310788_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental QuA

Type of Visit: WCCiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up 0 Referral Emergency 0 Other 0 Denied Access
Date of Visit: v Arrival Time: Departure Time: '31 County: I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: L r Title:
On site Representative: F 'e ^ 7 n`� 7 C (vy
I
Certified Operator:
Operator:
of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
q 7 Q3zo
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop,
Layer
Design Current
Cattle C**specify Pop.
DairyCow
W n to Feeder
Non -La er
DairyCalf
eeder to Finish 2 QD
14 Ff V
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr, P.oultr, Ca aci P.o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No . NA ❑ NE
❑ Yes O5o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 113ate of Inspection: p
Waste Collection & Treatment. ��
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a ❑ 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 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 M 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 environm ntal threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? O Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No• ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Js there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[.G K "' ❑ 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
of N ❑ NA
❑ NE
l5. 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
❑ YesF3-N-o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No -NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
- Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'-O NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
rNo
[,] NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: -7 Date of inspection: 1301f
24, Did -the facility fail to calibrate waste application equipment as required by the permit? []Yes No NA ❑ NE
25.•Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No O<NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
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
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
❑ 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
Reviewer/Inspector Signatui
No
❑ NA
❑ NE
No
❑ NA
❑ NE
4!�No
❑ NA
❑ NE
[�No
❑ NA
❑ NE
]�No
❑ NA
❑ NE
❑NA
❑NE
r'
N
❑ NA
❑ NE

i
Di'vi"sion of Water Resources
Facility Nutnber - ®, 4' Division of Sail and Water Conservation
Other Agency
Type of Visit: Co fiance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine Complaint Follow-up Referral 0 Emergency Other Denied Access
Date of Visit: Arrival Time: Departure Time: ® County:( Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �ZLa-a EL=caccl_,
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
�DUCS
;Non-L
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other I I IMI 10ther
Title:
Latitude:
Poults
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: q 1 T3Zb
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:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑(No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes V�4o
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

JjFacilityNumber: -gg Date of Inspection: `
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
StructurerrI Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 44q(;1" Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 7/
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 ,ronmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2r 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?
❑ YesrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ 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 WNo
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes d�o ❑ 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? - ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continuer)

acifi Number: - IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes [jy -o ❑ NA ❑ NE
35. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes fNo ❑ NA NE
the appropriate box(es) below.
0 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 ZN ❑ 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?
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 I <0 ❑ NA ❑ NE
❑ Yes 21"No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ` 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 dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VNo
❑ NA
❑ NE
Comments (refer to question #)° Explain any'YES answers "sand/ar a_ ny ailditionaU;"reeomrnendati6nsvdrfany ,otlierA commtsen
„ }{.Y.i=> -il -+ 'jY Si-^'S.B
Ae, i.;
Use drawings of facility to bettei,explamtsitiiahnns,{use, additional pages,a's necessary
1 9ECA
A4izl.ct
�'
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
�1a q � i b
C ([1 Phone�glo
re: Date: 3
21412015

(Type of Visit: O Copepliance Inspection U Operation Review U Structure Evaluation p Technical Assistance i
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
%�
Onsite Representative: ulk#Jr Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Wean to Finish I I
I Layer
I
I Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P.oultrr
Design Current
Ca acit P.o ,
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Layers
Gilts
Non -Layers
Beef Feeder
S
Boars
Pullets
Beef Brood Cow
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 DW R)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
j�N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U9�
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 ZNo ❑ 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 N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes YNo ❑ 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 [] 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 PJ/ No ❑ NA ❑ NE
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [✓] No ❑ NA ❑ NE
❑ Yes [�Ko ❑ NA ❑ NE
❑ Yes 0N ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Other.
Yes D Nc
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ Yes
[3No
❑ NA
❑ NE
[:]Yes
VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

hacili Number: Pg 1 - Date of Inspection: 154 ) I )s
I
�24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
NA ❑ NE
❑ Yes rr/No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0No ❑ 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 Ill 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 2No ❑ 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 El"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 4�6Nio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes g/N0 ❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes ❑ NA ❑ NE
Comments (refer to yuestlon #) Explain any YES.answers any additi6nal recommendations or any other comments.
ja,nd/or,
Use drawings of facility to better ez lain situations (useadditional�pages as necessary):`
DUFALL
is ZS5T or
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
kPhonq Q b `-
re: 06� AM Date:
/4/1015

(Type of Visit: Q CCopliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:, Region:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: l3(11 or Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 lD 15 t0
Certification Number:
Longitude:
Design
Swine C*apacrty
Wean to Finish
Current
Pop.
sign
WStp-RufflovE.2alacity
Layer
C*urrent
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Design
ltr.. C*_a aci
Current
P,o
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
ers
Feeder
Boars
LBeef
Beef Brood Caw
IS
Other
Puults
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
❑Ycs ❑No DNA ❑NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o
❑ Yes E-0 X
❑ Yes 21 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes []No ❑ NA ❑ NE
Structure rStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U V
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 WNo ❑ 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 environmen 1 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 N ❑ 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 P/Nc ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes L.I c
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E(No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ 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:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑YesYNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Cj No ❑ NA' ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes L"J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments:,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:(
Date:
2/ oll

l ype 01 V1511. lJ I-OMPHUUCe 1115PU L1VU %-J UPCFUL1UU rkCV1CW V JLCU%AUFU r,VU1UHt1U11 V IUU11111CA1 HJ�15LAl1CC
Reason for Visit: GrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: i �_ :� County: Region: k%PF R110'
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: lj'0✓1 / V t�'�[��,� ` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
tj 290
Dairy Heifer
Farrow to Wean
Design
Current
Pry Cow
Farrow to Feeder
Dr. l;oultr.
Ca aci
P,o ,
Non -Dairy -
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
❑"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
2No
❑ 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
o
❑ NA
❑ NE
3Were there any observable adverse impacts or potential adverse impacts to the waters
.
❑ Yes
No
❑ NA
❑ NE
the State other than from a discharge'?
Lof
`,ge 1 of 3
2/4/20II Continued

Facility ]'lumber: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StructureA1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Yt 1
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 ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [?r No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [7f 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 [7f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�!rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[6No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑/ rNo
❑ 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
dNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2-No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili L�umber: - Date of Inspection: q73
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2]"'No ❑ NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2 f No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[;TNo
❑ NA
❑ NE
❑ Yes
%[rNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes ['rNo [] NA ❑ NE
❑ Yes G?'No ❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
[:]Yes
[]"'No
❑ NA
❑ NE
0 Yes
E2"Sio
❑ NA
❑ NE
[:]Yes
[R'No
❑ NA
❑ NE
Comments (refer.to question #): Explain any YES answers and/or any additional recommendations or any other comments,-..
Use drawingi.of facility to better:explain situations,,(use additibnalwpagei ai necessary)
Qcc o G C T Q ACX_LR 03:25"'-
Reviewer/Inspector Name:TI-tPIL)P-0,. Phones
Reviewer/Inspector Signature:,,,, �� Date: `'[
Page 3 of 3 1 21412011

Type of Visit: Q 7Routine
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: OS Departure Time:O County: DLPCJ►3 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 20 "-371
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C*urrent
Swine Napacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pap.
La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
DairyHeifer
Design Current D Cow
Farrow to Feeder
De. P,oultr, Ca acit P,o Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
lBeefBroodCow-
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[DNA ONE
DNA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes WNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facifi Number: - 7 Date of Inspection: L
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 D NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t.f4Qmnj t L gc"uW Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3!3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I 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 env ronmental 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? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑/Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
'[J Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L d 1V o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Q,�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 640
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3'N'o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
040
[DNA ❑ 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
[3 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
Q4
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E:�No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
[3 NA ❑ NE
25. is the facility out of compliance with permit' conditions related to sludge? If yes, check [:)Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
[]Yes [2/No ❑ NA ❑ NE
0 Yes ['/No ❑ NA ❑ NE
[:]Yes [�No ❑ NA ❑ NE
❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
LJ 1 o ❑ NA ❑ NE
FNo
o ❑ NA ❑ NE
o ❑ NA ❑ NE
❑ NA ❑ NE
dt_.D (SA* 11
� ty
N"") M
!bC wl"E' aFC E VG c
wrz eec
cAAI
6tjt_ y fF r
A YEArL,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( `� .3
Date: /17
214/241

` t � £ 332 ft !'�'.: f•:j: "'is`'3; S;i .k(�.:1-R
tl -�
g °Dtviston ofq Water QualiE
Facile Number, O `Dtvision of Sotl and Water ConserVathon
� r ° i�'� � +� 4� tpde`a. _,� v d. �k J ���i �'! � � �}- •1�.
�i9ther gency }. a
.S�t�Ew?'ka.�'i'i-3..rli-,
F
f Visit 7Routine
piiance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
n for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 44E]
Arrival Time: Departure Time: $ County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
TT �
Onsite Representative: .JAB Juli6s „-, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: C
o ={ = ii
s �urrentl4��
x� r : C
a.�� ®. $ l]es�gn
S
.. �+ f - � A 5 �,t F ;� �` 91,� F.1
f $ b:.R�. : �:
g r, Design' Current .
tDesi n %Currents
, Swrnehg:�z fl`
1"IE]
C�p,acity Pgpulafioan
r 'Wet Pohl ry g;capact,.y� R opulahon�
Cattle- Ca acit Po
r
a. s:� Rpy i�pulahon
".
❑ Layer ❑ Dairy Cow
;x ❑ Non -Layer ❑ Dairy Calf
„ ❑ Dairy Heifer
t P+#� iZ {, *:r r❑ D Cow
t +i`lt , b„«,
ElNon-Dairy
El Layers 3 [] Beef Stocker
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
fi
❑Farrow
to Wean
`
❑
Farrow to Feeder
rs
El
Farrow Finish
to
1 ❑Non -La ers
`:ilts ❑ Beef Feeder
V
❑
G
❑ Pullets
❑ Beef Brood Cow
r
Boars
ElTurkeys
❑
T---pp--.a� ,#
..>
'❑ Other:
t.a.�.,
Turke Pouits
❑ Other;
' 'N tutber
o.p}f Structures
.
�i .+i:' ,;. qfY..
;�".E �, :� �;�.:
?.}',�"-'"' {: .r,. ,.4a. •a ,.3- ° iSgaa.�%§�.d
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 past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 1 J No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ [I NA
El NE
❑ Yes
El Yes
I N El NA
El NE
El Yes
i,�'N0 ❑ NA
❑ NE
12/28/04 Continued

Facility Number: 1 --IN Date of Inspection z-
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: VAGg oN_A _ LAr�at.1 L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 3 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I,J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed El 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 th at, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes N ElNA [:1NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes7No
❑ 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 ❑ 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 UhTo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
& ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IL N Q ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[:3NE
18. Is there a lack of properly operating waste application equipment?
ElYesFNo❑
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or9riy otheiycomments
Use drawmgsEof.facility to better explain -situations: (use�additeonal pagesas necessary} ° a f Yx ,
Reviewer/Ins ector Name
poBW:►J
F E, a ".,..i - Phone:
_ 't''
y-
r
m i
(�
Reviewer/Inspector Signature:
Date:
5 Z
Page 2 of 3 1 I2a8104 • Continued

Facility Number: 3 — Date of Inspection 11
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 ❑ Maps ❑ Other
❑ Yes B No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
DNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil'Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
El
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
❑ NA
[__1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
El NA
I--]NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
1 N
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
UZ
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
20
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B No
❑ NA
❑ NE
General Permit? (iel discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
X
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

i
1
01
Division of Water Quality
Facility Num3:3 Division of Soil Fand Nw,ater Conservation
Other Agency
Type of Visit �C(ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l 30 Departure Time: County: EM Region:
Farm Name:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: gA4jjT frM7CFiL-L_ _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number -
Back -up Certification Number:
Latitude: = c = 6 = Longitude: = ° = I 0 11
Design Current
Design Current Design Current
Swine C►apacity Population
Wet Poultry
Cl. VU —ac I 2A Population C►attle Capacity Population
❑ Wean to Finish
❑ La er I I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I I
❑ Dairy Calf
El Feeder to Finish
7'as
❑ Dairy Heifef
❑ Farrow to Wean IDry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
El Turkeys
Other
❑ Other
❑ Turkey Puults
11❑ Other I I
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ NA
❑ NE
El Yes VNo
ElNA
[INE
Page 1 of 3 12128104 Continued

r
_
Facility Number: (—rlw
Date of Inspection
o
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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAr,_,sN�) �-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a3 0�3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,/
LJ 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
CNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[j-fvo ❑ 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
CTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CYN. ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElL✓J 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
&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[: No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑/No
❑ NA
❑ NE
Comments (refer to question #): Explain any'YES answers and/or any recommendations ormany other, comments
:Use drawings of t'acility to. bette ' explain situatiaris. (use additional pages as necessary): , Ftk *
N`y.
XF- nsAT tic_ '3C> DAYS A-)D r0.K- to OWQ Iw,Zt2¢ 4&
aC. , o rr- CAW
RCVlewer/In6 eCtDr Name i € . "r%` k1�'�* '�
p + B ..T .. Phone: tC) Ib
Reviewer/inspector Signature: �71, Date: 31Sollo
Page 2 of 3 12128104 Continued

E
Facility Number: 31 Date of Inspection o
` 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 ❑Maps ❑Other
21. Does record keeping need improvement? If yes,,check the appropriate box below. llJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Zoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R, No ❑ NA [I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes WNo
Oo ❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? UYes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE-
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ld No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
EJ/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,_ ,�
L/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (5 C pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Y a9 Arrival Time: !/ Departure Time: County: �yi� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e =' = Longitude: = ° =
Design Current Design Current
Swine Capaci#y Population Wet Poultry C►i Design
Population
Design
Cattle Capacity
Current
Fopulation
❑ Wean to Finish
Layer
❑ DairyCow
❑ Wean to Feedern-La
Non -Layer
LJEEJ
❑ DairyCalf
Feeder to Finish ZAO
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
0-Turkeys
❑ Turkey Poults
❑ Other
❑ DairyHeifer
❑ Farrow to Wean
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Beef Brood Cow
of Structures:
❑ Other
_::::]Number
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
El Yes
El No
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 —
Date of Inspection b o
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1d 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: (Iq 6yn1 / LA Cy6d 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,..,(
LI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
uL 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
ff No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo ❑ 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
C?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo ❑ 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 101bs ❑ 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 E3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;;�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes �I/No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
;?No
❑ NA
❑ NE
aIj rmt copy of CA
�Lp
Join. rewnfus oc MA4 f
ReviewerlInspector Name `` Phone: 91U 7%G 4
ReviewerlInspector Signature: -ZyDate: 6
Page 2 of 3 12128104 Continued

71MFacility Number: — Date of Inspection 6
'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 El Other
❑ Yes 5(No ❑ NA ❑ NE
❑ Yes JNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑W_,e(ekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking LJ 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
u No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
]No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�f
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,L�eNo
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CN o
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [T'�No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[]Yes
0 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
,,(
L�J 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
Cl Yes
eo
❑ 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
0No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�.] No
❑ NA
❑ NE
Additiiinaltommentsandlor'Dra'wings:
T
Page 3 of 3 12128104

Facility Number
W Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 6Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Owner Entail:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
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
Back-up Certification Number:
Latitude: = o = 6 = Longitude: ❑ o = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non-Layet
Dry Poultry
Layers
Non-L
Pullets
Poults
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
❑
DaijX Cow
❑
Daia Calf
❑
Daia Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes iNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 7do [INA ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

Facility_Number._3t— Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ 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: A Gats-r� l LjA&-,vly 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
/
D 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?
0"Yes
El No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IQ 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
0 Yes
C No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
Ep 10
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
ElNA
[3 NE
/No
15. Does the receiving crop and/or land application site need improvement?
ElYes
2
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`?❑ Yes
Q oo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]'No
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
io
❑ 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):
?) Se+�E G2ASJ Wd1Ll� v d �,,►At4S d16EfJ6lJ�
•
�,� 1V b fo B� uP ry OAS �N WEATW R- 4PPe AAW /r a rtnl/ �T '✓.
Reviewer/Inspector Name o Phone: le 7d 3
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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes dNo ❑ NA ❑ NE
❑ 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 Analysis El Analysis ❑ Waste Transfers
EluaI Certification
El Rainfall El Stocking Crop Yield 120 Minute Inspections Monthly and V
El
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z�
LlJ [?(No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WN o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VN❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q'lVo ❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U4c, ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
l d'N ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,.,/
ld N ❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
;21
❑ NE
Page 3 of 3 12128104

J
Division of Water Quality
F,�cility NUmbCC' ')�Q Division of Soil aril Water Conservation
Q Other Agency _.
Type of Visit (Z) 7RPoutine
Hance 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: �Arrival Time: _J Departure Time: County, L)dPC.Zt✓ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AV J',Afel
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
�❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish Iwd
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: F__j o [—] ' 0 Longitude: = 0 0 ` 0 "
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ex
Dry Poultry .
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design k Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes ErNo ❑ NA ❑ NE
12128104 Continued

Facility Number: -- 3on Date of Inspection d�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2�No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L46fimiV I _ �rf67rAl
Spillway?:
Designed Freeboard (in): o,
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [-d"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 ETNo ❑ 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, thrree t, notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes DNo ❑ 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI 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 l0 lbs ❑ Totai 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 [CNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
1..3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ENo
❑ 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):
orj N6E b '(e CL,6kJ y r S G 0 FR-f vIy oUS CUT rbNC,
kF6-"wT4 STt2oN �i
•
Reviewer/Inspector Name Lrdlyw
Phone: (9V) 19„ " 13g J
Reviewer/inspector Signature:
Date: S c,
12128104 - Continued

Facility Number: — Date of Inspection o v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NNo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�E
a No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑4o'
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LJ_?6 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D 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
Dlq�o­
❑ 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
Cl 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
[J
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division'of Water Quality
Facility'Number 3 7Bri O Division of Soil and Water Conservation
Q Other Agency'.,
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C3Y/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Rate of Visit: Arrival Time: Departure Time: County:
t7vPlz&l
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: SAM6S only I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current)
Swine Canacity Ponulation
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts r
❑ Boars
'Other
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 c = = Longitude: = o [� g 0 "
Design Current `Design ' Current
Wet Poultry, Capacity, Population Cattle.' Capacity Population°'
❑ La er I
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ 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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE,
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑NA ❑NE
❑ Yes 2No ❑ NA ❑ NE
12128104 Continued

Date of Inspection 3 d
Facility Number: 31 —
•Waste
Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1�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
r
Identifier: L;1605N 7 L/4G'00wr
Spillway?:
Designed Freeboard (in): L'F' J
Observed Freeboard (in): 3/ 3J
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
Z No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ETNo
❑ 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
El Yes
�,/
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,�
[2 o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1f 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) 13694MUOA (15) 56-0
13. Soil type(s) AloA AuS r A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9?"'No
❑ NA
❑ NE
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?
[I 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 additionalpagesas necessary):
AL
Reviewer/Inspector Name _- __-- _ _ C Phone: �/C G $~
Reviewer/Inspector Signature: Date: 3 -) O L
Page 2 of 3 12128104 Continued

Facility Number: 31 — Date of Inspection 7 0
• 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 [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes LJ 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 InspectionZNo
Weather Code
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 2 No ❑ NA ❑ NE
❑ Yes L/I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [;Io ❑ 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 QNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E�<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�To
❑ 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
[:�I�o
❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation () Technical Assistance
Reason for Visit 110Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: rQ� eparture Time: S County: � Region. —�
Farm Name Owner Email:
Q M�
Owner Name-� `'s 5/�Ci Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative;z ��.r" Integrator:
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:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = I Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
�i ❑Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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 /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
.,ONo
;2rNo
❑ NA
❑ NE
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 ❑ No
❑ NA ❑ NE
Str
,yfire I §care 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:' S
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes A 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 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Applicatign Outside of Area
12. Crop type(s)
13. Soil type(s) L • ��%, !U /y_ l�f �/ �. �1�_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes /E�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes V El NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes ,.�,�(No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ' J/CJ No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes ,IJ No ❑ NA ❑ NE
�,) A�p� /fie
i90
Z 744
Reviewer/Inspector Name 1
R Phone: �—
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
1;1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I;lNo ❑ NA ❑ NE
the approprrate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VfNo
❑ 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
/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
9No
❑ 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
IE� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments andlor�Drawii7
�/.i1x//e/�
IIJJ /J
)
4✓ 1/ 4f �/� �! �� Val
• �� ec e 1 ! 7 Axe 4✓i
12128104

Type of Visit 7Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other Q Denied Access
Facility Number Date of Visit: Time:
O Not Operational Q Below.Threshold
PPermitted 0 Certified © Conditionally Certified 13 Registered Date Last Operatr Above _Threshold: .........................
FarmName: .......is....... .................. ......................... County:..::�,PLzI................................................
OwnerName: .................... ... .. ... AR S..... .................. Phone No:.......................................................................................
Mailing Address:
Facility Contact: ............................................. ..................... Title:.......................... Phone No: ...................................................
... .................
n ` f ' � t' ".. . OnsiteRepresentative: � ....... T................. Integrator:...0-CyQCz0k0,,,,'....._........_..................
Certified Operator: ................................................... ...... .... . ................................ ............ Operator Certification Number:..........................................
Location of Farm:
Swline ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
f C ' s ` ltl•!# i it x k k s tk 5€ s r'i t h t�l : Cy
,; i. kj .rDe.51 .ri €I CLrrent �i�F wy , , y Design �Current :
C-6 a 3iiCPQ ulabon €! i Ot� Y,.' `�<t?.¢;.?i.Ca aCl $PO nlabOn;, €kCAtt�Ca, tit€ ;is., tlkCB 8ei ,:p0 illStlOnk z2
F ❑ Wean to Feeder 1h ❑ Layer s�! ❑ Dalry
Feeder to Finish ❑ Non -Dairy
�,, Non -Layer ill ❑ 4
' Farrow t0 Wean
❑Other
❑ Farrow to Feeder k
' ❑Farrow to Finish 1 * , €t ` ,,' , " "t,
w`�,;tt�� t '7Gpd ;Total Design Capac><ty
❑ Gllts�! a
a.i
' x <
❑ Boars t dWt z f� r��� i Sas z , ai `Z'Ota1 SAM-ii
i
-�. .. ,t ._:. S-• ._'..#e kfF ti3 .
� ,.c.?�..z.� i, < �t
f T !
g t ia h:E
l iv! .
€ Ir F€ € _ R:
1 r z iN111nber O i OOns
ti �ru qa�, r
r� w�� �
Discharges & Stream Imapacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JdNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
S ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:'
Freeboard (inches):
12112103 Continued

— Facility Number: — Date of Inspection
5, Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes m No
/�
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste_Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes X No
❑ Excessive Ponding ❑ PAN ❑ ydrau 'c Overload ❑ Frozen Ground ❑ Co r and/or Zinc
12. Crop type
13, Do the receiving crops differ with those desi nated in the Certified Animal Waste M gement Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes /No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond, wi.nagitaion? o /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) !!
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes INO
Air Quality representative immediately.
Field Coov ❑ Final Notes
Vwshe/ /09 'VX;r774J &ACA 2;z4e
34) Am ew 11�5 / A9E 41 r�PPGzC� �o�e S�in�c � /'/v 11AXx1V11 .
IlMA�w "IS©MF c��r1Fi✓r�7 zoo �i✓ �P�rz�� ter✓ Are
,4,VD 62VheA CE,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

FacHity Number: Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 00No
23. Does record keeping need improvement? If yes, check the appropriate box below. �i'es ❑ 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 �No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ZNo
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,ONO
28.
Does facility require a follow-up visit by same agency?
❑ Yes ,/No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Z5ro
NPDES Permitted Facilities
30.
Is -the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
Yes [:]No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 9No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes gNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes [;fNo
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes ,fNo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes 9 No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit )b Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for,'visit Routine O Complaint O Follow up O Emergency Notification O Other OD enied Access
Facility Number2:2D��M
Date of Visit: Time: /2/D
O Not Operational Q Below Threshold
Permitted 13Certified [3Coynditionally Certified E3Registered Date Last Operas or Above Threshold:
FarmName: ..... / ............................................................................... County:............�........................ ... ......... I.............
OwnerName: ,. �no -5 . Phone No: .. ................... ............................................................................................................................................................
MailingAddress:.................................................................. ........_
FacilityContact:.............................................................................. Title:.... ............................................ Phone No:...................................................
Onsite Representative,. 1....t.l. �y"�Gi....R"A)5 Integrator: .............. ...?!��............................
i .
CertifiedOperator:...................................................•............................................................. Operator Certification Number:..........................................
Location of Farm:
swine []Poultry ❑ Cattle []Horse Latitude • 6 K Longitude Q" Q` t�
Wean to Feeder
❑ Layer
< ❑Non -I
Feeder to Finish
Farrow to Wean
<> Other
Farrow to Feeder
Farrow to Finish
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �Io
Discharge originated at: ' ❑ Lagoon Q Spray Field [:]other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes .1121to
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Flo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �Vo
Structure I Strg� e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........�.j.. .... .................... .............................._................................................................................................................................
yy�� rl�].,,.. ....-6
Freeboard(inches): 1.1.......................2)0.......................................................................................................................

Facili Number.
ty Numb,3 %— Date of Inspection /� 4 -"�-•
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes XNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 4-6 Yes �No
(If any of questions 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? ❑YesWNO
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level�No
/
elevation markings? ❑ Yes
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over applicati n? ❑ Excessive Ponding ❑ PAY ❑ Hydr ulic Overload ❑ Yes XNO
12. Crop type r1
Arze+
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Manag e t Plan (CAWMP)? ❑ Yes No
14. a) Does the facility Iark 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
I S. Does the receiving crop need improvement? ❑ Yes PNo
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design,, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes AA o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ YesjjNqo
o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) I] Yes
1�No
.23. Did Reviewer/hispectorfail to discuss review/inspection with on -site representative? ❑ Yes �No
24, Does facility require a follow-up visit by same agency? ❑ Yes ( eNo
25. Were any additional problems noted which cause noncompliance ofthe Certified AWMP? . ❑ Yes No
P -No violations.or-deficiencies•were noted during this'visit. You will receive no further correspondence -about this visit.
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z>: rr ..:<•ta: ,~. �}>�>„,.-��}.,�:?�r#,:.. �r�:Y„LLB{: .,:rk L{t'?L, )C Py ❑ F al Notes . L, .�...
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:}i{iL` S {{{{'n`{�ff.Jtik r{L'iL?-'. SGS i00r S`--� :} ;} ?:;{ 4 �{'.•{{�{{". {.{YS{` '^{ .{ :,r�'ri .::{r�2m ',,,{{ `t {<�S{2Y.Cµ'S <i"!:CK4:ti{{{^`:OC^.C! 2 .[N^k
:: :.},„E,. ,..£�..., ::{:::•i,$�,,.. �.:,T:.kY.:�:..�:.:{•".., :.7:: .. s.�Y:,f., <..::k,:..,:E-.. ,. r...:.�r,8.,£F„ n:£:.. .:,£m£'E:'::#..:
kti:' ::i `Y •r;:Sa::'4:' SSSi!r:{r::0:44•J.iii:'..:-:::••.:v.ri4:t: •:S :err [•: f.y,•�•.Y:•m:tia:::••'.•::.:rp%O:S:*.{:?:Y.:�i<tiO: lilt??:iv:srii•i{x^r:o:::. v. :
.:,.. ,��, .; ... .;. .. •: •.r: v. :.4�....... .:,. .. �.:�r. �:::: �:: ^:.,:.:w;;::}:. :�vr,:;r. �::..-::v. �.,:.: �:::.-:•:: ,.x Wit:^r::..� {�r�lrs:gic::cr„w^:?.r:{P
ector Name :::...... .
-Reviewer/Ins
Reviewer/Inspector Signature: Date:

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 ❑ Yes [�No
liquid level of lagoon or storage pond with no agitation? T
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 �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 XNO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? El �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additinnnl Cnmmentc-an'dhir nr4Winaa:
T) ld r ), ,C
�I"
DuiQ 40-cx/z'0-ic
ka—li S.
/g) 47 M'571"C
,L's Gt/o2n��G
LOi ap V'r,"'r I � ! &4C
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Y
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�,�,os S✓ �� off,
J
05103101

of Visit 0grnpliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O(Routine O Complaint Q Follow up O Emergency Notification O Other
Facility Number EE� I Date of Visit:
K
ermitted © Certified © Conditionally Certified © Registered
'#-z'
FarmName: ............ 5. ....................6 .........................................................
❑ Denied Access
Time:
Not Ouerationat O Below Threshold
Date Last Operated Bove Threshold: .........
County: ......... ,.. . .............................. '............
OwnerName: ............... .....%................... .......................................................................... Phone No:.......................................................................................
Facility Contact: .........r......1/C.�ili.l.................... Title: ........... 1.lF.L.VI(1......................... Phone No:....................................................
MailingAddress:............................................................................................................................................... ........................
Onsite Representative:.............. ................................ Integrator:............ . ..f.ho.........lf?....
CertifiedOperator : .................................................. .............................................................. Operator Certification Number:.........................................
Location of Farm:
ne ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 " Longitude • ` «
Design Current
Swine CaDacity Poonlation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry
Capacity Population Cattle Capacity Population
❑ Layer
I
I
I[] Dairy
❑ Non -Layer
I
I
JE3 Non -Dairy
❑ Other
Total •Des. gm Ca&dty
Total SSLW
Number'of Lagoons ' ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-x Haldmgal'onds l Solid Traps,_ ❑ No Liquid Waste Management System
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. I.f 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?
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes o f
01 /0I/01 Continued

Facility Number: —
Waste Collection & Treatment
Date of Inspection 9Q
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi t ier:................:..............................................................................
? ........... ........................................................................................
Freeboard(inches): Ll .................... .................................... ........... ............. ............ ....................................
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 maintenancelimprovement?
11. Is there evidenc�,of,gver application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
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?
- ��s:+Ti1L*iRl�lil'rlA. 1 - —;.;. ..e .
,�-. r •
❑ Yes (No
❑ Yes No
�cs [—]No
❑ Yes )<No
[]Yes No
❑ Yes X No
❑ Yes P ANo
❑ Yes,)dNo
❑ Yes No
El yes o
❑ Yes OL
Ayes ❑ No
❑ Yes ❑ No
I11R+ •.. � �^
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of. emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. 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?
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes
❑ Yes /)Vo
N(Ils #N
AYes [:]No
❑ Yes 5<o
❑ Yes o
❑ Yes QTo
01/01/01 Continued

Facility Number: _`h �� Date of Inspection f Printed on: 1 /4/2001
30. 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)
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0
32. 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 kA 0
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes (NO
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �['/ �No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� �iP(ds ivy W¢Sk.Claw,
5 �,la���s In fc'uvl �-�As tea[ r
7zceQc/ti h� n nit- �"
Field Cony ❑ Final Notes
dOlvcL
U /
c
Ir'..'i4�l���/ AaN0�1s�
Reviewer/Inspector Name 0,11
Reviewer/lnspector Signature:
ME
0l /01 /01

4� Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �j rjg Date of Visit: g' G7y Time: / 3: OD Printed on: 7/2112000
Q Not O erational Q Below Threshold
Permitted 0 Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ..............
FarmName: ....... ..................................1131�r.......................................................... County:..........1..R....................................:.......
Name: ✓ O-[�S Phone No:
Owner N.r .....�I
...........................................................................................................................................................................................
Facility Contact: ...................... �lwtaS I'it1e:...... Q w........... Phone No:...................................................
MailingAddress: ................................................................................................................
Onsite Representative:.. (��(,(/�/ J-4vt4l .,/ / Integrator ..... JA. ylj........
1 !..l It))
Certified Operator: ................................................... ............................................................. Operator Certification Number:..................................
Location of Farm:
�1
Swine ❑ Poultry []Cattle []Horse Latitude 0 �° �" Longitude
Design Current
Swine Canacitv Population
❑ Wean to Feeder
Feeder to Finish
QU Lf o
❑ FarroW to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originalecl at: ❑ Lagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man -[Wade? ❑Yes ❑ Na
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
C. If discharge is observed. what is the estitnatcd flow in gal/Min?
d, Does 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
So tt�re I Str#t 2 Str�tqrc .1 Structure 4 Structure S
Identifierr: ...................... Z.......................................................Rr%.,.............................................................................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes 4 No
❑ Yes [(No
Structure 6
Freehuard (inches):
5100 Continued on back

Facility -Number: — 1 Date of Inspection"vcS?
Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures otrees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Cl Yes A 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 5�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ,1
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes JNo
12. Crop type P& , � G _ SG M_ SG M
13. Do the receiving crops differ with those designatedin 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?
Renuired 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?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ 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?
*•yiol;aiotis or• dteticiencies Were• note[.• do -ring Ibis;visit: • Y;oir will-eeeeiye Rio further;
corresoondeivt : abut: this :visit-' '
❑ Yes b(No
❑ Yes &No
❑ Yes RNo
❑ Yes jfNo
AYes ❑ No
❑ Yes Vio
❑ Yes ONo
❑ Yes VNo
❑ Yes XNo
❑ Yes KNo
❑ Yes %NO
❑ Yes �(No
❑ Yes XVo
RlYes ❑ No
❑ Yes C)-�No
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):
I5 YI%�!L w,- �.,r�, s l� .�, CGVJS 1-wt` ..
yjV1,r.-Tc�e w� 1t �- 13 �� � �s w: �.
W WQ S jA. kv'eZkVz_d_�5 .
:Za,,) 1�>K)0_ VJVAkk 1,1'Lk— +V VJV�_ +b 6619,rV.4—
lJ
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: i Gb = PO 5100

Facility Number:2. — Date of Inspection I r Printed on; 7/21/2000
• Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge w/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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes R.
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 o
30. Were any major maintenance problems with the ventilation fan(s) noied? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ffNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [; o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Q�NI o
5100

r
Division of Soil and Wa • . • �� t "� terCorlSerVatlOn-- Operation RCVICW�
© Division of Soil and Water Conservation - Compliance Inspection i
,Division of Water Quality - Compliance Inspection
0 Other Agency -Operation Review.
104 outine O C:omplaint O 1,"i)llow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of lnspcction
Time of Inspection 0=24 hr. (hh:mm)
�'rlcrmittcd © Certified © Conditionally Certified © Registered JE3 Not O crational Date Last Operated:
..........................
Farm Name: ......... County: ���.
................................................................................ ' � ......... r� n............................
Owner Name:..... �. �..�.1"1 —S. ... 1 hotic No: � � 4 d�............................r..............................
Facility Contact................................................................................l'itle:................................. .... Phone No::.+.� ..
-' .....
MailingAddress: .......................................................................................................................................................... ..... ..... 1........... ...........,..............
Onsitc Representative:..•✓ IntegratorC�.................................
............................................................................
Certified Operator:.,.., ...... ............................................... Operator Certification Number: ................. I.........................
Location of Farm:
A
.......................................................... ............... .....................
Latitude 0 �6 Longitude • + «
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
'0
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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: ❑ Surface Waters ❑ Waters of the State
c. V discharge is observed. what is the estimated [low in gal/ruin?
d. Dues discharge bypass a lagoon System?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of th'c State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (inches): ................
Structure 3 Structure 4 Structure 5
❑ Yes )No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes VNo
❑ Yes IgNo
Structure 6
1/6/99 Continued on back

Fadlity Number. — 5 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any sluctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence ol'over , phcation? ❑ Ponding ❑ Nitrogen
12. Crop type �.......... C1E..................................................I.,......... .................................... ....... ............... I..., ...........
,.....
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, 1'rceboard 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?
0. No.. ...io ..or. deficiencies .were noted during.this.visit:. Y.ou wifl.receive na further
agrresptxidence about this :visit: ; ; ..:: ; '
❑ Yes �(No
❑ Yes 1XNo
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes 9 No
❑ Yes 15�No
❑ Yes &0
❑ Yes 7No
XYes ❑ No
❑ Yes kNo
@!�_Yes X No
❑ Yes �KNo
❑ Yes Cg�No
❑ Yes b�No
❑ Yes NrNo
❑ Yes VfNo
❑ Yes j eNo
❑ Yes 19 No
Comrrients`(refee'to question'#): Explain any YES answers and/or any,recom' 'mendatrons or any other comments
Use drawing s of.facilit .=to!better ez lain�,situatiotrs. use additional ages as necessar y
1..,, _ '4_ -,. -� .,..
021
LA
Reviewer/Inspector Name
Reviewer/Inspector Signature: s � L � \\ham, ._ Date: �1`1 1 (71 I1 /6199

0 Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Routine O Cam laint O Follow-u of DW inx ection O Follow-up or I)SWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
D Registered U Certified © Applied for Permit Permitted O Not O erational Date Last Operated:
FarmName:.....5.' ..... ram! . ....... ......................... ............... County:...... .. ..�`......................................................
OwnerName:.—EMPr...�r...........`::5es........................................................................ Phone No:... ..1+.Q.." . ...I r'............... I ............ I........
FacilityContact: ..............[...........�................................................... Tittllee:......................................................1........... Phone1 No:.........................G.........................
Mailing Address:....1.0....... Q?. .......... w4..1.�....(...n`L..... .`.......................
Onsite Representative: ... Q � `"`�4 f ..... Integrator:.....
Certified Operator:............................................................................................................... Operator Certification Number:..................
Locatia of F rm:
... ........-�..o........... 5 .. `�, ..... .................................................................
�'
...... '. .... ..6...y......1, ...........[3.a.H..e..............................................................................................................
Latitude �_ �•�� �f° Longitude �• �' 0«
Design
Current ,o . Design
Current
Design `Current
S Capacity Population,, Poultry ..,.Capacity
Population Cattle
Capacity ;I'opglation
❑ Wean to Feeder
' . ❑ Layer
[I Dairy
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
,; ❑ Other
z
10 Farrow to Finish
»,
Total Design Capa 4t
❑ Giltsy
❑ Boars
<Total SSLW
_.
ryr
rilter of4L�gtiptiS/,Holtltn Pbrids
Subsurface Drains Present C] Lagoon Area
D Spray Field Area
s
ER":
r
❑ No Liquid Waste
Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
U(No
2. Is any discharge observed from any part of the operation?
❑ Yes
A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
ONo
b.- If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
O(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
1KNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Cd No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
CgNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
CKNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
((No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
VtNo
7/25/97

Facility Number:'3 — �$4
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures (Lagoonis,flolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .............. .............................9.'................................................................................... ..............
Freeboard (ft): ..........rdZ.r.............. ............ 4....:�.............................................. .................. .................. ........ ........................ ....
.......................,............
10.
Is seepage observed from any of the structures?
❑ Yes
ONo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
$Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
P(No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
M No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type . S............ ...................................... ......................................... ........... .... ............................................. ....................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
(YNo
18.
Does the receiving crop need improvement?
2[Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
ONo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
O'No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
9Yes
❑ No
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
ONo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
ONo
0` No.viO'Nti6ns' -or deficiencies'rvere'ntited-during this; visit.Aou'yvill rece'ive•no-further,
correspoti<dence about •this'visit: .
a� 4h P�[ .`��S`'��S v G' + Q e[,^ Q�� ta�vn►-.'l't h2��. Z��1�, ►�LGtiR
C�c.e�' vera�c5, �, �,e ,�I \ � �jR�> 4c�', L �'ti CQv`'4�.�-� • .
VQ
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

f
[] DSWC Animal Feedlot Operation Review
h ] DWQ Animal Feedlot Operation Site Inspection
t
52
Jo Routine OComelaint O Follow-up of MVQ inspection 0 .Follotiv-up of DSN C; revie►v 0 Other
Date ofInspection
Facility Number
Time of Inspection F 13 24 hr. (hh:mm)
Total Time fin fraction of hours
Farm ,Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ® Permitted or Inspection (includes travel .and processing)
13 Not O eratiottal Date Last Operated: ...............................................................................................................................
FarmName.ST.......... F7W..nn...... #Z.............................................................. County :........bghr........................................ .......................
Owner Name: .........5. .....�Gacr':5....... \.V.►L. ............................................................. Phone No: ..(ftq..49X=.7t?.tl...........................I......:.........
Facility Contact: ........ ...j,opt,S......................................... .ritle:........... ok'?.+.. ok'J.4jr .................................... Phone No. ....(y.1o.)lq.i..,?of,l............
MailingAddress: ....... .p.0... &X .... 3-3.?r............................................................................ ...... .............,.,......,................., g. iQ.B.........
Onsite Representative: ......t,.(ay....�p:,�....................................................................... Integrator: ........... Ql&SoCQ.......t'3
Certified Operator:......... 9.......................................................... Operator Certification Number: ... 7-W.3.L......................
Location of Farm:
.....a1,... &... moo...ear...S-IV.....1~.:?o,t.&W.a...,.eum......k-......Mn...AR. ► ....urn...AwI.....
4' ....SR.. ... A.S..it,- .r...r 'M. ........ ! ......t1f1...5&130.....F&-r----rA A.1-30..... o ........... �
or Aa 6 —5 r „....:i�uh. lei n? ' ri,
Type of Operation Design Current Design Current Design Current
:. Swine Capacity Population Poultry ;- Capacity Population Cattle ; Capacity Populatran
I•k;
❑ Wean to Feeder
Feeder to Finish
7440
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
... ............ ................ .. .
❑ Other
It Number of Lagoons / Holding fonds- L, I . ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5, Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/9.7
❑ Yes 14 No
❑ Yes 1 f1 No
❑ Yes
[4 No
[j Yes
[)W No
❑ Yes
[P No
❑ Yes
10 No
❑ Yes (,O'No
,Z Yes ® No
Continued on back

Fa;ility Number: ...11...... —...�i..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes PNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures-(I,agoonsand/or holding on"
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes g;No
Freeboard (ft): Structure 11k Structure 2$ Structure 3 Structure 4 Structure 5 Structure 6
2.5, 1
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Applicatian
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. i9i'.1tltdJiL...... ........................................... I.. ....... —sfkt l .. i.+......................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes [J.No
® Yes ❑ No
Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes R No
❑ Yes 6d No
W Yes ❑ No
❑ Yes ® No
CR Yes ❑ No
❑ Yes JgNo
❑ Yes 19 No
❑ Yes No
Yes ❑ No
ConimentsT(refer to question,#} Explain any YES answers`and/o'r any recomrt i ndatEons a'r any other comments€'`:"
Use drawings,of facility to better expia�n situations (use additional pages as necessary)`;
S.//Ir'r�gA�iw� sys�C.;ti. r•d�' 1ns'lillrc} u+,c� �c�a C.%aQrin� i'�o'E- Co�*,Att,.[-c. Q
/IZ l'ias,an �Yeaz a, 0VXW'— a�aU� r- wu.1ls of 6*P- ID5000s s�o��� bR- �ti�c� w�`f• c
,u.. i14
M4 meede d. Jko- . spo"f S on W%& V010n.; s 64o he. me«.dej.
i$. pa MVdV cno� sho'jlj lie, tmQcovcj
ailys�s %6,46 -t- vQhkj, AR osrcc�•Ar_ wa�}t ►� be- cLPICIO
'a otN s�04
b� Jes;r5rw'�d 1-N cer�► 6A r6n. .5 roj Zow % skwO %e (4*W w,� 1ltlm6em iyA'
HO
Reviewer/Inspector Name ` Y��,k4�c, ,��
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97