310863_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

L ype of Visit: Co nce Inspection O Operation Review O Structure Evaluation p Technical Assistance
for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� [,.. i� i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: '�, 7 0 2 �_
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
W to Feeder
Non -La er
ceder to Finish
Q`a Z o
Dairy Heifer
Farrow to Wean
Design C►►anent
O i. P,o .
,
ILayers
Dry Cow
Farrow to Feeder
Farrow to Finish
I
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qthe_r
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes D<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)
0 Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 3 1 3= jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ef No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
[:]No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑i' ❑ 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 environmentaleat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
;7[:]NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jrNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesVNo❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[]Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers, ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 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 �No
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ElL Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 61NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes VINC ❑ NA ❑ NE
[:]Yes No
❑ Yes
ElYes❑
V
Yes
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
)'kff
Ind lR Even.
J,.;,^ & Kllyl.,
Phone: [phone]pg
Date: r 7
21412015

Type of Visit: ®'ZRoutine
pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: („ Arrival Time: ® Departure Time: /p County: 62 P Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Qu u l M,-'rTe_W 6 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: O'A,�Q a -
Certification Number:
Longitude:
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Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No - ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Z:XNoO NA ❑ NE
❑ YesNo ❑ NA ❑ NE
Page ] of 3 21412015 Continued

Facility Number: -R G2,7 jDate of Inspection:
Waste Collection & Treatment
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 O No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier-
Spillway? -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [6 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 Pi 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 DWR
7. Do any of the structures need maintenance or improvement? c es ❑ 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 U/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Zlqo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [: No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑.Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN9
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes V_'No
❑ NA ❑ 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 ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 N ❑ NA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 1- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 6�No ❑ NA ❑ NE
t.
2§. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 64o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 'E;�<0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
la
❑ 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
""
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up by
❑ Yes
Yes
❑ NA
❑ NE
NE
the require a visit the same agency?
❑
No
❑ NA
❑
Comments, .xplainany;omndations or any ottiercbmmer refer to uestion#}EYESaswers-andloranyadd�honarem
Use-driwings of fa&6to: better explain situ atiomXuse:,additional°pages;as,necessary).
`) 9,TKE till .c� N'4,S
ASS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S6M E ] , oT1 ytlo �/ � C"�►
n 91 OLML,
Phone:t��
Date: a ?
214120 S

Type of Visit: 0 C mpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up . 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I bj ITl S I Arrival Time: Departure Time: County: �}Q�� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 3R.c-_tjr (AMTr'fl(-i.L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity P.
Wet Poultry
La er
Non -La er
Dry P,ou1t ,
La ers
Non -Layers
Pullets
Turke s
Turke Poults
Other
Design
C*apacity
Design
Ca acity
Current
Pop.
Current
P.o ,
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Finish
Wean to Feeder
Feeder to Finish (pao
Farrow to Wean
5950
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes No ❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes L;Ji
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 3 L - Date of Ins ection: WI V IS
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ly/]
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
El Yes
6 No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? R1 Yes ❑ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El
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 EZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F3rNo
❑ 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
1Vo
❑ 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 Ea/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections /❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [249o. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EKo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �/No ❑ NA ❑ NE
25. Is,the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �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 EKNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 3-N(o ❑ 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 0 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
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 [/'No
❑ Yes 0 No
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
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comirients (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 addihoiial pages as Necessary).
1.) D1*_C WALL-- WCOS tSOMC G2- 55- Woi\-(L.,
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
SN O
Phone����
Date: tJ
214,12015

type or visa: w v.ompuance inspection V vperation xcview V arrucrure Evaivanon CJ iecnmcai Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: CJ, O County: WPL Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Qr¢,ES.tC!{C=[mil. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 2,q4 ZZ
Certification Number:
Longitude:
Design Current Design Current
Swine a, AW7111111op. Wet Poultry Capacity Pop.
Wean to Finish La er
11
C►attle
Dairy Cow
Design
Capacity
C►urrent
Pop.
Wean to Feeder
jNon-Layer
I
airy Calf
Feeder to Finish
Farrow to Wean
Design Current
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
I
I
Dr, P■oul Ca aci P,o ,
ILayers I
Gilts
I
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[/! rNo
❑ NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [I�No
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No
Structure I
Identifier:
Spillway?:
Designed Freeboard (in): , I
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
EYes No ❑ NA 0 NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EfTNo ❑ 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 [21f4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�J/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O No ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? LLJ Yes ❑ No 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C3/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]'No
❑ NA
FINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP [I Checklists ❑Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes E�YNo ❑ 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes D/ No ❑ NA ❑ NE
25. Is tke 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 E]"'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes Z[No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes EJ/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 dNo ❑ 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 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 ❑0fio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E]*/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.. ew
Use drawings of facility to better explain situations (use additional pages as necessary).
(5 c�r✓IE ►v661000 PC- FASC Ktc1° SPY a r� LZ►�t
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
.Spw JW&U-
Ir ClC C--]' �✓ 4��a�1,
Phone: � lia 1q 6 - ! bD
Date: (/ II IN
21412011

Type of Visit: (D Co fiance Inspection U Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: [Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /Q 0.S County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1; akt j 0- -T C -o r&t' Integrator:
Certified Operator:
Phone:
Certification Number: 11Z ZZ/
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -Laver
DairyCalf
Feeder to Finish
Design C►urrent
D , P,oultr� Ca aci Po ,
Layers
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
[:]Yes ZD ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
Page I of 3 21417011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4.%storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: c A �!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):V
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑i 'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ 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?
eyes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
040
❑ 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
[ Jo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
040
(DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesWN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 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 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 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
ElYes No
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FacHity Number: -L Date of Inspection: ! 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. A the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Y ❑ 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 [2<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
,--,�
❑ Yes D'1YD ❑ 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 PD 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 ffNo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVRAP?
❑ Yes I_J 11 ❑ 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 �7No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings, of facility to better explain situations (use additional pages as necessary).
Reviewer/InspectorName-
Phone: �91b} /9 4 -7-
Reviewer/Inspector Signature:
Date: S S 1
i
Page 3 of 3
21461

49
r
ype of Visit: QJVRvutine
pliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jai Arrival Time: Departure Time:© County: DUPjj2qj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: B M qGN a L_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: a as
Certification Number:
Longitude:
Swine
Wean to Finish
]Jesi HIMOOKERMA
Capacity Pop.
I
Wet Poultry
ILayer
Design
Capacity
UIT.IEW11
Pop.
t
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder Non -La er
Feeder to Finish 6Q
Farrow to Wean Design Current
Farrow to Feeder D , P,oul Ca achy P.o
Farrow to Finish Layers
Dai Calf
Daia Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Nu ber: - Date of Inspection: 'lam
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 J Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &t:6/u
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes rNo ❑ 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 MIN o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesrN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes �o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Vo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes dNo ❑ 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 /N0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of inspection:
24. Did the.facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ 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 ❑ 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 [:]Yes C2 o ❑ 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 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZrNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CfNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewfinspection 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
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4 pll

Type of Visit: O Co pliance Inspection Q 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: S Arrival Time: (p Departure Time: /n; County: D%CfL,,7fj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 3R*p_�T M rT t_Nc L,-- Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
La Layer
Design Current
C*attle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
xr6
po
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
I) , P,oult , Ca aci_ P,o
I Layers
D Cow
Non -Dairy
113eef Stocker
113eef Feeder
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
e Poults
Other. EOther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[]Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ N ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge? T
Page I of 3
2/4/ZOII Continued

Facili Number: - 3 Date of Inspection: Ssyll
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
i a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure` 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [Jj(5�_rJ�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(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
waste management or closure plan?
�3
No ❑ NA
7/No ❑ NA
0/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en onmental 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 Fj/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
dyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
64co
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ 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
ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CJ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - to"'j Date of Inspection: Ili
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
Ef No
❑ NA
❑ Yes
•
❑ NA
[] Yes
YNo
❑ NA
❑ Yes
No
❑ NA
❑ Yes VNo
❑ NA
❑ Yes ❑ NA
❑ Yes [DNA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other camments.-=
Use drawings of facility to better explain situations (use additional pages as necessary)., w,
i,) %D V-( WALL. Lvo tt- tom Sntr L- OCEOCD,
tS,) LramE oc-cocb AqJD SCE 0(-E05 T,) ISC 2E.W10AD, APiL 74"" 3k1� DArC,
Reviewer/InspectorName: J090 (AQ_sX (A, Phone: `Gib ��3Y0
Reviewer/InspectorSignature: 4 Date: s ��
Page 3 of 3 21412011

Dkvision of Water Quality,
tI- acility Number g 0,Dtviseon of Soil and Water Conservation � `°'
w (?,,Other, Agency �..w, .
Type of Visit Qf Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y 1 a Arrival Time: 116d Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: (3tZ6+jr M T( jCt-L, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o Longitude: 0 o = ,
Design Current. Design Current. -
Sv►me 11
Capacity Population Wet Pou_ Itry 7 ;Capacity Population. Ca
-❑ . Wean to Finish ❑ La erEl I
E' Li
We to Feeders ❑Non -La er
Feeder to Finish 00—�
_ ❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[]Boars
`Other -
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
L_=:�
Cow
Calf
Dry Cow
Non -Dairy -
Beef Stocker
Beef Feeder
Beef Brood
Numt
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 EJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
[I No
❑ Yes
❑ NA
❑ NE
❑ Yes
VX0
❑ NA
❑ NE
12128104 Continued

Facility Number: S — Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes Uf No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 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 L1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L7 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
zi Mgr- zt is «� -
,t
Comments t`efer�to uesnon # Ex lam an YES answers andlor an r endaftons or an other min nt
( � q. „,..) .P ....,y � �. � Y .ecomm
Use drawangs-of facility wbetter explainsituations (use-additio al pages'as,necessary.) ,
7,) S o r� . lam► o(Z.k_ %llj Si'T.A-L WF-6JDLS Xy, e-9-,0Cy—SdT d UJUC.E-
( 1)4 C�
T
Reviewer/Inspector Name _ `' W: Phone( 916
hLJ L
G
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 ' Continued

1.
Facility Number: Date of Inspection !b
Itee uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes b No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 o ❑ NA ❑ NE
the appropriate box. ❑ WLTP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [/NNo ❑ 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 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes Wo
❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 6�9- El NA [I NE
27. Did the facility fait to secure a phosphorus loss assessment (PLAT) certification? El�,d'No Yes ❑ 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 7No
El NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? El Yes ❑ 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 Z 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 dVN
El NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Additional Comments andlor Drawings:
Page 3 of 3 12128104

•Division of Water Quality
�F.aciility Number = — (p — 0 Division of Soil and Water Conservation
Other Agency
Type of Visit QJ Crpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _0rzowr_ MZ7G(46 U_ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [ [� Longitude: 0 o = ` =
sign C%urrent
Design Current
Design Current
pacPopuat
1777
❑ La er
❑ Dai Cow
Non -La er
❑Dai Calf
6 b
L t.&V
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑No
❑ Yes
2No
ElNA
-[INE
ElYes
12 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — R� $ I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: 1,4&yyIg
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L4 Z—
❑ Yes ZNNo ElNA ❑ NE
ElD Yes o ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ['No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q 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 2
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 B—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 ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [:Xo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9.iGo ❑ 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
El"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
B'Ro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E5r`No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
b'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L"7 No
❑ NA
❑ NE
Comments�(refer to quest�an;#)Ezplamany, YESanswers and/or anyArecornmendattons grany other comments.
F"' 2. •` v' Y Y
RUse'dr wuigs of facility to better explain sifuattoris (use addthonal�pages as n ce ary)� �
r �iZtt� .1 (3 ACtL s6 4 7 Co tiAM,
AIL
Reviewer/Inspector Name dv 14 Aj AA � Phone: d
Reviewer/Inspector Signature: Date:
Page 2 of 3 D 12128104 Continued

Facility Number: Date of Inspection d
Required Records & Documents
19. Did the facility fail to have 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 EZ"No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ 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 I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
!J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
25.
Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
9:�No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[31vo
❑ 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 BIN_o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<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
r_rNo
❑ 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
f5 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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ((rRoutine
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: �,. Arrival Time: / a d O Departure Time: County: h � ty� Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 3 R'(. ot M =r" eu _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = i Longitude: = ° = I =
Design Current Design
Swine Gapaacity Population Wet Poultry Capacity
Current
Population
Cattle
Design
Capacity
Current
Population
Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
f
❑ Non -La er
❑ Dai Calf
Feeder to Finish TZap
Dry Poultry
❑ Layers
❑ Non -Layers
❑El
Pullets
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Gilts
PE]Boars
Beef Feeder
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes U<O ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes idNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — g{o Date of Inspection i c
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 0z)(0- ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 2 o ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ElXo' ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,L�,�N//o
L7 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
El NE
18. Is there a lack of property operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
t7) R A0C_ e.r C,- 4T C,', (tAJM- a (- rV.]:tc-C- I &M tA_ 0 ECC DS t� �M1 t� F2o,.►-�
Ea­10S?crJ, '?LC--kSF ADCW-ESS P40b 1pawV^ ENT,
L
er/Inspector Name ��4 )..) t j �!� (jam Phone• %y6er/Inspector Signature: Date: La.
111261 4 Conhnuea

Facility Number: '3— Date of Inspection
119auired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes g o ❑ NA ❑ NE
the appropirate box. ❑ W­1Jp ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑I o ❑ 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 [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �❑'No El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L"No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L 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
9/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
C5"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
ET&
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Q Division of Water Quality
=Facifityumber 3 j $(03 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit eCompfiance
Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ) Z3 O Departure Time: County: tDUP LE 0 , Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q q_.r_'_y7 NIi7L t�
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = i = Longitude: = ° = 1 = 1{
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish G o o 1ISO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Cattle
Design ,,Current....'
Capacity ; Population-,�
❑
D iry Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
El NE
❑ Yes
El Ye
El NA
El NE
❑ Yes
VNo ❑ NA
❑ NE
12128104 Continued

• Facility Number: 3) — 8 Date of Inspection is
Waste Collection & Treatment
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3 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: (A Limn }
Spillway?:
Designed Freeboard (in): a%
Observed Freeboard (in): 51 ,
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
Do improvement?
environmentaltheat, notify DWQ
any of the structures need maintenance or
El7. Yes
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Zo ❑ 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
CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L?I 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
E3'NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
FN
❑ 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):
G �
Reviewer/inspector Name 1 2� j� L Phone: ry 77(— �3 �d
Reviewer/Inspector Signature: Date: S~ t 6

Facility Number: 1 --
Date of Inspection
oRequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
JNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If es check the appropriate box below.
P g P Y�
❑ Yes
Zwo
❑ 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
N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[/ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[�INo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
LLJ Yes
Ko
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ILI No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Id 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
r 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
2 No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�o
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;ZNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

IJ
Type of Visit (Br7Rco
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ;LI o(0 Arrival Time: ? Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: s 1 Title: Phone No:
,/�/�
Onsite Representative: T 1 t 1 �Tcw Et/U Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = =' = Longitude: = ° =' 0
Design
Current
Design Current
Design C+nrrent
Swine Capacity
Population
Wet Poultry Capacity Population
C*attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai! Calf
Feeder to Finish to (a0
Dry Poultry
❑ Dai Heifer
❑ Da Cow
❑ Non -Dairy
[:]Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Pullets
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ Boars
El Turkeys
Other
❑ Turkey Poutts
❑ Other INumber
of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ No
❑ Yes
❑ No0 NA
ElNE
- ElYes
o
❑ NA
❑ NE
12128104 Continued

Facility Number: — '3 Date of Inspecdon L1lIa� I
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cl/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: L4 4ivc>
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ETNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EJ4o
❑ 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
B<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KkNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) G (.R-nA UK)A (- &) S�
13. Soil type(s) rjp L'D.S iaan.10 t`�s ,_,/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I/J No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? B Y s ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question ff): 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): _
ReviewerlInspector Name I J Phone: V-0
Reviewer/Inspector Signature: Date:
n_--11..tea 7IVrroin4 r ...,.,,.
- -1-J

Facility Number: — 3 Date of Inspection I a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
lJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[: No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�& ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,�
d 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
LI 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
VNNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;�/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 9 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit fO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of'Visit: �jr Arrival Time: r p eparture Time: County:
Farm Name: /I�7� [/`" '0 Owner Email:
Owner Name: �-� Y Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
,Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: ❑ o
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0 Longitude: = o ❑ 1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
h ❑ Layer
1 II ILI Non -La et
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoAi
Number of Structures: =,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )" No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
/
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number. 1 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: /C
Designed Freeboard (in):
Observed Freeboard (in): �Z
v
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
[YNo ❑ 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?
9yes
❑ No ElNA ❑ 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
0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes; check the appropriate box below.
❑Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Win¢ow ❑ Evidence of Wind Drift �❑ Application Outside of Area
ti
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;YNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
El
/Q(No
No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
El
No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElYes
)] No
❑ NA
❑ NE
Comments {refer to,questtti E plain any YEo�S answers andlor any recommendations or any otlRer co xnents.
Ilse drawings of factyFtiietter eaplainsltuatrons. (useadditional pages as necessary):
1. rJ
719,
den- e`E ysiT' -6Y'
Reviewer/Inspector Name � f ` � D !3: : .. s�. �.w : Phone:
15�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Reciuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ElNE
the appropirate box. ElWUp ❑ Checklists ElDesign El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No El NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IVNo
5z,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
El NA
El 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
eNo
❑ 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
o
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0No
❑ NA
❑ NE
Additional Comments'an&or Drawings
JPRO
I5
'24y�
12/28/04

(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint Q Follow up Q Emergency Notification fj�Other © Denied Access
Facility Number Date of Visit:
Permitted Q Certified © ConditionaRy Certified Registered
Farm Name: -_L�
Owner Name:L%. , , . , 1m1,-
Time:
10 Not OFerational O Below Threshold
Date Last OperaM or Above Threshold:
County:C)
Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
�,� Phone No:
6�' _
� Integrator:G�3%/E'�
Certified Operator. Operator Certification Number:
Location of Farm:
J( Swine ❑ Poultry [3 Cattle ❑ Horse Latitude • 4 Du Longitude • 4 Du
Swine
_ G
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
CIIirent , s Td w ,]Des-w., y Cnrc�st Delp �C�mrrnt
-1PnenlatinnpOII�tr9=Cariiv ..PeYunlatin=, ,Cable. ,. a „rsanardv- tPniasitlaf�nn'
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes JffNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Qf No
❑ Yes )Zf No
❑ Yes oNo
Structure 5
Identifier:
Freeboard (inches): jo
12112/03 Continued

1l
acility Number: Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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
❑ Yes
❑ No
elevation markings?
Waste APRAcation
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 ydraulic erload Frozen Ground ❑ C r and/or ' c
12. Crop type 5 Lr �ier►'1+:��
13. Do the receiving crops differ with those designated in the Certified Animal Waste hrmagement P (CAV;W)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
;Comments �reirr to gruestxoxuF�cplam* YE�i�s and/or agy or any N®REE
..a
Use drawn of iac�Tety to better a glare sttm oasc.,(i a did- edges as ter]') [I F Copy 0 Final Notes
iJSI��C72DN OA)4)�C���
R _� D�
APPI-OF-0 SDI
f
Reviewer/Inspector Names / _ pT !
Reviewer/Inspector Signature: Date: / r7
M
12/12/03 v, Condnued

1
Facility Number• _ Date of Inspection I Z�
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JONo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the. Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You w01 receive no further correspondence about this visit.
,Q�PR 5
eo/
12 I2103 —"� WA-755.i64— P-AO t UA} 5 TZi W26G

z ihvon of Water QualEety�'M -; 'S
Div�sron-of Sotl and Watery Conservation,-
V. Fz,y.. `,E-m-r "�.fr-.".'?:" i �,�R .�,Y _. e.s z.^-- _ ��-.....-•� . - 'tea �' -.
_ er gency
y•
_ z
r m
Type of Visit Xcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit AtIoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: i• L
Q Not Operational Q Below Threshold
Permitted © Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name:.... .......................... County:.L1.1n.W »..........».........».». ........
n Z= }
Owner Name:._�Qir1�.�."�.I,.�......»».....�CACJI... Phase No:
Mailing Address:
Facility Contact: ........ . _......._....,... Title: Phone No:
Onsite Representative:.1.IQL ^�► . i..» >C t� ...» •..�..}»t TC�121 1 Integrator: .........................................
Certified Operator: . . .. . . . ......................... . . . ........... .. . .... »»......._.».» .»......»».».» ...»... Operator Certification Number:...»»..............�.»»......
'Location of Farm:
J(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��°s
rreat� „Desrgi Current
-
_=�;
{rQ iLLiF f.-i.V YaY.ivu _i"-...ice r--Yr •�-- 4F�{• �JI. .V ./.V.•avu;
Wean to
Discharges & Stream impacts
ff
" Design „�' Cusreiiet
`- ,CaaacrtvhyPaaulti<tion "=
,I
1. Is any discharge observed from any part of the operation?
❑ Yes 401L
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 eNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �2No
Stru tureStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ .......... ............-...................... ».... .-».................... ............................ --
»
Freeboard (inches): a
12112103 Continued

• Facility Number: j — g Date of Inspection /y O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes QINo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes V1No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?ElYes
® No
9. Do any stuctures maximum and adequate, gauged markers with required maximuand minimum liquid level
❑ Yes ,No
elevation markings?
Waste Application
I0. 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 ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste anagement Plan (CAWvIP)?
Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ YesXNo
b) Does the facility need a wettable acre determination?
!!❑ No
❑ Yes
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 /EfNo
Odor Nsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes No
liquid level of lagoon or storage pond with no agitation?
eE�
1
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes �No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ YesN0
Air Quality representative immediately.
:Commie s {refer to quesfian #) 4Ezpia�n any�YES answers andior "y,. a idiii aeons or any otne���commeats:
'Udraf facility=to better explain srtuatroas.{use addrfEoaKA
se wings o sl pages as necessary) ❑ Field Copy ❑ Final Notes s
/1A©r4
A cow5 l/�'e� N�"-> A40 ©Qom
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: /
12112103 Continued

Facility Number:—63 Date of Inspection j ff
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? 1
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes fp No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes A No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Q�No
/,,����ttt
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
YNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
/Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JgNo
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
toNo
VNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
XNo
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below.
❑ Yes
XNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit , 95 Compfiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
]DO"tof visit.
U Permitted O E3 Condition lly� Q Registered
��C��erjJtified
Farm Name: .....!�y_�.._.LLSA
Owner Name.........�� .............���,l�.
Certified
..... —..... .......
r"' '
Maiiins Address:..:: ............ .._.................
a] Time: 1=
Not Operational 0 Below Threshold
Date Last Operate ..r Above Threshold . .......................
County:... /'/°LZ!`!.......-.-...... _......._,
PhoneNo: ......................................................................... .......
Facility Contact: ................. ....... ^...... Title:............................................................. 4
hone No:
p..�...�../..�...................................
Onsite Representati....... 'C(T� Integrator. �fJ-�'� a4................... ................
.............. f........_.........................
Certified Operator.........................................._.......... .... ........... Operator Certification Number:
Location of Farm:
/wine ❑ poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude • �4 K
Wean to Feeder
❑ Layer
EE
?<' ❑ Otluer
: ... ...:......
Feeder to Finish
Farrow to Wean
Farrow to Feeder'
Farrow to Finish
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 galimin?
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?
Wake Collection & Treatment
4. Is storage capacity (freeboard plus storm,storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..........
Freeboard (inches): ............ .................. ............
YesINo
❑ Yes ❑ No
❑ Yes ❑ No
Yes Q No
❑ Yes No
❑ Yes1/1
❑ Yes INO
Structure 6

Facility Number: ( — o Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,' ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?, ❑ 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
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes INIO
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 6NO
11. Is there evidence of over applicati El Excessive Ponding PAN ❑ Hydraulic Overload! ❑ Yes No
12. Crop type ./P&&e
)6?W 111ai4- 1 �}7f� f / }}Z�) r�+��� �iYLiiiT
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?
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes _z o
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes X
NoRenuired
Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/X,
(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)
0 Yes No
.23..Did ReviewerfInspector fail to discuss review/inspection with on -site representative?
❑ Yes Xo
.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 XNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
EM
eld Co Final Notes
.r.v. .. v....vv. v..v ..v . ..vv:....v... ....... ... .. v , .......vv:.- . ...v..v.. uvv-,v ...,:.vv.axv.v .vvvs..:..r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /t� D'�-

}
Facility Number: — Date of Inspection `! T
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
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 permanentitemporary cover?
❑ Yes VIo
❑ Yes
X No
❑ Yes
;Z(No 2
❑ Yes
? No
❑ Yes
9140
❑ Yes
J1J No
❑ Yes
❑ No
Additional Comments .and/or Drawings:., `_,,.: , : —� 1. A.+" A.
&�iz-z- (tA-ao9,-J 64
V'q 7;; 5, � -o 7",2 C-
f Ttso yI-Ew IZ G9
y,
15�-r)e -Zel4kY A;;?W 1&,e5-45EV&,,a,4;7A,<
05103101

.Division of Water Quality ,z
O'Division of Sail and" Water Coaservatioa
4_
Agency
Type of Visit OCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification ffother ❑ Denied Access
Facility Number 3l � Date of Visit:
0 Permitted d Certified © Cond-i-tiioonally Certified 0 Registered
Farm Name: VV .. ����s . ��i. L?! �
Owner Name: ............ 04......6'.rol ,..i................. I ...... ..
Facility Contact: ........
...................... Title:
MailingAddress: .................................................................................
Onsite Representative: , e.n .` .....6
Certified Operator:
Location of Farm:
"',02 Time_ :Z40 Printed on. 7/21/2000
Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County. ,VVrb'yt
Phone No:......
Phone No:
Integrator:...-l._!.l..QP Q..........
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude 0 & "
Design Current
Design Current Design _ c6ri east
s - Ca o ulation
Podtry Cattle Ca �.-.o an
P
Wean to Feeder
❑ Layer
Feeder to Finish
❑ Non -Layer Mar
Farrow to Wean
_
Farrow to Feeder
❑Other
W
Farrow to Finish
Total Design Capacity
-'
Gilts
Boars
Total SSLW
-Nttmlyerof Lagoons3
❑Subsurface Drains Present Lag�cui Ares Spray Field Area
olfd'wg Pon$slSdtd Traps
_;._
T
No Liquid Waste Management System
.x
Dischar & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ElSpray Field [IOther
a. If discharge is observed, was the conveyance man-made`' ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑yes ❑ No
c_ If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes []No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................ ....................
Freeboard (inches):
5100 Continued on buck

Faciltp Number: 31 Date of Inspection
L 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
❑ 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 strictures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
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 wettaoie acre determination'
❑ Yes
G 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
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1JP, 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
Y(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
Yi $�K? .e! ii fjf�ettc;e vt re nQfe d><rrift �. sAsit� - Yojr wi11 •>�eeTiW too furth0r -
corieso! rideuce: abbi f this visit:
�D. /ti'rne?e4l, $cs-� �` 44e PvxI 610. 14eA14, Dept. C'r+1led se1�d
4he-re is mot" e1d well i"' 4 k 0 -Trv,yP,c0 e,nd 4� Wlr. �r�d7 wi►1Y
v4 do wn view . w e 11 � - P N1 e4 u./ ;4 ti M -. 6 ray TA e e-1 A
�,
1n�1/ s' yn LtP S�r!sy�iC'rG'� • Mr, � rr�� Soi S ��a � e t �X
a�td b k Dv, a ava�d spray ; aver ell , Mv; ed 4"-t 41,e
c.an✓1,o4 be rvoTd w;-!?z,,, 1o0-tree4� 04 4kc well.
Reviewer/Inspector Name ,' �"� ` _ - �°
Reviewer/Inspector Signature: Date: ! Z,00Z— Slpo

Faeiity Number. 9) —,?b3 Date of Inspection Printed on: 7/21/2000
'Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional -omments'an orDrawings: _ -
lo.C��n�;�►�ed� Isa, a IDD -Aeo4 6vf�',zv- kvtvs*� be ker-r e `
hew i;,�e11 Ioc'M4'o� f -khe neL4 we// i.rpinkLned 4o
�,, p4 ; n 4ke sf rA. ,t ---Id 4ix6�c G1 use, 4,o 44e old well,
b� 4he 1p0 /'oe 4 b y f�er s uct, - ked -the was4e W ill n o4
5'f r1o,� W r 1�:h �i-aC l D� �oo� 6 v� r. Ttte Z.✓�S0'e rtA), c,eV c e
1
0
'ri1544ioK Az"AJGe} q ( iy+r&i-1reoord rz.,ertJce
need 4o be moo(, ';eel atcAM;4�1 -}n si o w Ae 4c"C'17 of
+Ile Vm.vdi.-;'ed be dons %�•��'��a�el
Sen4 ce ;es o ®4he A 0-1o4i,C;ed w4f4c lAh nd,
rri 5 o14;a., cues ►o n � 6� > ����A iJ 2 -{� mQ 14
M p� ; �, g 1¢av i R �Svs; nas ccr'' 4 w pia P-1r. Grata{
I
J
5100

Type of Visit ($Compliance inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit �V,Routine 0 Complaint Q Follow up 0 Emergency Notification Q Other
Facility Number Date or Visit:
t�ermitted ©Certified © Conditionally Certified E3Registered
Farm Name,. .......... `YEL.i... �............ .. rM.4 ..................
Time:
© Denied Access
10 Not Operational O Below Threshold 1
Date Last Operated or ove 7reshold:........ .............
County: ..............(.......... ...
Owner Name: Phone No:
............ ............................................................................................................................................
D ,a
Facility Contact: C..l ...........Title: ........................._........_.............. .......... Phone ....................
................................_........
MailingAddress:.......... ......... ............................................. .....
Onsite Representative: ........l�1`,_..........d.±.(� f ........ Integrator:.....L1}'(��-••�`
Certified Operator: ............... Operator Certification Number............................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° C 1. Longitude • C�` C.4
Design
Current Design
Current Design Current
Swine Capacity
Population Poultry. Capacity
Population Cattle Capacity Population
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
-'
❑ Boars
TotaISSLW:.._
Number of La oohs ;' > ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
_g..
Holding Ponds / Sohd Traps' ❑ No Liquid Waste Management System
r z„
Discharge & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes.)(No
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsened, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observers, what is the estimated flow in galhttin? �
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
01/01/01 . Continued

FFacility.Number•
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes kNO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......
...................................
Freeboard (inches): ..............
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 �.Dio
(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? s ❑ 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 [�N0
Waste Application � \\
10. Are there any buffers that need maintenance/improvement? ❑ Yes [(No
11. Is there evidence of over application? ❑] Excessive Ponding ❑ PAN ❑ Hydraulic Over[oad El Yes r
o
12. Crop type sc,4n . Y /` A . 1'n r 1 /i ) C
13. Do the receiving crops differ' with those designated iii the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;KNO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes _P�No
b) Does the facility need a wettable acre determination?
❑ Yes
TqNo
c) This facility is pended for a wettable acre determination?
❑ Yes
f�j No
15.
Does the receiving crop need improvement?
❑ Yes
.No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
JKNo
upp y we ray to oun ary?
Required
19.
-te
Records & Documents -
Pail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KN0
20.
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
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
26.
Does facility require a follow-up visit by same agency?
❑ Yes
No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
V`O
01/01/01
Continued

Facility Number: Date of Inspection lj/ Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property) ``
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VNO
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 10No
34. Do the hush tanks lack a submerged fill pipe or a permanent temporary cover? ❑ Yes j�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.// _
Field Copy ❑ Final Notes
r } Q Ovv. 9�G 5 'W o s p wI;cI Ob -(f
vLJ i v`S ray`- �V" ��' U 5 �e t -4- cry..4 z�
l Y ov,
`�-
if
Clo,,,,,,,►,:,,,, .
fell
f�
U adw
�a��� 7t/���-%/irsl� /����//IQ �I�'1 f//'l��/l✓YY� � T
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
01/01/01

Facility Number Date of Inspection ��—
Time of Inspection 24 hr. (hh:mm)
Permitted'Certified ©Conditionally Certified ©Registered 0 Not Q erational Date Last Operated:
/Far—m N. ...........il�-S-..._..:...........0
c....���'� ..- County: ... ri........- .....� :.......
........
OwnerName ........E.e W. a . ................ .. Phone No:.......................................................................................
FacilityContact: .... ....... --..................... .. . . ....... Title: .... 1l. it i a...............................-. Phone No:...................................................
`Tailing Address: ................................................................................................................................................. >> .......................... ....... I..................
Onsite Representative: % Integrator:
d .............................
�i.............i.r..... .............................. Is..
Certified Operator: ................................................... ................................................. . .......... Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude �• �` �"
Design
Swine Capacity
Current J Design Current - Design Curr'eht
Population Poultry Capacity. Population' `Cattle Capacity PopuEation`'
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
,Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holdtng.Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(inches): .t(f ....................................................................................................................
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes ZNo
❑ Yes XNo
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
...................................
OYes ❑ No
Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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? W—Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes
Waste Application
10, Are there any buffers that need maititenance/improvement? ❑ Yes �No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes $1&z
12. Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [LrNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes O No
c) This facility is pended for a wettable acre determination? ❑ Yes \o
15. Does the receiving crop need improvement? ❑ Yes o
16. Is there a lack of adequate waste application equipment? ❑ Yes [2�No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes n4To
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes154-NO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes E(No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes _jEriQo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _B�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,R—'Vo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes R No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,IRNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0: Rio yii latiotis:ot- deficiencies Wire poted during this'visit: • Y:oil ' iil•tec iye o #'ui-tbee .:::
correspondence. motif this .visit:
Comments `{refer. to question #):,'Explain aoy YES answers and/or any recommendations or:any other comments n
Use;drawings of -facility to better:explaiii situations: (use additional pages as necessary) x - zZ
a Z.
!� � � � ►'ia� I `' .�� ✓�„�. �,/ ire/)( _ `V J/i � `� J ` I • �Y —. C� � /� f� l � 7
r114- 1Yf� p ro d �1 Ae4we eti-
l �r � r l can �"�� Sv: l °`Gr�.�✓Qda�- � s
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number: — fate of Inspection
Odo lssu's
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[:]Yes
No
liquid level of lagoon or storage pond with no agitation?
`\
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
(INo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
RNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�N0
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
FNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
040
Additional omments an or aw�ngs " m
- .. -.. _. ....., ......:..........._ .. _.._ - _ : + ;_. it
0&d
Cy o-�
;
—tlt� Ile �.
Uo,� vk�
SP l(' °�Sr e�dh-e-t t, - a <SO
wag
3/23/99

Facility Number 31 863 Date of Inspection 3/3/2000
Time of Inspection 11:15 24 hr, (hh:mm)
Permitted 0 Certified ! Conditionally Certified E3 Registered JE3 Not O erational I Date Last Operated:
Farm Name: :4 jnkM.T]ram.-.CVm*.............................................................................. County: Rup& ............................................... W.. JRO.........
Owner Name: R..2., ......................................... GrAdy ......................................................... Phone No: 9jo:.25.7.- 4&1.( ..9La: 2 z-897S.L .
FacilityContact: ............................................................................ Title:................................................................ Phone No:...................................................
MailingAddress: P..O...Bcta97.8......................................................................................... Fai&OKLAC .............................................................. 283.41 .............
Onsite Representative: ........................................................................................................... Integrator: GQldsboi A.kI9g.X l=$i.......................................
Certified Operator: $icWAuxin.I.......................... Grady ............................................... - Operator Certification Number: 22022 ............................
Location of Farm:
AL
YQ iI tl #iS�Y9�.�Y�1Y�li Hi�.t1�., )� Q1.Ap�lr�td..�. fA � ,aAtlRf 5 i �..................................................
..............................................................
........................................................................................................................................................................................... rr
Latitude 35 ' 03 ' 27 " Longitude 78 • -04 ' 40
❑ Wean to Feeder
IN Feeder to Finish 6600
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
. ❑Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow;in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ;. ❑Yes ❑ No
3_ Were there any adverse impacts or potential adverse impacts to the Waters of.t_he State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............................................................................................................:.............
Freeboard (inches): ..............46 ::..............
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31-863 Date of Inspection
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 Anulication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility'fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
3/3/2000
[] Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [} No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
Leo irio[atiaeis �r:tiefrciencies iverc:rioted:during ifiis visit:: me
facility!
1W
Reviewer/Inspector Name :� <;::::.;,....:::;v.....,.:......:::::.�.:�::_.
EM
Reviewer/Inspector Signature: Date:

Facility Number Date of Inspection '�
Time of Inspection © 24 hr. (hh:mm)
Permitted © Certified (] Conditionally Certified © Registered JE3 Not O erational Date Last Operated .
Farm Name: ............ County:....Dyph.�......................................................
Owner Name:.,,., . - Phone No: V
...............................I..............................
Facility Contact: ............................................................................. Title:................ ............. Phone No:....----
...................................
MailingAddress: ..................................................................................................................... ........................................... ...............
Onsite Representative: -Ojr� ..., ...• Integrator: ,.,......�
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
r........................................................... ........... ............... .......
! r
Latitude �•�`•; Longitude �•�� �«
- - Design . Current Design- ; Current Design Cii�rent
Swine _ Capacity Population °^Poultfy,. -Capacity Po u]ation' Cattle Capacity Population
__.
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish 00 ;T_ ❑ Non -Layer 1E1 Non -Dairy
r ❑ Farrow to Wean
-
❑Farrow to Feeder ❑ Other I I
❑ Farrow to Finish _ Total Design Gapacify _
❑ Gilts
❑ soars Total'SSLW ..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the esthnated flow in gaUmin?
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?
Structure i Structure 2 Structure 3 )(Spillway
Structure 4 Structure 5
Identifier:
Freeboard(inches): ........_. 1. �.......................................................................................................................
❑ Yes 4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Mo
❑ Yes
ro
❑ Yes
[ No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes EyNo
Continued on back

. Facility Number. J ` —g Date of Inspection
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 maintenancelimprovement?
8. Does any pan 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 applic on? ❑Excessive Ponding ❑PAN
12. Crop type jLftj 1 SG1F , rp t� rJ , ':�y
-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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 VNo
❑ Yes KNo
❑ Yes - XNo
❑ Yes (<No
❑ Yes DqNo
❑ Yes R No
❑ Yes �gNo
❑ Yes CK No
❑ Yes 14 No
❑ Yes gNo
❑ Yes 9 No
❑ Yes V No
❑ Yes ONo
❑ Yes j (No
❑ Yes XNo
❑ Yes R No
❑ Yes �y No
❑ Yes P No
❑ Yes G 'No
❑ Yes R No
❑ Yes -'No
0: Rio violations :or deficiencies were ngted- dirr#ng �his;visit: - Yoi will-f&6*e fiq i.fur#h.&.-.'-..
corres�orideuce: abauti this visit.
Cominenis (refer tortquestion #): Expli�n.;anry YES,answers and/or any recommendations or -any other.coinnlents
Ui�s je drawings of faciItty to better explatn`situations (use -additional pages as;n_ecesspy
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: 3 —g6 3 hate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
k(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 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4 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
PqNo
M
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
X No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
N�qo
Additional Comments and/or Draw�n
3/23/99

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