © Cer�tiffied 13 Conditi hall a ed © Registered Date Last Operat or AboveThreshold: .._ W.» ... ..
FarmName: _,[ `� ..............._............................................. County:...,,e.»..........._......_ ...._ .........,
Owner Name: �.a&1_.e _.Rj43C.✓QVfPhone No: .................... _.»»»»............................ .............
MailingAddress: __.._.. _ ._........»..»_ .».».. ____...._.» W_........_ _..__ . _._.»._. _. . .. ....._.....__....... _.... ».:......................
Facilitv Contact: . _._. _»... ».n''___1__._W_Title:� :. _W.W_._ _1.e`�W �Phone No: »...._». »».W......... »w ....
Onsite Representative:. �u, (C �1* /Y ,.�G� Integrator: ` L_.95�
Certified
Location of Farm:
Operator Certification Number:
af Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 0" Longitude 4 64
;!wine ;.; Ca ara
.., tion
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Other,
J!
Discbar�es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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/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? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes '09 No
❑ Yes g(No
❑ Yes 0 No
Structure 6
Identifier: _» . _ ....... __........»»...__».. _..................................., _.__ . __ ..._........ _ _»..........__._.. _.»»..»»» .. .. ....
Freeboard (inches): �tIJ
12112103 Continued

'A
�jFacjtity Number: — jj 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
v
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AtMication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydkaulic Overload ❑ Frozen Groun¢
12. Crop type
13. Do the receiving crops differ with those
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
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.
❑ Yes 'ONO
❑ Yes Q'No
❑ Yes /"' No
❑ Yes �No
❑ Yes )dNo
❑ Yes VNo
❑ Yes ZNo
❑ Yes R(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 41ffNo
❑ Yes JR1No
❑ Yes XNo
❑ Yes PNo
❑ Yes I—
❑ Yes V(No
❑ Field Copy ❑ Final Notes
—emoa U)K ---L-)/L) 70' '64
4a-r 6
i1A
'5" r �ae 5 5 '6 Pce
Wf�Rr�SF���?z (/'
GAgrF
Reviewer/Inspector Name 4
ReviewerMispector Signature:
Arcw- A41),
-!50 ol
—swine o
Date:
12112103 C"onUnued

FWciuty Number: Date of Inspection I
Required Records & Documents
21. FaiI 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?
Oe/ WUP, checklists, design, maps, etc.)
No
❑ Yes X�'
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ 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 ;�'No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes )ZfNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes RNo
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes JZ(No
28. Does facility require a follow-up visit by same agency?
❑ Yes 0"No
/❑
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[IYes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes ❑ No
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?
1Z
❑ 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.
❑ YesXNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
1 0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ZR� D Son %61n• (i- CDv SF �) ant
)003(gO 111��IbO)e
DN'1 ��Nl LC 14014 4-r, S r �
C.'4C
y-T� �� �' ��f%� 12�r(<%03 � 2� f � `� G dry �l [./� ✓��
t
f 'C./� 41H v ► " '^ " �.- ©� �� iJ . W 14✓�" i c✓ a � i /t��� � T/ 1 �� v
v✓ � ��T�fFR �7��oGzCi9-�
192 !�V �/`� T/R� � 1
a
12112103

Type of Visit Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Vis t Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
hucility Number Date of Visit: Time:
13 Permitted ©Certified Conditionally Certified 0 Registered Date Last Operate r Above Threshold: _
Farm Name: County:✓
Owner Name: p� NlfWPhone No:
Mailing Address:
Facility Contact: Title: - t Phone No:
Onsite Representative:N integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
(swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' LG Longitude 0 6 GG
Design Current
Swine
❑ Wean to Feeder
Fccdcr to Finish
Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gills
❑ Boars
Number of Lagoons I 1 I
Holding Ponds 1 Solid'Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer PC
Dai
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present 110 Lagoon Area 10 Sorav Field Area
id Waste Nla
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (lf yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. is there 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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): Z
05103101
❑ Yes /R1 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El No
❑ Yes JCJ No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: C — Date of Inspection QZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
!,Q No
PI
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
XNO
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/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
VfNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�f
LQ No
11. Is there evidence of over application. ❑Excessive Ponding ❑ PA ❑ Hydrauli Overload
❑ Yes
�(No
12. Crop type
13. Do the receiving crops differ with those esignated in the Certified Animal Waste Managemen Ian (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
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P 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
(
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
, ,�No
LJ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9,No
21. Did the facility fail to have a actively certified operator in charge?
ElYes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
QNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IQ No
24, Does facility require a follow-up visit by same agency?
El
/No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.iR - rYk :-.. Fyxa'..,;
Comments (refer to question #) Explain any YES ariswers and/or any recommendations or any other, comments.
Use drawings of facility to better explain situations. (use additional pages a necessa '�) V Field Covv ❑ Final Notes ,
��i¢nJ7�'D
/ 4C A6*0k 6 `HV
S r ,oi�2i✓G-
Reviewer/InspectorName
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ,Q., 3 0
El Yes /1[j No
❑ Yes ZNo
❑ Yes 9
❑ Yes No
❑ Yes ❑ No
Additional CooiiiiefiWbOlor::Drawings:
AL
O5103101

k.
'' qn - i I t iE 3�xx 42.,:r[s-s+3 -
" ' i> t D1ylSlO[1 of Water dal r r +' � ijs �� r
— f r .: r a 4 i'. r5 I�j�� r^dpr rfi p w �q
J4ix Dhision of Soil and W.tter Conservation r �i �° �F I M�
3..'tN.A.
en `!.
r g -r� �'�'.t.�i €7� t-
j
Type of Visit 9 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit (*Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: —d �Tiine: 0Uo Printed on: 7/21/2000
Q Nut Operational O Below Threshold
�Oer>tnitted © Certified [3 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: } '�. County:....... W..................................................
.................................................................................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ..............................................................................Title:.................................. Phone No:..........:....
Mailing Address:...............................................................
-...�....,..`... 1................................ ..........................
Onsite Representative:,1!`''~.?.....C'.....""'L.k ................................... Integrator: .....d�S+�L`!`!l]5......... ..........................................
Certified Operator: ...................................... ............... "" ............... Operator Certification Number: .......... ........ ........................
Location of Farm:
..
J
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� Longitude �• �°°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lago-in Area ❑ Spray Field Are:
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System 71
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. Ifdischarge is observed. what is the estimated Ilu%v in gal/min''
d. hoes 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?
lVaste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
St UCtUre t Structure 2 Structure 3 Structure 4 Structure 5
Identifier:........................................................................
Freeboard (inches):
5100
❑ Yes ,KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes *0
❑ Yes C No
❑ Yes 5<No
Structure 6
Continued on back

Facility Number: br) — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
•t ►-- Q
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?
Re uired 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? Oe/ irrigation, freehoard, 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?
�'.. yi. . do is ;ot- cieficiendes -*&ia- n6ted. daring #his visit; - y0o will •reeeiye fio further;
�corres�6ridence: about: this :visit:
❑ Yes , �No
❑ Yes XNo
❑ Yes gNo
❑ Yes rWNo
❑ Yes �No
❑ Yes brVo
❑ Yes gNo
❑ Yes �rNo
❑ Yes J�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WNo
❑ Yes gNo
❑ Yes 9No
❑ Yes N(No
❑ Yes 9No
❑ Yes No
ElYes &No
❑ Yes �rNo
❑ Yes 'iLDd No
❑ Yes f No
[:]Yes ZNo
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):
1L'T Ck"cL-A-54) t� \,-\ vv-,*<4oys c:� 4z3��,
�-• ��s �- sal! � ��:�- � ►�e-� � AL,,,14�
SY
Reviewer/Inspector Name i
Reviewer/Inspector Signature: Q Date: 5100

Facility Number: Date of inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below �SCes [INo
liquid level of lagoon or storage pond with no agitation? ''
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes k/No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INo
roads, building structure, and/or public property) i
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes INo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or 1
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 permanent/temporary cover? ❑ Yes t4No
Additional rn n n Aye �tllf»
otnmett#s'aet orl'. rfsfl lrl .�
_ 3 1 i
c9 '1
FF
P • ¢ ,a9j fi, i
3 ,
t
5100
J

Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
*Permitted [3 Certified 0 Conditionally Certified j3 Registered Not O erational Date Last Operated: ..........................
�G�+
FarmName: .....County:.....................................................................................................................................
Owner Name:
Phone No:
FacilityContact: .......................................... Title: ................................................................ Phone No:...................................................
MailingAddress: .......................................................................................................................................................................................................... ..........................
l
Onsite Representative:...`. i''^ ....... ...... Integrator:.......�Jt..��rd.....................................................
. ......... ...................... .....
Certified Operator:................................................................................................................ Operator Certification Number: ..........................................
Location of Farm:
........... ... .... _J
Latitude 0° Longitude
I , Design '€Current
lr
Design Current 1` Current
Swine ' aculi tion
Ca" >I
In
tr PoulyMahon; Cattle ' ;k Ca acr R- ulation
,,,`Po
❑ Wean to Feeder
❑ Layer ; ❑ Dairy
,rli Feeder to Finish 43 'd-0
❑ Non -Layer ❑ Non Dairy
Farrow to Wean
,ol,l.l t•.._.�i.:. :I�,el.GLIE, �, ,�I� r�� iasF,Fi i7��,� , i
ip
I
i ❑ Farrow to Feeder
❑ I f J I itn c i
Other ��IFf lit ' ��E� H. �"suit
It 1�d ❑Farrow to Finish
t t
TO al,Desigtri Capac1fit ,
3! ❑ Gilts
' Tota1�SSLW'''3
Boars
Y
!! 6 ! i�. i ?> ii1 11I ''�I"•.< i 3p� 311 - -,
um ber of Lagoons! 1 ��
kl ...E -',
Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ,,.
; loltlin Ponds / Solid: Traps ❑ No Liquid Waste Management System
H
Y ,,...
DischaMU & Stream Immcts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. li' 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 gallmin?
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 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[XNo
❑ Yes
D6No
❑ Yes JN�No
Structure 6
Identifier: /
Freeboard(inches): ............fl'......... .................................... ....... ............................. ....................................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes V 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 �zNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes NTNo
11. Is there evidenceofover application? ❑ Excessive Ponding ❑ PAN
❑ Yes J�No
bh
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes VNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes KNo
b) Does the facility need a wettable acre determination?
❑ Yes ff No
c) This facility is pended for a wettable acre determination?
Oyes ❑ No
15. Does the receiving crop need improvement?
❑ Yes tKNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes t(No
Reauired Records & Documents
17.. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes gNo
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 J�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes N�No
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 9 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes V No
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes fio No
No -*ijAOti#tjs'0 dt#jcjencie5 wire y1O04• ¢4rlr 09 01s,visit; - XOO wI[Vteeoiye 00 rufftr -
coriespor�dence: a�otit this ..Visit.''.. :::::..................:::.. .
r(w- -�Ct� �n2W,s� �se�'_T 3�►� \
W
Reviewer/Inspector Name00gK""
Reviewer/Inspector Signature: ���_ Date: S I �.

4, Facility
cility Number:6 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 XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed ol• properly within 24 hours? ❑ Yes A 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 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 FYNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes D'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes gNo
Additional Comments an oC Farlipgs: - ' . ' t `,} i 1' � i ! , .
1.
3/23/99

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - _ Operation is flagged fora wettable
Farm Name:. -- acre determination due to failure of
On -Site Representative: Part 11 eligibility items) F1 F2 F3 F4
lnspectorlReviewer's Name: �\
Date of site visit: — i "QU
Date of most recent WUP:_
Annual farm PAN deficit: pounds
Operation not required to secure WA
determination at this time based on
exemption F1 E2 E3 E4
V/ Operation pended for wettable acre
determination based on P1 P2 3
1 rigation System(s) circle #:Q hard -hose traveler; 2. center -pivot system; 3. linear -move system;
stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wipermanent pipe; 7. stationary gun system wfportable pipe
FART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part 1 exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an 1 or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an 1 or PE.
E3 Adequate D, irrigation operating parameter shei~t, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that Tail the eligibility checklist in Part B. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational :table in Part 111).
PART 11.75% Rule. Eligibility Checklist and -Documentation of WA Determination
Requirements. WA Determination .required .because.operatian rails :one of the .eligibility
requirements iistedbelow:
Y
F1 Lack.of:2creage--whichTesultedin:over appiiC2bD ref_-wastewater_(PAN) onzpray.
field(s)accordina7o:farm'sdasttwo -years mf:irriaationzecords._.
FZ Unclearjllegible,-:ar lack of information{map.
F3 0�viousfeld1 imitations -(numerous:ditclyes;dailureAmdeductTequired:....._
bufierlsetback-acreage; ar25°lo oftfltal�acreageddentiffedjrt�CAWMP:Tint udES ' _
small,-irregulady'shaped .fields = fields:less-ihan5 :acres�or.:travelers_or.iess-than
2 acres -for. -stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Rvvised April 20, 1999
Facility Number
cart ilt. vela oy yield ueterm:nauon or raio mxemptton
We Tor vVH Determination
LNUER
FIELD
NUMBER'
TYPE OF
IRRIGATION SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
COMMENTS3
I
I
I
I
1
I
l
FIELD NUMBER' - hydrant, pull, zone, or. -point numbers -may be Itred in place of field numbers depending on CAWMP
end type of irrication,system. If pulls, etc. crossTnorethan one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER` - must be dearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acFeage�exceeding`75% of its total acres and having TeCeived less than 50%
of its annual PAN as -documented infhefarm'sprevious-two years' (11997 & 1998) of irrigaiionTecords,-cannot serve•as,the
sole basisTorTaquiring a WA Determination:: -Back-up fields Tnust -be noted in the -comment zeciion:an d must -be accessible
by irrigation -system.
Part IV. Pending WA'Determinations-
Pi Plan -lacks: Following -information:
P2 Plan -revision -may:satisfy-7.5% rule based on adequate overall PAN deficit -and by
/ adjusting -all field -acreaga_to-below 75% use rate `
v P3 Other (ie/in process of installing new irrigation system): h�.� �zst �4�t �c► -AW

,.
41�7Lagoon Dike Inspection Report
Name of Farm/Facility Jog
.y
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection i Names of Inspectors , J:La e `II
�f � i L
V T
Structural Height, Feet <p Freeboard, Feet
Lagoon Surface Area, Acres Top Width, Feet
Upstream Slope,xH:IV 1 Downstream Slope, xH:1V
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No. .. .
(Check One, Describe if Yes)
Erosion? Yes ` No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments�C'_ %`(��rti ,� �iy� �` ZS Lc'�

i,
13 Division of Soil and",Water Conservation'- Operation Review
,
' ,k ' # },
[3 Division of Soil and Water ;Conservation -' Compliance Inspectio>) 'ft E s ,��
{
!
! i [ ,
} �.-
t,
tvision of Water �iiit iCoixi itance Ins ectton E, ` �, , € €, f ` `'yy € E F E' ,€ , E i ,
y i ! 1E Y I,f�
{, (dj, I j $
1
�!3 5
,.� € {
,I I f it ,I5 4 € I a,
C,IE'
pY
i, 1-. I tr 9 3 Y1 I p' f i ,[ 1 4' f
13 Oche"r Agency'- Operation Review €{€ '
" i ! '.�
''
�! ;i
> Ej
10 Routine O Complaint Q_Follo v-up of DWQ inspection Q Follow-upof DSWC review Q Other
Facility Number
Date of Inspection 1� r
lime of inspection. -7 24 hr. (hh:mm)
fU Permitted 13 Certified [r Conditionally Certified [,] Registered JE3 Not O erational Date Last Operated .
Farm Name: %� V11F. I%C,2� C c1G tUQ E //� C. County: L2 LO G�/............................
Owner Name: ......... N..¢_F....... ".R.xjv,�T-..�.e...I!v<............................. Phone No:..9�D.... ..~/. .%................................
FacilityContact:.............................................................................. Title:........................................................ Phone No:
R 6 �2 N� �11 C //
Mailing Address:... .. ....%.. ..:. ................... ....... / ., ..........................I......... ..........................
OnsiteRepresentative:...........................................................................................................Integrator:...........,..........................................................................
Certified Operator:•..,C+�-� A'L L 71,411 0 �f!or0
/V........,�...................... U.UN...................................... Oper.itor, Certification Number:.,.... 7......
Location of Farm:
�........................... ... ............................................................... ............... .. T
Latitude Longitude 1,37 1`��
Design Current
acit o `
Y Ca Po alai!
Swine Caeaicgit Po CurrentDesign, ' esign ujla n Cattle Ca acit ' .Po ulation
Poultr
❑ Wean to Feeder `, ❑ Layer ❑Dairy
Feeder to Finish .,3Z0 JEI Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish�kity 43223
❑ Gilts. €.
❑ Boars Total SSLW 6,?3 a 00
4 € ' ,} Nrxnnber of Lagoons (, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
�3,
HoldingPonds Solid Traps ❑ No Liquid Waste Management System s.
;a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made'?
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/min?
d. Dees discharge bypass a lagoon system? (If ycs, 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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: t�
Freeboard (inches): ............�.. ................................................ .......................... .......... ... .........
....................... ................................... ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees,'severe erosion,
seepage, etc.)
3/23/99
❑ Yes JVNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
IRNO
❑ Yes
bNo.
rYes ❑ No
Structure 6
...............................
❑ Yes �Po
Continued on back

Faciolity Number: ? — Date of Inspection <<'
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes k-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 )i�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
ld.
Are there any buffers that need maintenance/improvement?
❑ Yes
NO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
12.
Crop type aL '
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JKNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
6KNo
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
.tNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�qNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
ANo*
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
KYes
❑ No
20.
Is 'facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
['No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
CkNo
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
1*0
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EMO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[�Vo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes❑`No
1o•yiZ iotis:oi� dteciendpe -Wgre j10 ed• djrih 4his'v.'tsit' ` Yottt ' iil•rea�ivee do fui•tbvr: • . -
�corres�6fidence. ab6ut. th' .visit.
,Comnients (refer to question #)=lJxplain any YES answers and/or any;recohi nendation's or any other comments - : l ;
Llse;drawtngs of facility to better explaaniituataons� (use:adchtio'nal pages asnecessary.}
�t'l
It, FAC-tt, rq NA.S 11Ab A New w W err 0 / �71 WS7ZIe-I-4FFic45
W14(. f-i/!vC SO4.f11 Sie-T AfAP—CH AND Woc-,c. 4LS47 GlSE THE
JZGrGL. N6v`� t-/E�t7 /N P�.l�n/ �}Nt� NE�ZLS TU d4lE2SD Vit'in�' 7`a
s/09A
,io.
;�S rtlE�D 'Td p y peo t: �� tir aye rA c., r/ 12�M c v.g � - iv c r• B�.�v�, �,�iHd yr A t� � T.5►,nJ TJYC-
.7
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Fi6lity Number: — T,
Dale 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
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
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
(VNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Nlo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? N/1-
❑ Yes
❑ No
JAdditionq omments an or rawtn s• , i i w a
g r d
3/23/99

i'.
�� Division of Soil and Water Conservation ❑Other Agency _ ����' `�
� n n
19 Routine O Coin' faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 9If 1S
IT
Facility Number N (, ; -,
330 q.r,/ Time of Inspection 24 hr. (fih:mm)
�
M4egistered Certified Applied for Permit 13 Permitted 113 Not Opera . Date Last Operated:
Farm Name: 1A.... tH C 2 i Cvc.7U12 L county:..........1yS. DID ! ..........................................
1.............................................................................................. 4�
Owner Name:..... 9::&P.gAA11....... ...................... ..... Phone No: ................................
Facility Contact: �y� c- Ov �� IJ OC.UI�4G� t
....��!�1......�.!>`.....5........�......................%..... Tllle:............................. �............................ Phone 1\�0:
Mailing Address: ..... 1�13....... ............�� GI'ILh!Nd>.. ........N.. -... a�S7 �... ..I .......................
...........................
Onsite Representative:.... ...............................Integrator:.........f:.4440[.L S.......................................... ...... �....
Certified Operators..Cr....:�=�: ................. . n l�iu-�: .. Operator Certification Number;.160 � Cl.................
Location of Farm:
.... Q�....X...l.(1......:QT��.,QY!Y!.r.... r`.n!!+..Atr.F".w...f1z4PP�.�?....CrptP9? • ............. .
.......................................
m`e-
Latitude I .J'f i*.I YX I I Ids i" Longitude 1
s',Design Current
Swine`' , ` , : `Capacity Population
❑ Wean to Feeder
® Feeder to Finish
ZO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
`Population
a Nu tuber tyf Lagoons 1 Holding Ponds, '� ❑Subsurface Drains Present ❑Lagoon Area ❑ spray Field Area
nZ.
„ ❑ No Liquid Waste Management System r� n
'eneral - -
1'. Are there any buffers that need maintenance/improvement?
❑ Yes
(�No
2. Is any discharge observed from any part of the operation?
❑ Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?.
❑ Yes
�No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
4No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
9No
maintenance/improvement?
Is facility any
❑
kNo
6. not in compliance with applicable setback criteria in effect at the time of design?
Yes
7. ,Did the facility fail to have a certified operator in responsible charge?
❑ Yes
VNo
c:lata,V
7/25/97 Continued on back

i
Facility Number: v-7-- a0
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
M\fo
Structures (Lagoons.Ilolding fonds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
_�rNo
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:.................................................................................................................................... .
Freeboard(ft): ......., .a..f..................
..................................................
10. Is seepage observed from any of the structures?
❑ Yes
�TNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
VINO
12. Do any of the structures need maintenance/improvement?
❑ Yes
*o
(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 marker~''
❑ Yes
Rill o
' �
Waste_Annlication
14. Is there physical evidence of over application'?
❑ Yes
�-o
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15 Crop type C 4j?e,1 5 A! �A44� + ra✓ �,Gr�c
r... 1..... �...... ................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 1�'No
17. Does the facility have a lack of adequate acreage for land application.
18. Does the receiving crop need improvement?
El Yes &No
❑ Yes ONo
19. Is there a lack of available waste application equipment? ❑ Yes � No
20. Does facility require a follow-up visit by same agency? ❑ Yes kNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
22. Does record keeping need improvement? ❑ Yes AN0
For Certilied or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes �JNO
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J,H—�,No
25. Were any additional problems noted which cause noncompliance of the Permit'.' ❑ Yes , 6Z..."No
0 No.violations or deiidencies.were noted -during' this.'visit.- You.will receive no ftirttier
correspondence about this.visit
Comments (refeir'to.quesiiom#): Explain any YE5 answers andioranv recommendations or'any other comments
Use drawings of facility to better euplatn:situations.' (tisc additinrial pays as necessary):
/Z CS LO Feu' 1J
y� �yyu.."�cc �"�'-�'�-�- � t-a-PJQ-c� :/[R�-►'t.[�,�-�-.�1. Y�K�cJ s�.''�u, s fit-trrr-Y+^-`P�
7/25/97 H
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: j/ j�
S

k�[] DSWC Animal Feedlot Operation ReviewW __.
XXXX
[IDWQ Animal Feedlot Operation Site Inspection���
JoRoutine O Cum laint O Follow-up of DW't inspection 0 follow-u of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
© Registered © Certified © Applied for Permit 13 Permitted 13 Not O erational Date Last Operated:
FarmName:. .. .. .....% . 7.r .1. t l...i.. ..Lli�...................................... County: ........ %.� ...:......5.........................................
r
Owner Name: t .....Ut't'�.................. ................ Phone No: Z
t r .. .r. k .... .... ..... .,....... ....... ............................................................
Facility Contact: .f ! DLL ... per f7 �►(� Title:... ............................. Phone No ...........,.. ..,.......
Mailing Address: T�v] 'Z
Onsite Representative: ...�Fq�..+� �-.. ..... ........................................................... Integrator: .....
..............................................
Certified Operator;..n..L.............rr��� Operator Certification Number;....1.�p�7 ...................................... .............
Location of Farm:
Latitude �• �' �" Longitude �• ��' �"
::Swine
Design Current
Capacity Population
❑ Wean to Feeder
Feeder to Finish
1{3 O
S
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
lumber of Lagoons l Holding Ponds
Design Current Design Current,
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy Is
❑ Non -Layer I 1E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
10 Lagoon Area S
Subsurface Drains Present � pray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes [�<o
2. Is any discharge observed From any part of the operation? ❑ Yes E340
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [allo
b. If discharge is observed, did it reach Surface WateO (If ves, notify DWQ) ❑ Yes E2 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 01 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Mo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes G31No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes GM
mai ntenanceh mprove ment?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'? ❑ YesEl"No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (9"No
7/25/97 Continued on back

Facility Number:(Q —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes EiKo
Structures (Lagoons.tiolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes GJ-No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard (ft.): ............ ..........
10. Is seepage observed from any of the structures'? ❑ Yes E?No
11. Is erosion, or any other threats to the integrity of any of the structures observed`? ❑ Yes Q-Ko
12.
Do any of the structures need maintenance/improvement?
❑ Yes
CKo
(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
GJ-1 to
Waste Appliratiott
14,
Is there physical evidence of over application?
❑ Yes
VO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.......�16.,r..............-......................................._.....................................................................................................................................................
16,
Do the receiving crops differ with those designated in the Anima] Waste ,Management Plan (AWMP)?
Cl Yes
[No
17.
Does the facility have a lack of adequate acreage for land application`?
❑ Yes
O<o
18.
Does the receiving crop need improvement?
❑ Yes
Q-10
19.
is there a lack of available waste application equipment?
❑ Yes
015o
20.
Does facility require a follow-up visit by same agency?
❑ Yes
211�0
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
22.
Does record keeping need improvement'?
❑ Yes
&3,<o
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No violations or deficiencie's.vvere noted'durin ' this,visit. You:rvill receive no further
cofresporidence about this•yisit
Comntents.(refer to question #): �Fxplain any YES answers and/or any recommendations or an}, other comme
C7se d awhip of facility to`better explain: ' Watigni (use additi4nul pages as;'necessary).
ps plc
7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature: