310848_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

/I)
Type of Visit: O Co lance 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 O Denied Access
Date of Visit: D Arrival Time: 9 o Departure Time: County: Region:• Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 11 / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: ! l
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Pointry Capacity Pop.
Wean to Finish
Cattle
1DairvCow
Design
Capacity
•urrent
Pop.
W an to Feeder
Non -La er
Dairy Calf
feeder to Finish
Design Current
D , P,ou C•_a aci P,o ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Nan-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
I
113eef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ 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
KNo�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

FaciliNumber: jDateof Inspection: p /
Waste Collection & Treatment ,--,��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ !CJ Yes 90 LJ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
t z 3 v
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
s-
4p
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes E3'go C—] NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes D No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes r No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 rNo❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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
[DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
gNo ❑ 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. o ❑ NA ❑ NE
❑ Waste Application ❑ Weekl reeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking Lall5rop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]YesNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ef No CO NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ff 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
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No P ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 ONo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
JZJNo NA ❑ NE
No NA ❑ NE
No ❑ NA ❑ NE
0
Reviewer/Inspector Signature: Date: 7
Page 3 of 3 � 1 21412015

Type of Visit: Q Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: ® Departure Time: � County:, Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Bat -NTT
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator: p a
Certification Number: O D
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity F.
Wean to Finish Layer
Cattle
DairyCow
Design
Capacity
Current
Pap.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
S��
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
Dry Poultry Ca aci_ P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
on -Layers
Boars
Pullets
Beef Brood Cow
Qthe.r
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
K 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Ins ectiow
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&mw LAomi CZ/ a ( � )
Spillway?:
Designed Freeboard (in): }}
Observed Freeboard (in): 1��Q,� 3! t 1 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZrNo ❑ 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 envi nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Noo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 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?
❑ YesVNo
2�N❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Zl�a ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
0 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 a]I components of the CAWMP readily available? If yes, check
[] Yes
VNo ❑ 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 EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ' ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Zo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of Ins ection: s
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes M/Nco ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ 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 E6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E!rNo ❑ 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)
3 L 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 [2 No ❑ NA ❑ NE
❑ Yes rj/No ❑ NA FINE
❑ Yes L_J NNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Zo
❑ Yes
❑ Yes g XNo,
❑ 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 pages as necessary).
c7) Lae"rvpJ.S p-T (3AC V— riJ-o SETS 0f l 60,SEs 0660 n OC44 M61_1�
puck Law Kfo(z--}Co
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon 16 - 1398
Date: s "'
21412015

Type of Visit: d Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 9 j Arrival Time: ® Departure Time: ® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: :360 mL-i (<6 YAZOUE7,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Qom]
Certification Number: V
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
C+ap.acity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish 199
Design Current
D , P,oult . Ca a_cit P,o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes dNo ❑ NA ❑ NE
❑ 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 ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ 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: -&LIgDate of Inspection: q IS
C
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: CA % ( LA &p�� 1 Z ��
Spillway?:
❑ Yes E!fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
CA
J4 Structure 5 Structure 6
CA N i..6t(�Ut�.i S_
Designed Freeboard (in):
Observed Freeboard (in): 2_ l 11�9 39
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IdNo ❑ 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 environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �lo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[7�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ 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
YNNoo
❑ 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.
0/Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F�/No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes A ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes YNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[J'No ❑ NA ❑ NE
fN[2'p
o ❑NA ❑NE
o ❑ NA ❑ NE
lComments..( to question #} ,Explain anyl'ES answers -and/or -:any additional recommendations or any other comments.:
useAr W1n s::.of facilit . eater egplain situations'(use additional pales as necessary).
21.) c otj"c7 F,4U 241 � SC-ro AfPUC -akf,
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
N A LC. Photo
re: Date:
2/ /2015

(Type of Visit: (Dr70utine
Hance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance 1
Reason for Visit: O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access 1{
Date of Visit: Arrival Time: Departure Time: County: I Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 5
A=464 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
i
Swine
Wean to Finish
Design Current Design C►urrent
Capacity Pop. Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
Dai Cow
C*urrent
Pop.
Wean to Feeder
I lNon-Layer I
Dairy Calf
X
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
0 b
Design Current
D . Pooutt , C*_a aci Pao ,
Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
L=
Boars
Pullets
Beef Brood Cow
Turke s
Other. Turke Poults
Other I Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CZ(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
[;[No
❑ NA
0 NE
Page 1 of 3 21412011 Continued

Faciti Number: j - Date of inspection: 5
,.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA) &,aj L Wvo� 1, 93
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LH 3 S _ 313 2 b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �rNo ❑ 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 dNo ❑ 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 environmenta 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 F31N. ❑ 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement!
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes To ❑ 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
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
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 LJ No
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps [—]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes �No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes �Zo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -Xyx I _ateof 12cx t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes <o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []' o ❑ 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)
[—]Yes [lo ❑ NA ONE
711
[:]Yes 4o ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E- o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
To
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
t1d q
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F2/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
"G.vaJ D-[�'Ctiv c� - c)-,rJc= .
1�;) 6KA0 wZ:VR gc-C"OPA . RCAE( AfJoft-CSS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 110 9 (6 — S
Date: $-$
14/2 I

71
Type of Visit: 0 C pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ' Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 8 Arrival Time: Q 50 71 Departure Time: County: s�C Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &-2'!&� ftA'-'-[ W 6 (A' _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
r
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer I
Cattle
a Cow
Design Current
Capacity Pop.
Wean to Feeder Non -La er
ffDairy
Calf
Feeder to Finish — i Qto
Farrow to Wean Design Current
Farrow to Feeder D . P,oult . Ca aci P,o ,
Farrow to Finish Layers
ai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
ke s
ke Poults
Other tOutffihcr
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /Xo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ 140 ❑ NA ❑ NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 94L jDate of inspection: 30
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure
__2II n Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J�(njUd L Ca,1 3 rA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SLI 7j� -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes eNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 � ❑ 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 0 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes WNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes W;qlo
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �Noo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspecti;�N
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacilityNumber: - Date of Inection: Q
24. Did tfie facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes lxe ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes V/Xo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes /Wo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No, ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
MUST NAVE
some OXI k lvft{" Do1JE o,j
CA6aA,,5
q 4P
Eto SZA/
.zs 'Z'VT'o6K ' : l e_UYOW T I "Mc
por f .
4aTV
PLf,-45E 14Av( DdklC-
ka�b W6 AX, kiA 5
Reviewer/Inspector Name:
e SLIMK 25 649.
8�(41 D*16 ,
�=13
Reviewer/Inspector Signature: Date:
Page 3 of 3
I

Type of Visit: 0 Co Hance Inspection O Operation Review p Structure Evaluation p 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: Q ( Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: taJE T AA=LT Cal F_L l--- Integrator:
Phone:
Certified Operator: Certification Number: (2 In%
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Finish
rpXFe?eder
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Da' Cow
Design Current
Capaciy Pop
Feeder
Non -La er
Da' Calf
o Finish 4
'zA6(�
Design Current
Dr. P,oul Ca aci $a
Layers
Da Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
I
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other JEJ
Turke s
Turkey Poults
r-.=m
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ N
❑ Yes [/�
❑ Yes ��No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

IFacilfty Number: 3 - Date of Inspection: 'L
Waste Collection & Treatment
4. Is itorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (9"J� L- G-Ot..f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3g 3 Z, 3 S ,q
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 [3"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
[D o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
12/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 [214o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 to ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes [2]'�o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 4d "" ❑ NA ❑ NE
❑ Yes [:o ❑ NA ❑ NE
❑ Yes [E]"No ❑ NA ❑ NE
[:]Other-.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 'No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fac' Number: j -yq XDate of Inspection: 7 7_—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
f i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tife drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
/No ❑ NA ❑ NE
ZNA ❑ NE
N ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other -comments.
Use, drawines of facility to better explain situations (rise additional patesas necessary},
IDS IJC.C_..b w6 0-4C_ or-' G 2.A SS el�EQ , L0466o,05
P&(_ D fZIL VEftrl' S ou1J,
nr►�, �,�+.ns Ij F� Ga45A sr�,:,.oC, Wa ��J Bf,(" 1 fe N(:r OVC>k'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: iD �—
Date:
21412011

i Division of Water Quality _
8�6
�Faciftv.Ntimber 6 O Dwislon of Soil and Water Conservation r"
I.. er Age
Oro
th ncy; -..
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: zt-z'llk I Arrival Time: 11 U Departure Time: 1 S 'I County: ./ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: SAT}",tW= A VA ZQ L1 C ; Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= 4 Longitude: 00
= f
s -
Design Current:_ -Design Current
Swine Capacity' Population Wet Poultry Capacity Population' Ca't#le
❑ Wean to Finish ❑ Layer - E] Dairy Cow
❑ Wean to Feeder Non -Layer ❑ Dairy Calf
Feeder to Finish 5 "��s ❑Dai Heifer
❑ Farrow to Wean ❑ Dry Cow
Dry Poultry ,
❑ Farrow to Feeder,' - ❑ N D
❑ Farrow to Finish
❑ Gilts
4.❑ Boars
Other
❑ 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?
on- atry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
-,Number,{of^Stru
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
No
❑WNo
El Yes
[3 NA
El NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3—
Date of Inspection 5 Z
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure Structure 5 Structure 6
Identifier: 1 S, C�0 1, LA t 5EN 3 U��tJ `7 (—A &,q3 ty
Spillway?:
Designed Freeboard (in): c�
Observed Freeboard (in): 4(o Lf 71 Z'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [] N ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ntal threat, notify DWQ
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �Vo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes �WNg
o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement? Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
,❑,/No
IQ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
;/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
Ll No ❑ NA ❑ NE
maintenance/improvement?
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes
`IJ No ❑ NA ❑ NE
❑ Excessive Ponding [:1 Hydraulic Overload El Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑FAN > 10% or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes
No ❑ NA ❑ NE
Comments refer to uestion # Ex lain any. YES answ " _ �( q ) - p y ers aiidlor any recommendations orsany other comments -�
Use drawings of facility to better explain situations (use additional pages as necessary):
�,� �,,4c ►.I u U W AW MC-,)s &" S E w () R.
ReviewerAnspector Name 4
Reviewerllnspector Signature:
rage z of 3
ruvuC f U b
Date: L t
12128104 Continued

I
Facility Number: —
Date of inspection
Ile uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
'VNo
[3 NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2J 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 Inspectio
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
bA "
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesrN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[INA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
VN
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Za
El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ 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 lj�j No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ElNA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Addftional Comments and/or Drawings:
Page 3 of 3 12128104

Dtviston of Water Quality
Facility-Number S� QDtvtsion of Soil andtWater Conservation-�,��`"'��
•eOtherAgency � � � "
t
Type of Visit 6 C6pliance 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 El Denied Access
Date of Visit: Arrival Time: /63O Departure Time- County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: 56 # T. LA to V4 ZG2UE -z' Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= c = S 0 cd Longitude: [� ° = & = if
Design Current .x �Des,gn Current :'" Design+ Current .
Swore e_s. --=CapacityPopulation
_ .'Wet PoultryCapactty, Po.pulatton Cat#le- Cap city,Population
,3
❑ Wean to Finish
[] La er ❑ Dai Cow
j
El Wean to Feeder
❑ Non -Layer ❑ Da Calf
Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry�l'oultry_ , «,� ❑ Dry Cow
❑ Farrow to Feeder`
[INon-Dairy
❑ Farrow to Finish
❑ La
❑ Beef Stocker
ers
Turke Points
El Pullets
❑ Turkeys
❑
❑ Other
Discharees & 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?
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 2fNo ❑ NA ❑ NE
❑ Yes
Discharees & 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?
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 2fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
f oNANE
ElYes
WNo
❑ NA
❑ NE
Page 1 of 3 I2/28/04 Continued

Facility Number: 3 j — Date of Inspection 3o O
Waste Collection & Treatment
r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.&6.az5,0-.) i L.YrCpc,,-t t_- LAGIon-i-33 UA Cam-14 QlI� 51
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): n ;Z3
5. Are there any immediate reatslto the integrity of any of the structures observed? ❑Yes
do ElNA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ENo ❑ 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? [ZYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
FzrNo ❑ 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
EI/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElEj Yes
��//
N o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,�,/
Ld No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from'those designated in the CAWMP?
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
EfNo
❑ NA
❑ NE
✓[ (No
❑ NA
❑ NE
dNo
❑ NA
❑ NE
El"No
❑ NA
❑ NE
Q<o
❑ NA
❑ NE
Comments (refer to'question #): Explain any YES answers and/or any recommendatrons or any othercammentsx�*
Ilse drawings of facility=to better explain si#nations. (use additIoinaLpages as necessa ry):
LIMED WlgLA_ 63UT. S-lrl-U. 0K—.D -tb Db W ofLIC, OFJ G fFr-r=NG— GSASS GaUEK,
AO D OoC1J 1� FNT.
Reviewer/Inspector Name G +J... , Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 Continued

Facility Number: - g Date of InspectionTef Ly I
,; Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes [_= No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EtNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IE�,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E;fNo
❑ 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
EYNo
❑ 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
VNo
❑ 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
UTo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ld No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2128104

Division of Water Quality
===�iljfyNmber • `� $�{ g 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit
VC07liance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
G Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: t. 6 Arrival Time: /Q O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: LAtJTS.AI,n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 , =6 Longitude: = ° 0 . = .i
Design Current
Capacity Population
Wet Poultry
Design Current
Capacity Population
Cattle
Design
Capacity
Current
i'opulatn
Finish
rWea-an2n
❑ La er
❑ Dai Cow
Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
JO
j a6
Dry Poultry
La ers
Non-La ers❑
❑ Pullets
❑❑Beef
Turkeys
❑ Turkey Poults
❑ Other
❑ DairyHeifer
❑ D Cow
Non -Dairy
❑ Beef Stocker
Beef Feeder
Broad Co
dumber ofn Structures:
❑ Farrow to Wean
❑ FaEowtoFeeder
❑ FaFinish
Gil
Bo
Other
❑ Other
�__ - E
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes d No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ N E
❑ Yes
No
ElYes
,❑
[:1 NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — $y Date of Inspection 6 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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: LA61&) ! Z 3 5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 40
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl Yes
14 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 Cl Yes
;�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,_,/
ld No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L/I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
v,--°ts` (h 'X .^ ' .,,.-' �.i --- ' P�mAC'e*,- "c*5' 'r - f
;Comments (refer to question,.#) �Explatn any YESanswersand/ior any recommendations or any,ofther'comme�ntt Y
'Use d'rawmgs of fact[ity to better'explain<sttuations: (use sddttioo`al pages as Lne_cessary,);
_ ,_..
`^EB.�YXe^. mrv'�i.� �"xvaGS �iY ,✓. r�Yx..:e:1--�3.-. ,3 .. ...a. 'if ��,C_.F"�`.-:s.F ��'. '+M'Y:'�� _ _
7.) LA&O,*l 0 O-US WAL1. f3ARE. Sport,
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: a
Page 2 of 3 112/28/04 Continued

Facility Number: Date of InspectionQ 109
Reduired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
ElYes VfNo ❑ NA ElNE
❑ Yes ZNo ElNA ElNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ld No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[21/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LI No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2(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
EI 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
E(No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
R�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Tq
Type of Visit 'Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
(p S p
Arrival Time:
Departure Time: County: AXLZN Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = [= Longitude: = c =
Design Current
Design Current Design
Current
Swine Capacity Population
Wet P-ouItty Capacity Population Cattle Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
11706
Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
110—Ot
❑ Turkey Poults
10 Other
Number of Structures:
er
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Yes
No El NA
[3 NE
El NA
❑ NE
❑ Yes
El Yes
NA
❑ NE
ElYes
�VZNQ❑
❑ NA
❑ NE
12128104 Continued

Facility Number: ] — yg Date of Inspection L 3 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CZ/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: LAN C_ t, 11 L4 S_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rg CJ Z 3 O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
dNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
d No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
r! No
❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LIJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WXo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LEI 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
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�N'o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�
❑ NA
❑ NE
�'14 "'�TZi { - F 8 � 3�.Y S �w�.: `Y�. isi: �� u r '".u: -•. .. .,.�."
.Comments�(referfito�queshon=#) Explain anyhYES,�answers and/or any recommendations,;or.any other�comments.
-
,[3seadrarvtngs�of�facility�ta bitter�explam�situahons(usekadd�honal;pages�as�necessary,).
r� �-.gym �v.�� �•. n� ��, .�:.�: , ,� - ,�,� ..,,�-
Reviewer/inspector Name �,t] �l:V Phone: [..
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 . Continued

Facility Number: 3 1 — qg Date of Inspection b S
Acquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. ❑ WUP ❑Checklists ❑ D❑esi n g Maps ❑ Other
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes �/No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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?
El Yes
_,/❑
L� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑'I o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ErYes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DrNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
G-Ro
❑ 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
E�Xo
❑ 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
�i o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawiings:'.
Page 3 of 3 12128104

Facility Number $
40 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (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: l Sl Arrival Time: UV Departure Time: County: J7uPLzt-) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: L? e_pg.0 E 9E RU3
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title: Phone No:
Integrator• I
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0' = Longitude: =°=, 0+1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
S -j_.o
U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ they
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 I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes LI No ❑ NA ❑ NE
12128104 Continued

Tacility Number: 3—$ g Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ 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: Lya &voAf cA &,-61J L CA 6 0 01j3 cA crvoN q LA (fig Jug
Spillway?:
Designed Freeboard (in): 11 S / S - S
Observed Freeboard (in): r 2 SL SO S O
5. Are there any immediate threats to the integrity of any of the structures observed? [I Yes E]'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 /U No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dN,
[I NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes CNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes '<4'❑NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �TlofNo
[I NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ 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):
2C WXV f>Qk_ r 000-C- 3 E (70 I- r EN C) ,
T
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection S 3p o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L.,d'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the approprrate box. ❑ W`Up ❑ Checklists ❑ Design El 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 l" Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IQ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
EfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,d,/No
E] No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
To
❑ 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
ONNo
❑ 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?
ElE Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

facility Number 3 R
Type of Visit
Reason for Visit
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
O'bivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
lance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
tine Q Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Arrival Time: ® Departure Time: County: A4pt.4LN Region:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title:
Onsite Representative: 4 d1,&6 _ Pmys Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: o [—] ' [ Longitude: =] o
Design Current Design Current,. Design Current<
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population';.
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
Zo
i T
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:.,,Other v;
Ji
❑ Layer
❑ 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
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Numher of Strut
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
gyres n ��
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
❑NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�VN
El NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 ( — Date of Inspection
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A_ Z y 5
Spillway?:
Designed Freeboard (in): .3(, �y+ �� L/. S 1 `J • s !
Observed Freeboard (in): 1p0 tl W LL tJ 4 q V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;jNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes R(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �f
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes �J No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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) jk3 S�p
13.
Soil type(s) A dp�Lf v:L L QAy_
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NEE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ff"No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
G3No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
E I No
❑ 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}:
i
T
Reviewer/Inspector Name Phone: 7 ` g
Reviewer/Inspector Signature: Date: Z7 0
Page 2 of 3 112128104 Continued

Facility Number: Ij — Date of Inspection
.Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U(No ❑ NA ❑ NE
the appropriate box.
❑ WLTP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
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
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WN o
❑ 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
UrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I'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
�/
IQ 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
El Yes
�
[E 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
Ko
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LdNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ), Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
�Arrival Time: Departure Time: jl County:
Owner Email:
hone:
Facility Contact: Title:
Onsite Representative:`"
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: (41�lo
Latitude: = p = I = Longitude: = ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1 0 Non -Layer
Other
❑ Other _._....
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No ❑ NA El 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? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StrpCtune I Structyr� Strugt� e 3 Structure 4 Structure 5 Structure 6
Identifier: �� : ��
Spillway?: O Na /gyp NO
Designed Freeboard (in): '/ 2
Observed Freeboard (in): Y` 7
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 )ZNo El NA [I 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 XN- ❑ 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 PfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes to 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 El Evidence of Wind Drift nApplication utside of Area
12. Cropn'Pe(s) �rn 1_5me�ez�.-�
13. Soil type(s) A'*f/1 y(i_-'LLe 1,4a 1 1�JiQ/t��1GllIG` /Q 2X
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes � No
❑ NA
El 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 X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Jse drawtngs�ofafac�Itty tosbetter�expJaen+sttuabonsK(use addihonaltpages as'necessary):
. �"� �i
1/)Z A,2- 405 � y /-� riP, uha` F auc7 �
Reviewer/Inspector Name 1%g '*<1Z t�1�� t „ y, Phone:
Reviewer/Inspector Signature: ' Date: Q
ryis 12128104 Continued

. Facility Number: 3 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP
❑ Checklists El Design El maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PIN ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA tlNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IV,,
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El 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 VNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes /No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes VNo ❑ NA ❑ NE
Additional Comments and/or Drawings:.
111WO 7��__s r 11�,;�Onotr C�-Wvu) &C9
s fug- �2 � Pf� � � � �`PE's�!►' � ,%�r� .5��
,:
oz'jG
12128104

Type of Visit J5 Compliance inspection Q Operation Review O Lagoon Evaluation
for Visit A'Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 13 Certified C1 Conditionally
Cerfified 13 Registered
Farm Name:
Owner Name:
Mailing Address:
ional O Below Threshold
Date Last Opera e r Above Threshold: .
County:.. ,4LL� G
Phone No:
Facility Contact: Title: - _ Phone No:
Unite Representative: ------ �4?G _ -���� -__... Integrator.
Certified Operator: _ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • 6 0" Longitude • 4
Desii'i C 1
Swine - - Caiiac�ty=Poiiinlatii
�tion , Catde
Wean to Feeder
Layer
Feeder to Finish
ZMO
Non -Layer
Farrow to wean
-
Other
Farrow to Feeder
Fi
Farrow to Finish
�� ' Total Desi�
w
G11L1
Boars
. `II:.1.a
Discharnes & Stream Impact$
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
& If discharge is observed, was the conveyance man-made?
Dairy
,inNo ...�.
Non -Daft
a7
otat SSLW
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?
❑ Yes)dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;Wo
Structure 1 Structure 2 Structure 3 �Iru�- ��� Stricture 6
Identifier: .....- .,t% _ _ ..�� •ri __
Freeboard (inches):
12112103 Continued

' Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes gfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement?
❑ Yes PNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
X Yes ❑ No
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes VNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes �No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Co d/or Zinc
12. Crop type f►1 O�%�
13. Do the receiving crops differ with those design in the Certified Animal Waste Management Plan (CA )?
❑ Yes /`j No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes )—,No
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
)eYes [I No
16. Is there a lack of adequate waste application equipment?
❑ Yes ] INO
<
Odor Issues
17: Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ yes FINo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ONo
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes XNo
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 j1No
Air Quality representative immediately.
j
'Comments {ra%r tagneson) Exphtm and/or sayer aapSoteropmts,w�
- �=s
ruse drwmgs of facyatabetter sativns. {use:sddziioaal pages ns:_neoessary? ❑Feld Copy ❑ Final NotesAil
�,�li? D✓�D.
"t-c'
Hw
Reviewer/Inspector Name - m ,we
MU rz R.
Reviewer/inspector Signature: Date:
12112103 1 / Continued

lFacitity Number: Date of Inspection
Required Records & Documents
2 L Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes eill No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [�No
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes lj�No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis [I Soil Sampling /
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes W(No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes PINo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative? ❑ Yes bNo
2$_ Does facility require a follow-up visit by same agency? ❑ Yes P"No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P(No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? /❑ Yes ;2rNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 'WNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes yNo
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Stocking Form ❑ Crop Yield Form ❑ RainfalZrm'
ispection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
kmd_ -_..
oral Caname��attid/� Drawiug� ,�.
fr'>
12112fO3

i
Type of Visit 9rCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit gf Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date or visit: I3 � 2 Time: /3 25
Facility Number
Not Operational Q Below Threshold
Permitted ❑ Certified 0 Conditionally Certified D Registteer'e/d Date Lrjstt 0 pirateWA.,o,.,e ThresholdFarm Name: F� � K `+" Counh~ L xnl
Owner Name: _ �-a� 'r /ymi Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: o/�wy_� 16 4T rS
Certified Operator:
Location of Farm:
Phone No:
Integrator: �i�'OEi�f _
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' 0' 0 " Longitude ' 0 0
Swine
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feede
Gilts
sign -,Current.. -` Design Citrreot W _Desigd;
scitr . Population` -Poult:Canacity-Taliulatinn . Cattle ry. Cauacity
tmILJ Dairy I
❑ Non -Dairy
Total besign Capacitti'_ ML
Total SSLW
-.,-.Numberof Lagoons ©1 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area
Holdin .Pokds Soud-Traps s 1
h p ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 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 ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes )zNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection S. Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
5 e 1 S cture ? Struclure 3 Jag -<1101
VH xe 4 5�� Structure b
Identifier: ��11'll N�F
Freeboard (inches):
0510310.1 Continued

w
Facility Number: — a& Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application , ❑ Excessive Ponding ❑ PAN [;] Hydraulic Overload
12. Crop type 0A=d DA- OW 1 114AL>l' (T9!.EeG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
WMP)?
16. is there a lack of adequate waste application equipment?
Regi ired Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes X No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes A No
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes �] No
❑ Yes XNO
/Yes El No
❑ Yes /� No
❑ Yes No
❑ Yes No
❑ Yes VNo
❑ Yes VNo
❑ Yes PrNo
❑ Yes ONO
10 No violations or deficiencies were noted during this visit. You will. receive no further correspondence about this visit.
Comments.(refer to question, 0 Ezplain;;any YES'ansK ers andlor an reconitnsntlstions� or any'otlier comments:.
Use ,drawings of_ zcc ity to bitter,'explaiat.situa&t ii (©se additional "pages as necessary) �
Field Conv Final Notes
.. _ ....
�FEp : A�,[�' �'� E F_ r ,E/1 �n �n/fF T�o,�1 S/�� R �/z.•�� -��
/,J r/it�0� Dn! �RP-F /�QE�s iJ ief}V,-- FL OS,
Reviewer/Inspector Name ry
Reviewer/Inspector Signature: Date:
0510310I A Continued

Facility Number: — Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additinnnl C'nmmentt anrllnr Drawin¢t ""
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes PrNo
❑ Yes 9No
❑ Yes ❑ No
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Facility Number i Date of Visit: ® Time:
Q Not Operational Q Below Threshold
1p�'ermitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: `� Coun • ................... l ....
OwnerName: ..................... . ............................ ........................................................................ Phone No:
FacilityContact: ............................................................................... Title:................................................................ Phone No: ................... ...............................
MailingAddress: ..................................................... ..........
Onsite Representative: ' D`.............................................................. Integrator:..... .......... 4� "�...... _.�� ... ..
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine []Poultry ❑ Cattle []Horse Latitude 0 4 it Longitude • 4 «
- Design Current _. :: Design Curt
Design , -Current Desi
Ca ci Po elation try _
Swine - - Pon!Ca ci Po elation Cattle Ca Po tlon
❑ Wean to Feeder ❑Layer ❑ Dairy
eeder to Finish ❑ Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish TotalDesign Capacity
Gilts
❑Boars .Total kw
Number'df 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Arcs
Holding Ponds- Solid Traps ❑ No Liquid Waste Management System 3.
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Po
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
0No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
[�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
CNo
Structure I Stru ere 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier: ...............��................... t .. ........ '.................... {-�
...............................................................................................
Freeboard (inches): 60 ti
5100
Continued on back

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes 10o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �lo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
?. Do any of the structures need maintenance/improvement? ❑ Yes krNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes tRWo
Waste Ayplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes &No
11. Is there evident of overapplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crop type `ijJ11-�
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
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
14 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
eNo
Reuuired 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?
XYes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
D(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes &No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes 12TNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes t9 No
4 Yi iQ4s.e dgfeieneiwirep0# dWmg js.vst; •Y0w•tebgiye &
...i.u.;t.b.�r...corresaoBdeike: abotuti thisevsist.................... .....
.
Comments_(re%r to gnestiorf #)_ Explain awry°YES arrswers and/or any recommendations os any.ather rnn to a
.. w -. _
Use drawings of facility to better explain situations. (use_additional pages as a ecessary
h y l •-PL" r
Reviewei/Ltspector Name
Reviewer/Inspector Signature:
Date:
E7
_CJ ( 5/00

Facility Number: {] — Date of Inspection C! dC
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 [ o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ofgo
Additional-Kamments andVor Drawings[[•
k CJG k'6 aoz:i'-� '-,
� � IM
14
ICL
5100

gDivision of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Ix
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )& Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: —P3-PC' Time: = 30 Printed on: 7/21/2000
NNot Operational_ 0 Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified E3 Registered Date Last Operated r �lbnve Threshold : .........................
Farm Name: ,�.�'.1°...� , W County:.......,
......
Owner Name: ,..... r 6'................................. ... �'`..� �.................... Phone No:.......................................................................................
�....
Facility Contact: ........... �^'t............... Q}trTitle: 4. "..................... �V. Phone No:...................................................
MailingAddress: ..................................................................................... 1-i ............................. ..................................................................................... .................
Onsite Representative:.......D�^!'1..► x...........�L.......................
Certified Operator: ............Y+i'k!.{...............�fri'n-.............
Location of Farm:
Integrator: ...........................
Operator Certification Number: ..............
Ok,Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude 0 ' 1 Longitude 0 4 6C
Design Current Design Current Design Current
Swine Capacity Population poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish !T ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area ❑Spray Field Area
Holding Ponds / Solid Traps j ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes CKNo
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 ycs, 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
struct ll 5truc� %., Strt c 1 Str*yrij-
Identifier:............ ...0....... ................ �.rr.L..tt....
q .................�.}..ta............ ���Ttl�..
Freeboard (inches): H"1
5/00
❑ Yes ❑ No
—N-4 `
❑ Yes ❑ No
❑ Yes IgNo
❑ Yes 0�wo
❑ Yes ,RNo
Strill, l Structure 6
.......... ...LU.... .....................................
Continued on back

7
:a
a;
g
1

Facility Number: Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed (ie/ trees, severe erosion, ❑ Yes &No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes b(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
hkA 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
14 No
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
KNo
12. Crop type
13. Do the receiving crops differ 4ith those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
-KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'KNo
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
JNo
15. Does the receiving crop need improvement'?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
0N0
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
9,No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Klo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ffNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
ff No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1!3 No
24-
Does facility require a follow-up visit by same agency'?
❑ Yes
R No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
3INo
0: Rio violations or defeie .....were . ...during this visit: Yob Will ieceiye tnti #'u�ther. :
.. .. ...................
correspondence: ab' ' f 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):
--�-��5 wzl��-. �3 CowW�r
3-� 0,4S (S,,,O "
100
V
�, ����.-, .p r-
Reviewer/Inspector Name L— -e
Reviewer/Inspector Signature: Date f '7d 31,.Zgd S/oo

Facility Number: :5 — Date of Inspection 6 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 $LNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes W40
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes TO
roads, building structure, and/or public property) \
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Q Yes r4No
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 RN
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R10
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional omments and/orDrawings:
A,
IAA do s^ (rvtt
Gt;\11 L I r C-1 er-s� I[_.fAf
J
5100

t
L
f
.,

Routine
0 Division of Soil and Water. Coasei atiori = Operation•Review .. - =
- oil an War Conseil atron Cpomphance lnspectton
Division of on of S Inspection,
Ci.Other AgenWatOperaher Quton Review ance M1
Follow--uo of DWO i
Fallow -up of DSWC review 0 Other
Facility Number Date of Inspection Zvi cif
- Time of 1A h r. {h Inspection h:mm)
© Permitted [3 Certified © Conditionally Certified © Registered 113 Not O erational Date Last Operated: ..........................
... . . .
Farm Name �^+ r�,� 1!7..1.5. !_....... .... County: _... � . ' n.....................................................
17
Owner Name:....._ .V.l n�.. t.?.q.G.......i !,!. '.:. W�j%....... Phone No:
......................................................... ...........................
J... t
Facility Contact: .............................................................................. Title:.............
:Flailing Address: .........................................................................................................
Onsite Representative: ...... CrA + &U).an.
CertifiedOperator:................................................................................... .....
Location of Farm:
Phone No:..
Integrator: ................
Operator Certification Number:...........
Latitude ' 6 Longitude • ° 4.
Design Current , Design. Current ": Design Current:
Swine Ca aci Po utation Poult
ty p �3' Capacity ..Population `Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
-Nm uber of Lagoons - ❑Subsurface Drains Present ID Lagoon Area JE1 Spray Field Area .t
Holding -Ponds olid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischargc originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. Ir 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. Docs 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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I l
Freeboard (inches): ........... ',�. ................. ................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [] Yes ❑ No
seepage, etc.)
3/23199 Continued on back

3

Facility Number:3I Date (if Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ 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
❑ No
1 L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
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
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required 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
❑ 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
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
yiolati6ris :or lief defies •were noted• daring this:visiC • :Y:oit will •reeeiW iio further -
:: correspondence abouf~ this visit. : ::::::::::::::::::::::::::::::::: :
C_n in ents=(refer to question #): E�iplain any YES.answers.and/or any recommendations or any other comments
w
_ _..
L1se:drawings of facilely"to better explain situations. (use. additional pages as -necessary)
- -
-
Reviewer/Inspector Name F _ d r1'e3+t�'i'l ., Q tE. �� fQ "/ S
Reviewer/Inspector Signature. .��a Date: ? 131
3/23/99

N .�
J
t
i
t

I , ,
Lagoon Dike Inspection Report 31 _ 848
Name of Farm/FaciIity
Location of Farm/Facility SR 62 2
Owner's Name, Address Cf�fS Q,1rK�L _ f/Q •x F3 `3S ? K
and,Telephone Number
Date of Inspection Z8 Names of Inspectors
Structural Height, Feet _ /d _ Freeboard, Feet
Lagoon Surface Area, Acres _ 3 _ Top Width, Feet
Upstream SIope,xH:l V 2 = Downstream Slope, xH: IV
Embankment Sliding? Yes �YNo
(Check One, Describe if Yes)
Seepage? Yes Jt No
(Check One, Describe if Yes) -
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
ras rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Yes �_ No
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes X No
a

Lagoon Dike Inspection Report _
Name of Farm/Facility
Location of Farm/Facility S',r2 r2 2 2
Owner's Name, Address �f4�s_�st.T st fla •2 F3 `35 _ _
and Telephone Number
10>4 �Sa•s� ,� s z��
Date of Inspection Z$= f ` ` Names of Inspectors
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
r
Freeboard, Feet
3 _ Top Width, Feet
_2: / _ Downstream Slope, xH:1 V 3 = I
Embankment Sliding? Yes Y No
(Check One, Describe if Yes)
Seepage? Yes /Y No
(Check One, Describe if Yes) - -
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
ras Tees)
Yes 1*4— No
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes T'- No
Is Dam Jurisdictional to the Darn Safety Law of 1967? Yes No
Other Comments

D Division of Soil and,Water Conservation Operation Review
[3 Division of Soil'and, Conservation ;:Co[nplianee )Cnspectron ;e
O Division of taster CQuahty e,Compliiance Inspection s
.Other Agency. Operation Review_ " y
JQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number g Date of Inspection �1G
Time of Inspection 24 hr. (hh:mm)
APermitted © Certified © Conditionally Certified © Registered 113 Not O erational Date Last Operated:
Farm Name: `� l ... .� ..... �.�.....wr,`iF�l"t?.'.i-............... County: ....... �.r�,1filn..................... LD.
Owner Name:.....lrA.....................................�lAr1.l kLa......................................-...... Phone No:.......��Q,..-r..--d.T�tanC #.........
%�
Facility Contact: ............l:�tii q......._,. K ,&V..................... Title:.4t.-............................ Phone No: �ll�). ��.� '. ../.tf hW1- #
:'failing Address:....................~..1...........................................................................................
Onsite Representative: GId ....... ...t l'i.......... r•.1�P1El7.t. �...... .... Integrator:....... I..r�l.........
Certified Operator:....aAYq-_ .......�...... ....... 4111JI....... ,................ Operator Certification Number:....�7Y.71.................
Location of Farm:
..........................
Latitude • �` C,1" Longitude • �` �"
L
_ Design Current s.' 'Design Ctiirent Design Current , :: :
Swine Capacity Population : . Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
/5
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
:
4
_
Holding Ponds S61i& Traps �` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. 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. Duet 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 A Structure 5
Identifier: I ��JA�G�M�r#Z 4►tt%�rrg5hr±� /vCH7ff�pL'w � ►1���#L
/�
Freeboard(inches): ............. ............. J....................... .............J .............. ........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
❑ Yes ® No
❑ Yes fj No
A14
❑ Yes No
❑ Yes No
❑ Yes qNo
❑ Yes P No
Structure 6
❑ Yes P9 No
Continued on back
3/23/99

Facility Number:31 Elate of Inspection
- 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes IZ 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 011 No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? []Yes {1f No
FVaste. Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
lip No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[91 No
12.
Crop type
T
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
jo No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
,� No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired Records & Documents
17_
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
jmtQ 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
�`] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JZNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
J� No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
10 yiolafibi is:or• defciehcies Were noted during this'Asit. • Y.
oix wiil•ceeeiive do further
' cce: aNOU this visit. .
•Comments (refer toquestion #} Explain any YES axiswers and/or any recominendatrons or.any•tither comments..
Us.e drawings of facility to bettervexplain situations (use addttional`pages'as necessary)
Y
XAm�?�Glitin,l s��nc�o by ,�_ Specirl
J'Wee— pfkrn fbw4wtt -AKd w;//6c sendt -" I,-
%t►u s .w� 'A' th,s wtcE
C irn r 1
FReAewer/Ins ector Name
Reviewer/Inspector Signatur
Date: A
3/23/99

Fa6lity Number: —. Date of Inspection
• Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation? -
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes T 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 kNo
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 , No
3/23/99

It

13 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
O Routine Cont laint O Follow-u "of D1V ins ection O Follow-up of DSWC review O Other
3 Facility Number Date of Inspection
•31 `��� •
Time of Inspection + D — 24 hr. (hh:mm)
© Registered 9 Certified [3 Applied for Permit Permitted 113 Not Opera Date Last O erated:
P ...........
` ` County • life ................. Farnt Name:..............C,rGI1:,:........-�i....�Z...... ......... ........... .........i?..11� ....................... .............
Owner Name:._: ............... ............. .�!'.! ..s Phone No: �q��?,.? .�' ,_ ........................................
Facility Contact: ...............C:!!�...:......Qu1YYx................... Title:.................:............................................... Phone No:..�k.1.4?}.1�.�s..j�7=!:..........
MailingAddress:...... a�x .......... ....... tr ........lad.r............................. w�f�ft1.,....���.�........................................ g�..........
Onsite Representative: .......... cv l:. � is S.X...................................
. �.....�tl.�klx.:�...................................................... Integrator:.......... tt.S:. ........ .. ..........
Certified Operator t........................................................ .. Operator Certification Number:................
Location of Farm:
Qi�....h>, ... ...:.SI .e....+r+.f....S.1L...r3s�..t. Q.n.�.. il��.....�4..... Afc. ,�.:.................................................................I...........:....
............................... ............................. ----- ---
Latitude •,4 « Longitude ° �_�46
Number of Lagoons / Holding Ponds J❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
« r .. ..' 4 Liquid Management System
❑ No id Waste Mao ent em
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? Of yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ONo
❑ Yes " f'' No
❑ Yes No
❑ Yes [ No
❑ Yes tp No
❑ Yes fp No
❑ Yes "No
❑ Yes 19 No
❑ Yes 1P No
❑ Yes (0 No
Continued on back

Facility Number: -
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes No
Structures f Lagoons,liolding Ponds, Flush Pits, eti.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Stn►cttrre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:-.......�.iT..�............... ................. S�z................ ................... j .z..... .........C: ............
Freeboard(ft): ............Z:. 1...................... Z.j... i..� .... �-•.{ ... ............. ............................................
10.
Is seepage observed from any of the structures'?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
yr No
12..
Do any of the structures need maintenance/improvement'?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public r health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers"
j Yes
No
Waste Application
14.
Is there physical evidence of over application'?
❑ Yes
( No
(If in excess of WMP, or runoff entering of the State, notify DWQ)
15.
waters
Crop type ................. skyA. Q....C,tay. .....---......................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
❑ Yes
M No
17.
ti
Does the facility have a lack of adequate acreage for land application?
❑ Yes
(N�No
18.
Does the receiving crop need improvement?
• r
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
W No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ANo
22.
Does record keeping need improvement?
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
10 No
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0 No.violations or deficiencies were'note'd during this. visit.-. You will receive no further
. .. .. . . . .. .. . . . .. .. . . . .. . . . ._.. .. ._ . . .._.. . . . ..
. correspbtidence about tttis.visit.
Cotnents (ietet;to question #}: Explain any.YES answers and/or any recommendations or any, other coatnnents `
Use drawings of facility to be#ter explain situations=(rise additional pages asnecestiarv) a
l�-• �.rt C�•t�-S o�-• I`i �`� `l- N l{ Z 5�1¢U�,t� �ae. V icJ�e�P��e �,1^C. Lw•Qfi� S o11 C� ZA c�'�"aJn� •�— �
iMJI\ ��+pC'� i�WUjfJ �e leS CrD5�6n ice. 51D�Y1� Wc� ��1ftl ^dA OLCJ 1jC,C�vi
i CQr rn�+� ��IJs�g s��J Jlie tiP,1/�
f 3 . 1-k COr\ ► xaY-`J 1"o + n l /!j . c 6xJ l-( 4 Pro*r- 't ,, Cck' �t3 \•.�' e�. J� �1�`Q�7�1 O (C� Wa f
It k3t t 0, 6eV'muda-. -dk S�f�t:#0 bk- a;/ '66 rt vOI
dt1 U1� �4, 00r, D�c5�5'tis �rir 0\11
S�Zetil �Dt'� on 5f �i ucU1'^m QKIeYEr � �-., LYYht� 01. y am +kme- , 7/25/97
Reviewer/Inspector Name "VIV\ .
Reviewer/inspector Signature: iNq ���� 61 Date: