310828_INSPECTIONS_20171231

Z V
NORTH CAROLINA
Department of Environmental Qual

MI c Ifm
Type of Visit: UCom nce Inspection V Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: A Departure Time: f pD County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: V _e 1-+d IT BI-. "" Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: z 6 D.3 b
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Deslgn Current
Cattle Capacity Pup.
Dairy Cow
can to Feeder
SZ
3 GcO
1
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D , P■ouitr, Ca aci P.o P.
I Layers
Non -Layers
Pullets
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
ffNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: '7 - Date of Inspection: 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ - Imo ❑ 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): 27
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment reat, 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 �❑ 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 ❑ 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
�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CYNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N0 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesE
o
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facifi Number: Date of Inspection: I& If7
14. 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 Fz�es ❑ 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 &No ❑ NA
B'❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �2'NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes OfNo ❑ 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
P<o ❑ 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
ffNo 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
7 N ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑ Yes
o ❑ NA
❑ NE
Reviewer/Inspector Signature: ,r��(��—.Date: z %GA
Page 3 of 3 21412015

Type of Visit: tZF'Com nce Inspection p Operation Review � Structure Evaluation () Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other p Denied Access
Date of Visit: 3 t' Arrival Time: f o Departure Time: z r} County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (� Title:
Onsite Representative: �e 1 �` e 4",
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 26 0.3 6
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Fop.
CattleCapacitytPop
tt�a.t.L.t:..
Wean to Finish
Layer
Dairy Cow kt
Wean to Feeder
Non -La er
I
Dairy Calf
1
Feeder to Finish
Farrow to Wean
Design Current
Dairy Heifer
W
Dry Cow
Farrow to Feeder
Dr, P■oultr, Ca _aeit P■a P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
P` Y
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
z
,
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 ET<o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[]No
[] NA
❑ NE
❑ Yes
❑<o
❑ NA
❑ NE
[]Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - L Dateofinspection: Tf
6
Waste Collection & Treatment
4. Is heavy less
Yes
storage capacity (structural plus storm storage plus rainfall) than adequate?
❑
['No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�NoEj
❑ 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
LEr No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�P O NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
;>e— ❑ 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
J2 ' ❑ 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 hio ❑ 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 '[I —No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes .in —No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 60
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ 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
E]N
❑ 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
[DINQo "
❑ 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
,�-�f0�
❑ 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 21412015 Continued

Facilit Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes F'1Qo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E No
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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
0-1;' lA
❑ 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)
3 I. 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?
Reviewer/Inspector Name: 0,GV F I �l ° �41
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [J1Z& ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes C j No ❑ NA ❑ NE
❑ Yes fo ❑ NA
❑ Yes �o ❑ NA ❑ NE
❑ Yes Ro ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
Phone: TP7
Date: ZZS C' i 6
2/4a015

Type of Visit: (TCoroutince
e Inspection OOperation Review Q St.ucttua Evaluation Q Technical AssistanceReason for Visit: Q Complaint O Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: °( i Arrival Time: ® Departure Time: 4 oO,rn, County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: k Title:
Onsite Representative: Vere l ` �l 04.-A
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C**opacity Pop,
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
zPo_5
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
1]r� P,oultr. Ca acit P.o ,
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Broad Cow
keys
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
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: '3 YZ.V Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes <o ❑ 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): 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 [j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 Cj No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E:fNo ❑ 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 [�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [2 f-4o ❑ NA ❑ NE
❑ Yes [J lac ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E] 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? Ifyes, check the appropriate box below. ❑ Yes Io ❑ 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 [D`No ❑ 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: 'j - 2 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes i=J o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA E TE'
[:]Yes []-No ❑ NA ❑ NE
[3 Yes f]No ❑NA ❑NE
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes e;
❑ Yes No
❑ Yes EI'Mo
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
Reviewer/Inspector Signature: Date: l
Page 3 of 3 21412015

Type of visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - -L Arrival Time: Departure Time: County:
Farm Name: R �1AI S�+c a Owner Email:
'I - 19 64--
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Region: kh,R b
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pap.
WetPoultry
Capacity
Pop.
Cattle C+apacity
Pop.
Wcan to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I)r> P,oultr.
Ca aci
1po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
F Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ZfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ;EI'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [!I No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: I I jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K 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: L' I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 [2-1to ❑ 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 J!j No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 41 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 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZJ No ❑ NA ❑ NE
maintenance or improvement? '
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Vj 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
Z5 No
❑ 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? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VTNo ❑ 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
Zj No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ej No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes VjNo [DNA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes VfNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: X;t'3j&r"'`Jn
✓
Date: a— LL/14
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: (fRoutine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: I3p ig County: 111�
Farm Name !Y 11�'LjsGt~`r ir� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
x Oil
Certified Operator: 6641 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Currnt
Design
CurrentSwijV
ne
Capaity
Pop.'
Wet%Poultrypacity
KCa
Pomp
Cattle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
a
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
!~arrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turke s
Other
Turkc Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No [] NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)? T
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes VTNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes FrNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes (TNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 1 21412011 Continued

Facili ' Number: - Date of Ins ection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C?fNo ❑ 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 O No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ['No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes Z^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 [2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes JTNo
❑ 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 ETNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2ffNo ❑ 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 No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [;;rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z 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 Frio
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [rNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E5'No
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 VNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VT110
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes RTNo ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes %—No ❑ NA [] NE
❑ Yes
;4. No
❑ NA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
❑ Yes
;n No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilityto better'exxplain situations (use additional pages as necessary).
PARev- VX&-f%#-N -
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ;15 1 -a—�
Date: 5� �1 Y>
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: UAL Region:
Farm Name: LAJ-5f- / f p� Owner Email:
Owner Name: q>(LowA/ Phone:
Mailing Address: �ayp� <S-jOGw'jC' a&AN Q-Gat"
44 c oju_4 r L
Physical Address:
Facility Contact:
Title:
Onsite Representative: �1 q_Gy_ � la/y Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
lgesignZOujrent
Swine
Capacity Pop. Wet Poultry Capacity Pop.
Cattle C►apacIf MPop.
Finish
La er
DairyCow
Feeder
j
Non -Layer
DairyCalf
o Finish
DairyHeifer
o Wean
Design Current
D Cow
o Feeder
rFarrowtoFinish
Dr, PouI Ca acit $o
Non -Dairy
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turkey Poults
NJ
,qth-UM
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[]Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Yes
ItNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facilt Number: 1 - IDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P(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; 5-IR-
Spillway?:
Designed Freeboard (in): �• s
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes qNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes kNo ❑ 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 A Iication
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 > LO% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr/op Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tl -6d) ��5 �11 1 S C�
jCC
13. Soil Type(s): rj"Q�i �t s 7�_ _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 14 No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No F] 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?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[]WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 No
[1 Waste Application 0 Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ Yaste Transfers
E] Rainfall ❑ Stocking ❑ Vrop Yield Q 120 Minute Inspections [] Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [3 Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [3Yes 9No
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[] Weather Code
[] Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilitv Number: Z I - RM7 I Date of Insuection: 21 1 I 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [DNA ❑ 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?
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 ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [� No
❑ Yes No
❑ Yes No
[:]Yes No
❑NA ❑NE
XNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to letter explain situations (use additional pages as necessary). j
CA���-A,1 oN Dc.� r �► �
w. R.
-ryeaE F}Q.0 VLoL6 M S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ALL i �
Phone: [phone]"f-
Date: 9-101 p' L
21412011

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation /
0 Other Agency ✓
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: e�1 Arrival Time: L1 Departure Time: County: L1m Region:
Farm Name: �-�"� 1J VU
I-W- -H O �: Owner Email:
�L'>
Owner Name: `-� - ,. Q�tO phi _
Phone: 1
n
G-d
n
- �-77 ql
Mailing Address:
L/�'S1QCESI -I
HjL,(-oA1C
20 yS�
Physical Address:
Facility Contact:
Title:
Onsite Representative: 't>eQ-E1�- 1 S(Z0LA_')j1/ Integrator,
0
Certified Operator: �&w%/ Operator
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
L! Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Ce 'tification Number: 0 CO
Back-up Certification Number:
Latitude: = e = 1 Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
^II110 La er
❑ Non -La ec
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullcts
❑ Turkeys
❑ Turkey Poults
❑ Othcr
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
EI_Dairy
Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef $rood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
XNo
❑ NA
❑ NE
❑ Yes
YNo
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L &00
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes XCI No
Structure 5
❑NA ❑NE
El NA [I NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-5 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
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes No
❑ Yes A No
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
[I NA El NE
❑ NA ❑ NE
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Wind Drift
El Application Outside of Area
12.
//oa�f
Crop type(s) &_\` Eeac E
13.
Soil type(s)
1D `'&S—jor<
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
/71`
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ YesNo
ElNA
ElNE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[No
o ❑ NA
ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYeso
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers "and/or"any'recomrimendations or:vny °othe"r comments.
Use drawings of facility to:.better ex plain,situations. (use, additional pages as necessary): = ` `
A,
ReviewertInspector Dame 1 Phone:
Reviewer/Inspector Signature: Date: a 1 1 [
Page 2 of 3 12128104 Continued

Facility Dumber: Date of Inspection 13
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP 0 Checklists [] Design [I Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
0 Waste Application 3 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ /aste Transfers
J❑ Aq�ual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute inspections ❑ Monthly and 1"
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
[INA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[IYes
No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes ;
No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑.NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1�No
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
' \
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
_
)o No
[:3 NA
❑ NE
/xo
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
PI'lUA) ta+V �)U15_ 1
LA-) •A'
al i11 a'a
)L IL
L
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: M [� Arrival Time: © Departure Time: County: U M Region:
Farm Name: Owner Email:
Owner Name: R1- L<d {� Phone:
Mailing Address: L I� 11i 1t-Q L QUtLLEc
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 7 L_D�- W Integrator: [,
Certified Operator: �-L ry'tQ_-FjA/ ��t�� A2� Op`�eGrabtor Certification Number: D5ap0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o = I 0 11 Longitude: = o = 1 ❑ 11
Design Current
Design Current
Design C►urrent
Swine Capacity Popu[xtian
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑ Layer
❑ DairyCow
Feeder
❑Non -Layer
El Dairy Calf
El to Finish
❑Dai heifer
to Wean
pFarrow
Dry Poultry
❑ D Cow
to Feeder
❑ Non-DaiEZ
to Finish
❑ La ers
❑ Beef Stocker
Non -La ers
❑ Beef Feed
❑ Pullets
❑Beef Brood Cow
❑ Turke s
Other
❑ Other
❑Turke Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
*No
❑ NA
❑ NE
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
kNo
❑ NA
❑ NE
other than from a discharge?
.12128104
Continued

Facility Number: '
Date of Inspection Id
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: La!SooN
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA ❑ NE
Cl Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ NE
❑ Yes
�RNo
❑ NA
❑ Yes
NNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,KNo ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes] No ❑ NA ❑ NE
11.
is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
IV
❑ 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 ElEvidenceof Wind Drift ❑ Application Outside of
Area
12,
_
Crop type(s) CC ,N1 (/V -'T ?�, S (S)
J
13.
Soil type(s) A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
XYes ❑ No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0 No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes 4 No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes CirNo ❑ NA
❑ NE
Use drawmgs.of fae�hfy�to better explain s�tuahans (use°add�ttonaltl
NOT 9-ECw 100--_s c�)010 0 iG C-Rid.-b 6E7 — C—V—D
I M-S alC_ fi-r-- 71 U
—k ", :r �, Reviewer/lnspeetorName aPhone: : �}Nf,� , � 1 , ,< ,��.;1 �,�,�� *;�ti y
Reviewer/Inspector Signature: Date: i
12128104 Continued

Facility Number: 3 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. B WUP ❑ Checklists Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA El NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑ Vaste Transfers .9rfinual Certification
0 Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
`� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
16 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Cl Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
MAIGE SuQ€ Tc>
w_A
N�-rr��LZ Uj- A • S&,?v7 OFF
c>C-T 'oCl �mp ��tC, /VaT cau ERGb
YIAM?,<AA:5� rvCAv7S
r C3U r—�Q AIEx i
rr/�►LS IMF j TO ��'�� pASircQ, —
fo
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 3gLRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Dep
narture Time: County: L-i K Region:
Farm Name: ry)4Q l LA R)L I �.?.Q�-� � 0l Owner Email: /�
Owner Name: Q_ P.O.,: 9)0_ d9 8-y9S I
Mailing Address: IL.C.AU1Crt ` )VC Q RS 1 2
Physical Address:
Facility Contact:
Title:
Onsite Representative: rn ow r k l 't— I I i 42Z1 _ Integrator:
r
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' = Longitude: ❑ ° = ` = "
esign
Currenwine
MENH.h.L
pacity
Population
Wet Poultry Capacity Population
Cattle
Cap�aciMty
Population
❑ Wean to Finish
❑ Layer
❑Dairy Cow
® Wean to Feeder
5
10c>
❑ Non -Layer
❑Dairy Calf
❑ Feeder to Finish
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other I
Number of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
K No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
%_No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection 11 :
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L•4400i
Spillway?:
Designed Freeboard (in): �5
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes VNo ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5. Structure 6
❑ Yes 1M No ❑ NA ❑ NE
Vy
❑ Yes O No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes h No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CQ(Z-N. S-S_l7�►-�6a4 1
13.
Soil type(s) F�%4
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
P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
& No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J No
❑ NA
❑ NI:
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA
❑ NE
IComments (refer to question #): explain any YES answers and/or any recommendations or any other comments.
Use drawingstoUfacility,to better explain situations. (use additional pages as necessary,):
9y. j4nit�wDr9• f)A-TcHER- s-r-#9bkt_E6 TO COME a/&)0I 7C� GOn1p[ErE
y
c4u 89.WTr 0A1
90o9 01C. GR� S nloT SEvToL,_ t3F_T-- C lc� AIMS n`)a 771S Rc-lei' fLp OZC ,4c7f
Reviewer/Ins ector Name _ �;: ��'� Phone:
Reviewer/Inspector Signature: Date: 30
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 3�
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Aaste Transfers
❑ �(nnual Certification
0 Rainfall 0 Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and I"
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I N 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
[A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ud No
❑ NA
❑ NE
Addi io al Cotntn nts4andlor l]`r wtn s i i'' A L
ash ..a .3 , � : w
i
Page 3 of 3 12128104

Division of Water Quality ✓
Fiteility Number 3 O Division of Soil and Water Conservation
O Other Agency
Type of Visit ($l Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit %) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: lA L4H Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine,
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =1 F Longitude: = o =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
rjai f r4 10 Non -La et
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 Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F71 .
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 A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
[ , No
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAA�d4A%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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
Ij 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
[XNo
❑ 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
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
AM No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ 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):
a5. )Vo5�,oC,E 5V.UF.� Faa. roe .AMP« ��g s�� F
Su��t=�,� ��
A6
stern coV 7-0 t�WQ
-
X`tTN : A 1►tiAA DA 614IN ES
A) c D 1- ?--nip
fad C44Lb1,va4L 11,9_1UG
wt ��1�6raN IV � �4 aS
Reviewer/inspector Name G )Al S
Phone:
Reviewerlinspector Signature:
Date: a�0'*
12128104 Continued

J '
Facility Number: Date of Inspection gtgu
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes � No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LANo
❑ 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?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Qj No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�INo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�Zefy\ErYlI��LL SOIL 510 PAP F v�fZU� SE 10(9 SAMQtE LC0r— 5
V- `o s MPeC a �S�-�qD� CC(--LECTE
AL6ocaN-'�,
12128104

Division of Water.Quality
/ 2 OlDivision of and Water Conservation
Facility Number
Q Other Agency
E
fVisit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Acces's,
Date of Visit: Arrival Time: i eparture Time: � ,'2 /
ounty: u��^I Region: �' �®
Farm Name: _4K a 2 Owner Email:
Owner Name: � r�z ��_! D Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:��r�JN
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' = Longitude: = ° =' =
Design Current Design Current Design- 'Current
Swine Capacity Populatiorr. Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder fJ(�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish E
❑ Gilts
❑ Boars j
Other
❑ Other --- j
❑ Layer
❑ Non -Layer
Dry Poultry
Non-
Pulle
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?
7
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures::2:1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes,)XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes z-ANo
❑ NA
❑ NE
❑ Yes gNo
❑ NA
❑ NE
12128104 Continued

Facility Number: BZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ni
Spillway?: 1 vim/
Designed Freeboard (in): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,ZNo ❑ NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No [I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ANo [I NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes IE�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift El Application Outside of Area
12. CroptyPe(s) .��.�� ��lJ .� � /�S '],a.
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes O'No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes �/No
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes JCJ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes No No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes )ZNo
❑ 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):
-�U��i9-C� ,�df2�/� ,�znJ� ..fin/ /gyp � �%`�/ �/�� �.✓�
�
•
/�or✓r�/ /—osP
y
Reviewer/Inspector Name - - �T - - - - - - — ]Phone p
Reviewer/Inspector Signature: Date: Z3 0
Page 2 of 3 - 12128104 Continued

Facility Number: Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X0No ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No O NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes X No ❑ NA ElNE
❑ YesNo El NA El NE
El Yes ❑ No gNA ❑ NE
❑ Yes )ZNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes
P"No
❑ NA
❑ NE
❑ Yes
'W(No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑Yes ENo El NA ❑NE
Page 3 of 3 12128104

xp.. Division of Water Quality
Facility Number .3 gZg O Division of Soil and Water Conservation
_� -- - - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Hate of Visit: (p Arrival Time: ; Gib Departure Time: aunty:
Farm Name: t i2 Owner Email:
� -�� b
Owner Name: 2l G�72Aee� Phone: _.._
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: A—:rZZRIqQ
Back-up Operator:
Location of Farm:
Design Cu
Swine?, Capacity ' Popu
❑ Wean to Finish
Wean to Feeder Jr
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
LJ Gilts
❑ Boars
Other
❑ Other
Region:
]Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = f 0 Longitude: = ° = i
Design Current Design, ',.Current, -
!Wet Poultry Capacity Population. Cattle Capacity Population-..
❑ Layer
O ❑ Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ 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?
a. If yes, is waste level into the structural freeboard?
St1r,ucture
Identifier: A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes _ No
El Yes /❑ No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
❑ Yes !LJ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? t
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑ Yes No ❑ NA ❑ NE
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.
wYes
❑ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) e0wiv
13. Soil type(s) 0
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
'0
P(No ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
V No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WfNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10No ❑ NA
❑ NE
Comments (refer to question ft 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):
of1'1J�h,I�PC�Gzc,4�2D,�5
//��
ex!op 4.(d'o D U) ! o 2 002XL 46)/0 o 5
/,'CAL/
�T,��s ��sd DCCc1Q2�p � � F�lcz�z�/ 31 2z9.
`
Reviewer/Inspector Name
Phone: p — �j
Reviewer/Inspector Signature:
Date:
Page 2 of 121'28/04 Continued

Facility Number: 3 f —$2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No ElNA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
❑ Yes
'VNo
❑ No
�NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes A No
❑ NA
❑ NE
❑ Yes '2� No
❑ NA
❑ NE
El Yes No
❑NA
El NE
❑ Yes No
❑ NA
❑ NE
❑ Yes '0 No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
2� �Z5) tA)icc. AJ[ ko --13rz ,Da,J6_ V 0er
)4
IA
47 Aul-9'414
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I fj/C'J,QS Arrival Time: Departure Time: �I County: L�+pG Region:
Farm Name:Xlfg-;rLI Owner Email:
Owner Name: '� Z7cZWp Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: /fib ����4AD
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = . = Longitude: ❑ o = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3 (p p ❑ Non-Layet
❑
Wean to Finish
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
El
Farrow to Finish
El
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
ElLayers
❑
Non -Layers
El
Pullets
❑
Turkeys
❑
Turke Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
ElDai Cow
❑ DairyCalf
El Dairy Heifei
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El 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 VNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ;9 No
❑ NA
❑ NE
❑ Yes ,11No
❑ NA
❑ NE
12128104
Continued

�.
Facility Number: aEm Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: Nn
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Z No ❑ NA ❑ NE
through a waste management or closure plan?
It 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
maintenance/improvement?
❑ Yes J?fNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes toNo ❑ 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) 64 r
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
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
VfNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
15) C,cJ L9w Ae_x'r ��C
��o
fo"�0 o �''
o�.�, it/•�y
ReviewerlInspector Name jE�'°, �Y�Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

i1 Facility Number: — Date of Inspection I`'3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZZI Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 16 120 Minute Inspections /21 Monthly and I" Rain Inspections 14 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
9No
[:1 NA
❑ NE
El Yes
❑No
6NA
❑NE,
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
[PdNo
❑ NA
❑ NE
Cl Yes
A No
❑ NA
❑ NE
❑ Yes
No❑
NA
❑ NE
❑ Yes
to
116 No
❑ NA
❑ NE
❑ Yes
;ZNo
❑ NA
❑ NE
Additional'Comments.:and/or. rawin s
00"014ors fan- Gc%P 2Gt,
12128104

Type of Visit P,Compliance Inspection O Operation Review O Lagoon Evaluati
Reason for Visit Routine O Complaint O Follow up O Emergency Notific ' � Other ❑ Denied Access
Facility Number 2 bate of Visit: Time: 0 3U
O Not O erational O Below Threshold
D Permitted Q Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ....................
Ce
FarmName: ...... I.'..,!]Gt.... .............. ........................... county: ...... UPZ.........................................................
Owner Name:
Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:...................................................
Onsite Representative:................................................ Integrator:......��� 01 �.S.............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 4 «
Disebarges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ao
Discharge originated at: [ILagoon ❑ Spray Field [IOther
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)
c. If discharge is observed, what is the estimated flow in gaurnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: l
................................................................................................................................................................................ .......
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes /No
❑ Yes 'JoNo
❑ Yes eNo
Structure 5
12112103 Continued

Facility Number: 31 -- Date of Inspection 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IN9,VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes IN9,
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El YesZo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes Vo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type [5 0 Y 6,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 11J o
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes VN
15. Does the receiving crop need improvement? ❑ Yes FNo
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes Zd�N
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
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 No
Air Quality representative immediately.
.,.� .�kJ.r,_ $:@-.t-1"t;"tid;1 •. E&!P$ i#f,f r,$.G: t,r .-{' {_' l�.e � "`-sa tF1''.F .t">W;D ..F"SIY,':€l .'i:-•..7">n.'N"`+: Y'1 �[.-...Yn 'ii::"Y.:.:i '' : ,tel.yy '. .<< Pt ;€1... •lrra^,� ikn{.,:,Y�€. Pr. �.-# E!F!._��r�<
=Comments (refer to guest,on!#) Explain any]]Y�ES answers�and/oe any recommendations or.anytotiie`omments , ��f ! r # ¢¢i,��IEtr, .P,�3: - i [ N } i��1'i�i.. � ,.. !� f$ • DF/ 1. i - jA, -�. ..i" '� _ e-'t! r nalE'"JH � 'fi .'�} i +. -.`/c ":'.E>:' i�.-:�„diriiu,3.j1E,c �w� .ii{.,:. ! � � - f:
iUse drawings'oi iacdlty=to better`explain s�tnapons: {wise siddittnttiirarl(pages:as necessary} !#r', Field Copy ❑Final NotesE+$ €E."+,r"E;
i 9�.f:'�.) t� #{ $f ?,-i;v. t � i #•1v"f'! Lii�;s ,�$$ 'd S t? {�}., SP i77EE ?d 1,s lt` r : At i :- .€�qg� � <ip d Bl. i - � f i � :IK i }t!•,: FrY 3f i -E IP:. f ' .,F x<f� ""! 1+'.i'r ; .
•;�,! .!€.J^. Y �..�-.. f ..Sr ;i<xr d }t•� h € nhA'r.:x. ,.'..:14�'h i .i° �'pr' f4 n:A.. x..R' Jr� �.�.. t�.. ..l(s.€e'` ! 1, rY.sir 'if°i'T �-.i e,iil:-r.d"t'�. trr= �. �3hi=rf�ri,i•�1:�.tEf rl.t {j �Na; 1 t.
C o( AN 0 PQZtv,xr oN sm Fai- B-cro FADS. 9
31-22 4- 3 1- 825�
w k) 4) w�► 5 � N
23) Sol-, SAMFU NOT UPT4 LATE
V"C C,t> A" "iE.0 D s To a 0.c e_o CO 'iE6 tC
j�R �'1' �7 E l_D nn Astvr A LN C
' f ta•1 !f �,�•���g}Kmn�q.'i'p "T...'T..i�' .'f'f�ir�& am f �' I' F';�✓fi r&'iJ` fY n F i" tiT'�y".`
)3Y 3i 3 -f;3f �'. W dE�' ll'dh - d i E 1� :�� 1 t
Reviewer/Inspector Name r �{� :� E lauu+Tdll h'-
Reviewer/inspector Signature: Date: 0
12112103 1 Continued

Facility Number: —
Date of Inspection O
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need i rovement? If yes, check the appro ate box below.
❑ Waste Application Freeboard ❑ Waste Analysis Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes No
V
s /No
s ❑ No
❑ Yes 0
El Yes V
❑ Yes 7W
❑ Yes
❑ Yes FNV
❑ Yes [ No
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit .0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit l6 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Fj Permitted [3 Certified [3 C ditionally Certified 0 Registered
Farm Name:
Owner Name:
Mailing Address:
'rime:
Date Last Operated Above Threshold:
County: , /IGi✓ �[/i/rU
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: V t.1%�_ _ _____ __ Integrator:,f2 �S
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 044 Longitude ' 06 0 «
Design,. Current Design Current Design Current
Swine Capacity 'Population P ultry Capacity Population Cattle Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy Feeder to Finish ❑ Non -Layer I JEI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish �Total Design Capacity
❑ Gilts
❑ Soars Total SSLW
r 'Number.of,Lagoonq,, ❑ Subsurface Drains Present I ❑ Lg.. Ares JE3 Spray Field Area
,Holding Ponds /=Solid1Traps t ❑ No Liquid Waste Management System wE;.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )!fNo
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)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier;
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes A No
❑ Yes No
Structure
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
i
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
'f No
(If any of questions 4-6 was answered yes, and the situation poses an
f�-'i
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. is there evidence f over applicatio ? ❑ Excessive Ponding ❑ PAN ElHydraulicOverload
El Yes
,�fNo
l,Q No
12. Crop type
/
/
13. Do the receiving crops differ with those designated in th Certified Animal aste Management Plan (CAWMP)?
❑ Yes
9.No
14. a) Does the facility lack adequate acreage for land application?
El Yes
gNo
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
JzNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Reuuired Records & Documents
/zNo
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
0Yes
❑ 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
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IVNo
PfNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_e.
Comm is (refer to question. #) Explain ally YES answe`rs,and{or® any recommendations or=any other cornments. h "
Use drawings of (agility to better explain situations (u"se additional pages,as necessary)
.`. 9, ❑ Field Copy ❑ Final Notes
`
: , F.
EFL
Ak X, M -r_
Reviewer/Inspector Name jr. i27-PA9 43,.
Reviewer/Inspector Signature: Date:
05103101 1 Continued

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

r.
ODlvislon,of,Water Quality
" , f Q Division of Soil and Water Conservation
Agency
E
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of VisiVisit:a4i.-C{ Thne: � Printed on: 10/26/2000
3 �
Q Not O erational Q Below Threshold
13Permitted jd Certified QD Conditionally Certified 13Registered Date Last Operated or Above Threshold: ...•..........
Farm Name: .�,`\u 1?1� �? - ... � County: 1`......................................................
. ....................................................
OwnerName: ................................ ........................................................................................... Phone No:.......................................................................................
FacilityContact: ............................................................... ............... Title:................................................................ Phone No:...................................................
MailingAddress:............................................................................................................................................................................. ........................ ..........................
Onsite Representative: G�-i-- .. Integrator: V�
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
rN
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` _]" Longitude �• ��
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population CattleCapacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Inl� pacts
I. Is any discharge observed from any part of the operation? ❑ Yes IC 'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. li'discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. li discharge is observed, what is the estimated now in gal/trtin''
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 ;�J No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 36/
5100 Continued on back

Facility Number: a Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes EYNo
(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
�ffNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
gYes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Ef No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes
ZNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
"No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ 5No
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
lb. Is there a lack of adequate waste application equipment?
Yes
❑ No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General 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
9 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes W'No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes 24 No
24. Does facility require a follow-up visit by same agency? ❑ Yes gNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes n No
�'VQ yiola(iojs;or dgljcjertcies-were nQCe0.00� irtg •thjs•visit! Yo(x will- eeeoiye iio futtitgr
• Corres' onden .. abi f this visit.
Comments (refer,to;question #): Explain any YES answers and/or any recommendations or:any other comments ` `s
Use di -swings of facility to better explain situa#ians. (use additional pages as necessary);
r7) AL
�Qw,e 1`">r`-a�-•.� ��r'e �¢, +``'� e s-T'� �'1 � � +�e�-t,.szi�e� _
Reviewer/Inspector Name 1 k-`tQIfZ,
Reviewer/inspector Signature: �U ��_�_ Date: C1 5/00

Facility Number: — Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,�] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes e[No
Additional Comments an or rawingss i
li� See. c��� �.�- �? L.e.�- �,,���� G���, �e�-►�- 'r CQ C ��-��--.
G' --1- Clq t . C4\ --:5 k---,
tt ff
Sties V-,Q-tee.f� �J r� c-b1,- • J
sroo

JWDivision 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 lam' Routine O Complainl O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Ad 'Time: © Printed on: 7/21/2000
� 1 ZS
o Not O erational 0 BelowThreshold
Permitted © Certified Q Conditionally Certified © Registered Date Last Operated or Above Threshold: .............
Farm Name: (21 i-zz-i,"A 4f -2— Count`':.�.?!f../��?�.........................................................
r''?..............................................................................................
Owner Name: 1�� r� iql.. Z-r9 Phone No:......................................................................................
.............................................................................................................
FacilitvContact: .............................................................................. Title:................................................................ Phone No:
,'Mailing Address: ............................................................................................................
1
Onsite Representative: ... Zz.ri!�i... Inkc� rakor: /.....................................................
G�r`►^o 'J
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm.-
w
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
14 Wean to Feeder _755Z 7S5"2— JE1 Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagwin Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, li'discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If dischar,*e is observed. whist is the C5timated flow in gal/min? It /A
d. Does discharge hypass a lagoon system? (If yes, nosily DWQ) ❑ Yes o
2. is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway [:1 Yes No
St]-UCture I Structure; 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifies' : ............... I....................................................................................................................................,.....,.............I.............................................
Freeboard (inches): 4,
5100 Continued on back

Facility Number: y — f3 2-b Date of Inspection Z OQ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes " No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
VfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
P No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type Car' 1 L'i) e-t_.SaybeAP1,;, S-Mq_1_�_ 6.rq "`I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan CAWMP
Yes
;gNo
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?
;z Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
"No
16. Is there a lack of adequate waste application equipment?
❑ Yes
R No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available`?
❑ Yes
j2fNo
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
C5No
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
S No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
J� No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes to No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �RNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes $No
Rio violatigris:o,r• doridenues •mere hot;ecl• 40u itig •this;visit' • :Ybit Witl•rebeive ii6 fut ft ;
coriresporidei�ce: aN k this visit - .. ' .............. • ...... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Fes: lI w able qrre /��Ie' +rn�11c�. Send trre ed gc�ts�4���
.�.,p sXet,r;,,j evIIJ) jrai W-1.4e PI4» btiseA er) weVCA Itleles ao me of
3®,/ ZODo .
f�. /Ueed r)eL., w-ci.s4e- gna1 40 %e
IG60 h✓+wyfo G,-,n,er belk'h weeftl y 1 �ee69,d reG�fG�r.
Reviewer/Inspector Name .�-Ae rt ew-1 1)
Reviewer/Inspector Signature:���„y �, Date: �� �%�% 5/00

Facilitl Number: 31 -RZB Date of Inspection Zy �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '& No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
'28. Is there any evidence of wind drift during land application? (Le, residue on neighboring vegetation, asphalt, ❑ Yes S/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 X No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes )0 No
31. Do the animals feed storage bins fail'to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
A �ttona omments an or. ravings !: ;it V:JR
a
A.1
J
3/2 3/99

Division of Soil and Water Conservation Qneration Renew a "s
€�y 'E It I ! ....� r E E r :r yl 9 € ! (� Eri r f5 r'11 t i 1, 1 r ' E ! ar Ir �E
'W, 'Q:Dlvision of SOil and Water>COIISe[Vatlon� ,,COmpliance,Inspect�Dn 6�1 I I . �E I ;.:
t Dom
lvisidn of Water Q�$hi] .Cpliance Inipeetloll 4
! I- it"
� I� ,; 3' a ! �' Other Agency,.' Qpera Won. R.eyj
ID Routine O Complaint Q Follow-ug of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection �$
Time of Inspection © 24 hr. (hh:mm)
0 Permitted Certified 0 Conditionally Certified © Registered 113 Not O erational Date List Operated:
FarmName: .......l L.... �........... .... .... County:......... .�1.(...................................................
Owner Name :..... ...`!'41.....1 ��i(.......:......................................................... Phone No:.qw,...^...1...........................,
Facility Contact:.............................................................................. Title.............. Phone No:
Mailing Address: ..... ll...j..l....lt!•.:....&Z.7 I.ion. .I.:�tr..::. ............ +J 1ea..Lf.o..1f .............................
......... .... ..
Onsite Representative: ............................................................................................................ . Integrator:........ 6�..�:....................
Certified Operator: ...... Operator Certification Number:
Location of Farm:
................'...............
........................................ ........................................................ ...............
Latitude Longitude �• �° �«
Design Current,'.,,' ,I Design Current € Design ' Current ,
'Swine capacityPo elation �P-oultry , Ca aeit Po' ulation Cattle Capacity Po `elation ,i�i
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non-LayeraJ❑ Non -Dairy I
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total.Design Capacity
ElGilts
❑Boars ° Total''Skw
Discharues & Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon [3Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway.
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: II
Freeboard(inches): .......;4..............................................................................................................................
❑ Yes [YNo
❑ Yes 0 No
❑ Yes XNo
❑ Yes 9No
❑ Yes X No
❑ Yes ANo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes kNo
Continued on ack

Facility Numberi3 ( ��$ Date of Inspection 10 e
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
( No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste A lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Po/n}ding ❑ PAN
❑ Yes
f No
12. Crop type dy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
NNo
b) Does the facility need a wettable acre determination?
❑ Yes
XNo
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
j No
Required Records & Documents
17'. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
KYes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
KYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
((No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
66
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ANo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
KNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
violafiQris .oe- ile#icje,nctp5 •acre noted during thisy, sit, • Y:oir 'will •reecive 00 wtl o' :
'corresaon'denc'e:aboufthis:visit:':':-:-:-:-:::..•.•..:.:.:......'::::....•.•.......'::.. .
Comments ,. refer toues `' { q tion #) Explarn any YES answers and/or any recommendations or.'any F other comments
UseArawings of facility to'better explain situations (use additional pages as necessary) + , s
I5. CarA shdwad bt t-emowd -fYD -A-eU as Saar 46 40„ol;4i,o,6 A110W. I�J�at 5 hawed .
jar �w� ;1t_ as SOZN* as f >5 A 14-
IS kaw ;nsrc� cortfril cher.�`s-- C�e�kl�s�ar� avarl�z6/� of o1;s�,
pp
)q . 4, p stt0 xF-4- 2- Ai-ovs r eAG,?- GY'&r .
Reviewer/Ins n A
P ector Name
Reviewer/Ins ector Signature-rR(_p f ..& Date: � I
P G l G D �%
(Q ib) 39s-390U 3/23/99

Facility Number: —
Date of Inspection
Odor Issue*
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
KN 0
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
KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
MNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
'Additional omments`an or D rawtn s ►'I'
tii p' S."{ Y f. H " 34
O '
x
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
2.
Division of Water Quality``
F p
IS Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number � [
Time of Inspection 24 hr. (hh:mm)
0 Registered ;a Certified 0 Applied fort Permit [] Permitted 0 Not O erational Date Last Operated:
FarmName: ..................RAYa ........��.iL.?wd...... t.?.4............ ................................ County:........ :► .�i,........,....................................................
Owner Name: ................................ .........ZttZ4G.tI............................................. Phone No: ...... C.,`31. P1k.::A4:S1..........................................
Facility Contact: .................................................................. .. Title:................. . Phone No:
MailingAddress:....... .1.....N....... -L ..... -J .w........'P..........I................. .........gx of F..Y.i�...p...N.�L.............................. Zrx.M.? ........
Onsite Representative:............a j Integrator:..........t .....
Certified Operator......................................1.......................................................................... Operator Certification Number...................
Location of Farm:
Cln ....t z S......::Ii 1 ....o....... SR. ... 1�0x...., ..1.:........twiG ....t'!s�...................................................... •
....... ........ . . .... ... .......
Latitude • 4 64 Longitude 46
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. 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 Surface Water? (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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other'than lagoons/holding ponds) require ❑ Yes No
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 IP No
7/25/97

Facility Number: 3 -- 2
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure t Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):..............1.1................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
5No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .57 r )1............... I ...............SS?`Q.Cw,............... ..... `a.f %.k..psvajr%........................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
1PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
®No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
51 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
59 No
22.
Does record keeping need improvement?A
Yes
❑ 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
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
ED No
0' No:violations•or deficiencies: Were -noted -during this:visit:- You:Will receive°n6•f6rther, .'-
: : eoirespOdeko shoat this'visit , ' • .::::: . .:
.'a`F�'�:cy?G.-.-.•:?EkR�zPf^.F��..�i�.3K'.b�:a:'�£Xs.,u....acx.£:'.�:.:...'�iTrk.e.ln.::r):=.ik�`P�P�§����..:--rEii�9d`.".�.s=L'�-.w'..'-de.Aa.�-�,'.'2f'r7•'�..at"d..-`,vc`:Y-.i'k"X'+3':;in.S'°4'°°�°2:Y`: �#.k:_r__YixSi �x��c:.FTo �;
{w�t� sr�vfid�� I
+ WO-S swmP� e.v.a`4�SeS SVteoW �� vQdoW, Q Se�ioveK i ��Z �r►r 5�ro�i� to,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: •K,, — / / I- � Date:

s},❑ Division of Soil and eater Conservation ❑ Other Agency 3
T Q ® Division of Water Quality . �30
..., - .. , ...-.,. ....: <e :.�. - x'S. , mats s 3£ . • .Za
Routine O Com Taint O Follow-u of l)1V ins cction O Foil ow-u of DSWC review 0 Other
Date of Inspection M
Facility Number
Time of .Inspection ! zS 7 24 hr. (hh:mm)
[3 Registered 19 Certified 0 Applied for Permit [N Permitted JE3 Not O eratirrnal Date Last Operated:
Farm Name: 1
.........AA,,,A?"......ft-T�1�1.A......... FArn......... ^# Z.......................... I....... County:....,.• 11` sxa.................................. ..... .......................
OwnerName: ........ Akw-.�........ ................................................................ Phone No:... �I43.. j. '..! zaii.....,........................................
Facility Contact h4................. Title: ..................................... Phone No- .1nLOA-11- 0-1.....
Mailing Address:...!.41.....�.t s�4�.....���Zri;w�....TlaUN...........RA .:.............................0'
v6viUk....�..N... �-......................................2-W- ........
Onsite Representative: ....... Kl -3)......�,ICE.ZAar.:A.................................................... Integrator: .... t4�!!Il.���s..................... ............................. I........
Certified Operator: .............................
.................. ..:..................................................... ........ Operator Certification Number .........................................
Location of Farm:
Ta.)4........ 2...... ............ ran...... cula�.l... ,r....'C, r....r..ig.. ,�xti.... i?.Q.......adr,,,....ts.....1.:.......t!�i s...... , ......... ..........
?5$.......s.. ..... t.e.................................................................................................................................................................................................................
Latitude •=1 " Longitude a 6 66
Design" Current `
<�,Design
Curiretit Des 'Current: ":
Swine.
Capacity Population
Poultry :Capacity CattleCapay Population ..
,Population
Wean to Feeder
3
❑ Layer I
❑ Dairy
❑ Feeder to Finish
JE1 Non -Layer"
❑Non -Dairy
.•
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Ot
❑ Farrow to Finish
Total Design Capacity rp L
❑ Gilts
u
[IBoars
TLtccT
�� �. I;SSL
oa
:Number'of Lagoons / Htlldmg Ponds,' ❑Subsurface Drains Present t] Lagoon Area
❑Spray Field Area ;
F ❑ No Liquid Waste Management System : n,4
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made'
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c, If discharge is observed, what is the estimated flow in gaUmin?
.d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than Iagoons/holding ponds) require
Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable :setback criteria in effect at the time of design?
❑ Yes
1$ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[Ml No
7/25/97
Continued on back

Facility Number: 3 — g�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons tloldin Ponds I:lush fits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier:
Freeboard (ft): ............ ;:4 ..............
Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
❑ Yes N1 No
❑ Yes (P No
Structure 5 Structure 6
.................................................................................................................
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... . �;g! r........................................... WLO-t.................................... ...... .................
❑ Yes
[id No
❑ Yes
9 No
El Yes
❑ No
❑ Yes
t9 No
❑ Yes
...................................................................
® No
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 reviewtinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No* violationsor deficiencies, were, noted -during this:visif - :You:will recei:ve:no•furrlier:;;
correspotadeke about this: visit., .. : .
51 Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes RJ No
❑ Yes No
Yes ❑ No
❑ Yes [9 No
❑ Yes ® No
❑ Yes ® No
12. i�,.t. a.,rcr,,S on 1{adWn �tl;.�. t,s�.11
s�a�a 1�e. �(�c.SLF�Q�. �irpSiBr.. «rcaS en
cnvu.r- wool o f'
[v-Soar.
i
S�ov}� toe F��} w;�. c(rw
PeCetdt�• tirD5iOY1 urY�.i CwYpW^f� i►��t
�i��i S�tJt(� toe
I tk. i3e. CVV'C�'t!j h0�' � OJa..Y Ar_l_�{�y
tt`� 0.Y'tfilC @YO�J� -fie.&} •
t(0. t U8 ci0t j1'�tiYSCI�IIS
` +s
tl�S�gtLACi�{j�r [O n. 1560viU
� }
�e ,JdJ �j
�o4i.
ft-�40-a�4(
: Z, µ/L�1A1 T94�R0001 IY.+10.11 1M1
t-110►7arCCO
'Oe AVaJ � ijCStt �%4r_A'+'iW �Ieo- - -iod a-'4
b xvsk-
fS_Y�toc/�
sD,t+�p[� a-+tia.���i e�^t)t)}O �a V�OGh�Cl tl� �tfpy�. CatraC� {�ii•roSta. �oA�Z.S
rA�S �%IOVI�
�e tlsec}
4rl drops. Ffttro r.cy
Wa� Shouj) .6e C,
�! 0
pi
7/25/971.1
Reviewer/Inspector Name
A tgF. a
Reviewer/Inspector Signature: .b.ku_ 1 _ A JU _,_ Date: