670018_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: f� r f r� Arrival Timefl­0_53­7 Departure Time: 11116 ::] County: '01Jst_6kJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: PARVE-Y _ III j11ALLY Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: ) IJ 3 0 6
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
C•apity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer___t_Dairy
Calf
Feeder to Finish
7.b
r�)b
Dairy Heifer
Farrow to Wean
Design
C►urrent
Dry Cow
Farrow to Feeder
D , Ploultr,
Ca aci_
Pla ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 21No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes ❑ ❑ NA ❑ NE
❑ Yes L'J No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: -G
Spillway?:
Designed Freeboard (in): }
Observed Freeboard (in): ±
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen7tO threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a4 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff 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
0 IIJA ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
VNo❑ 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
ZO)❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
gNo
❑ 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: i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes a 0 NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection: 6113
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesgNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ YesV ❑ 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 property 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 facility9 If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
JZ/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
eo ❑ NA ❑ NE
[Y
❑NA ❑NE
❑NAONE
Comments (refer to question #):.EXplatn any.YES answers and/or any additional recommendations or any.other comments:
Use drawings of facility to:better.explain,situations.(use additional pages as necessary):.
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: R ! O � 7
Date: 10 11,3
214 I5

I/
Divi"sion of Water Resources
Facility Number - G{s' ����A"i-nI06
lanConservation
her AgencyAp
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Q County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: NcJLei 1,4 a ({ f Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
2 0,306
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
C*apacity
Current
Pop.
Design Current
CattleMapacity Pop.
Dai Cow
Wean to Feeder
V Feeder to Finish
Farrow to Wean
-; a00
Non -La er
I
alf
'3514
Design Current
Dai Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
IJ , P,oultr, C_a aci_ P,o ,
ILayers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
No
1. Is any discharge observed from any part of the operation?
❑ Yes
E
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 6 - W Date of Inspection; z t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�'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): 2-z
`~•. 5.. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ©No ❑ NA ❑ NE
( i e., iai'gE`rees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 [5 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 E:fNo ❑ 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
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]—No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ 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
PNo
❑ NA
0 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 eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D 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 B"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili {Number: G - L Date of Inspection: z S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ffrNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
'�� � �'Ppr' /+�(•-fit✓ �ns'cIC /9k't s���e
CL�C. �s �. -� cc c- S jr oi--.'r„ijl
Reviewer/Inspector Name: Q 01L l4k—e
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
DINA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes []"No [DNA ❑ NE
❑ Yes [Er'�o ❑ NA ❑ NE
❑ Yes D—No ❑ NA ❑ NE
❑ Yes ETNo
❑ Yes [v]"No
❑ Yes El -No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: <tV
Reviewer/Inspector Signature:
Page 3 of 3
Date: Y ! L `( // �—
2141201 S

Type of Visit: Co ance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outme 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: aN,� L.rr5y,� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: d� Title: Phone:
Onsite Representative: H �`� �� � ALf- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: Z63 d So
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish ILayer
Cattle
Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
I jNon-Layer I
Dairy Calf
Feeder to Finish
Design Current
D , P■oulh, Ca aci_ Pao ,
Layers
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non-Da'try
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
O#her
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes VN9,
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection: ?�
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freehoard (in):
Observed Freeboard (in):
5. Are there any immediate threats
to the integrity of any of the structures observed? ❑ Yes t7Noo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify 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 [ 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 ZNo ❑ 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 o ❑ 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
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ 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
0140
❑ 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
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [3 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 �Zo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fac ity Number: - Date of Inspection:
24.,Aid the facility fail to calibrate waste application equipment as required by the pe ? ❑ Yes � o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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
❑ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better explain situations (use additional aaees as necessarv).
�) CAG-a��c/
�� 1;�—(Jmd?o
DUE fis
PR�vaov5 30Ay� RAC✓,
HA1�E
�� rlLt,EP 61nJr�
SC�
� G/S/C-G ./%G✓�,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone( gb V-31
Date:
2I4120l

Type of Visit: 6 C pliance Inspection O Operation Review O Structure Evaluation 0 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;l
Arrival Time: Departure Time:® County: n�% Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: i1��YE ` h! j�ly Lie I Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
26 366
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish Lb
Da Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
l
Design
Ga aci_
Current
Pao
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
r7p7_yers
Beef Brood Cow
Other
Other
ouets
Discharees and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ Vo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[fio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[]-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Condnued

]Facility Number: - Date of Inspection: y
I
Waste Gollection & Treatment
4. I4storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: � J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoE]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify 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 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 O/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 �Z/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
dyes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I! 1 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g �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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑O r:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections �onthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - jDateof Inspection: t
24. Did-tl}e facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E(IN ❑ NA ONE NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o [:3NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes N
❑ Yes No
❑ Yes �o
❑ Yes N
❑ Yes 90
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
106
SO ?�q C IW619 0
Ca /,tfa t>C ,
Reviewer/Inspector Name: L.�� Phone( l.wtvl [A 04
(} �-
Reviewer/Inspector Signature: Date: 3
Page 3 of 3 2/4/1011

Certified Operator:
Type of Visit: C3 Co
ance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: O Complaint p Follow-up 0 Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: L_L [Ls ]� County: ONft0l1! Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� WALE, i Integrator:
Certification Number: M 3 0 b
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Swine Capacity P-op..
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
on
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
zo 0
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
©i. P,oultr Ca aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke I'oults
Other
Discharges and Stream Impacts
i. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: Date of Inspection:
?✓
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:)Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZfNo ❑ 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.
Dyes Eallo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
,
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes U No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ 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 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 [� ❑ 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

Facili umber: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. t Yes ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesg�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 ❑ NA ❑ NE
g�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Wo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
' If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes <No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Vo
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ;'
Use drawings 'of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Date:
Page 3 of 3 1 2141201

►,
Type of Visit: Q'CCiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l Arrival Time: Departure Time:® County: L05PJP7 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: ),%4e IW I-1104UT Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultr3' Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
rj 2-6
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P�oult . Ca aci_ P,o ,
Layers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
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 [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E<O ❑ NA ❑ NE
❑ Yes E1No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Foci-li Number: - Date of Inspection:
Wask ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
4
Structure 3 Structure 4
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?
Cj"No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmto
threat, 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 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VX(o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I__I 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

Facilg Number: - Date of Inspection: p
24. EU the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
�zo25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ejlc ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�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 No ❑ NA ❑ NE
[—]Yes O/No
❑ Yes O/No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Vd ❑ NA ❑ NE
❑ NA ❑ NE
YNo ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or.any other comments- -''' I
Use drawings of facility to better explain situations (use additional pages as necessary). x,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone :C U I i7 3
Date: l0 J
21412011

Type of Visit 07Routine
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: t..l 25 RE Arrival Time: �--� �K� Departure Time: County: QAI S Z-4IJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: 6114 E � W uAL6.1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 6 Longitude: = o =' =
Design Current
Swine Capacity Population
Design CurrIII
ent
Wet Poultry Capacity Population
Design On; ren#
Cattle Capacity Population
❑ an to Finish
10 Layer
❑ Dairy Cow
❑ an to Feeder
ID Non -Layer I
I
❑ Dairy Calf
® Feeder to Finish
7.0
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Dry Poultry
El Layers
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Be" Brood Co
❑ Turkeys
❑ Turkey Poults
O#her
umber of Structures:
❑ Other
❑ Other
I
Discharaes & 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 n No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
I'J No
❑ NA
❑ NE
❑ Yes YNo ❑ NA ❑ NE
12128104 Continued

[Facility Number: 6W7 —
Date of Inspection
%Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes EYNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
tr�uc�turej 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -2,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E4 o ❑ 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 environmentalth
Eleat, 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 L 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2� o ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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
o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain AnyyYE&answers. and/or any-recominendations:or any other comments
Use'dravdn"gs of facility to better explain situations" (useXadditiona! pages as necessary) .MR = ',
Reviewer/Ins ector Name
p
u�
/�%I�+ !j �f %t_.g Phone T/O �`](- Y
Reviewer/Inspector Signature:
Date: f L—1 Q
Page 2 of 3 12128104 Continued

Facility Number: (� — Date of Inspection Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t"
Rain Inspections El
Weather
Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
El NA
El NE
25.
Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fait to have an actively certified operator in charge?
❑ Yes
LJ No
❑ 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
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
E!fNo
❑ 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 -
Yo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings: �=z4
Page 3 of 3 12128104

Type of Visit o 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1'� Departure Time: County: _#A).5l.Ak) - Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 14
1 '��•/�,� tt Title: Phone No:
Onsite Representative: i4AitV� yYrA� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] o =] ' ="
Longitude: [� o =' = "
Design Gurrent
Design Current
Design C►urrent
Swine IT aeity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I 1
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
DrY Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Nan -La Non -Layers
❑ Beef Feeder .
❑ Boars
❑ Pullets
ElBeef Brood Co
El Turkeys
Other
❑ Turkey Pouets
❑ Other
❑ Other
Dumber 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 E�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
W-b o
❑ NA
❑NE
❑ Yes
o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Q Date of Inspection
_Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA%4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2s
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
dNo
❑ 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
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
JNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
[Z/No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ENo
❑ 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
❑ o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El
o
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
LCJ No
❑ NA
❑ NE
C
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
E(No
❑ NA
❑ NE
�" ='�`X ;»eur•.r...•. l � fe -.;. � .� ,_^-"+, µ1r: '+.rr'l"r s+' - - t'�'°( -w.�;.v�... "�' �.� :.-;, � ..s
Comments (refer_to questton_#) Explain anyYl✓S,answerstand/or�any�recommendatronsarany illt comments.
Use drawings of facility to better explain stfuahons. {use addit►onal�pages as n c"essarv): y .«
qI
Reviewer/Inspector Name �— - ,�i/./ %�G -� Phone: 116 ! 3
Reviewer/Inspector Signature: Date: 0
Page 2 of 3 E 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
1�9. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes E, No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L/ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LS No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�'N,_Lo
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
o
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�'N
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[/No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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?
El Yes
�,/
El' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fait to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3 12128104

Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: do } rj Arrival Time: Departure Time: County: 869611 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: V6 NA LD
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i Longitude: = o = i
Design Current
Design Current Design Current
Swine. Capacity Population Wet Poultry
Capacity Population Cattle Capacity Population
❑ an to Finish ❑ Layer
❑ Dairy Cow
❑ an to Feeder
10 Non -Layer I
I
Dairy Calf
Feeder to Finish
3L-L4o-a
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non-ts ers
❑ Beef Feeder
❑ Boars
❑ pullets
❑ Beef Brood Co
El Turke s
Other
❑ Other
❑Turkey Poults
❑ Other
I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NN
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
VN
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: L=9 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VINo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structur@ 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (A%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L 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 E!fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
E No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L�J Co ❑ NA
❑ NE
- ..
Co nments (refer. toiqueshon #) Explam any YE5 answ ers, and/or a ny IFacme oi�s or a nv otlier com_ mentS."
Use dirawings:of facility to i�etter explainsituations {use aEddtttonal�pages asfneeessary,):-
.
�21) WASTE 4NAt Sf5 TO akr,-^- �i MI,40Z-Y P✓M P AldF 06fJ . 06 'f+/F Alf efl Ah"L
`
OA*. do edER- Me DY6 to TiM .ra F► TOO 6E Magf 1164EC.i oN
`RKZtjG-t
, ,hRf 6S. W aP D 0 C 5 J"JdT HAVE SG 0 and d✓J ,126Uf,
-Tf
doh 6C7
Reviewer/Inspector Name � � jo Phone: f/6 %
G 3
Reviewerlinspector Signature: Date: !
Q A
Page 2 of 3 I 12128104 Continued

Facility Number: Date of Inspection
%eguired Records & Documents �(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VJ 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 appropiiate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, the appropriate box below.
0Yes
El No
El NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard . Analysis ❑ Soil Analysis ❑ Waste `transfers
Zaste
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspection�Vpo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El NA
[3 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�Ioo
❑ NA
❑ NE
26.
Did the facilityfail to have an actively certified operator in charge?
Y p g
❑Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yeso
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L7 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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
U 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
0 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?
El Yes
BIN
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional. CommeQts. aadlor;l)rawings:
Page 3 of 3 12128104

1
Division of Water Quality
icility Numberul��j O Division of Soil and Water Conservation
-�— � — O Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Copliance
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: JQQ oi./ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 0 =' ❑ " Longitude: = o ❑ , = "
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
&_Z4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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 G
Cattle Capacity Pop
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑�No
❑ Yes
r N
❑ NA
El NE
❑ Yes
lJ No
❑ NA
❑ NE
12128104 Continued

i
�acilitpQ'umber: — g
Date of Inspection
WWste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 44/yun.)
Spillway?:
Designed Freeboard (in): 'LO
Observed Freeboard (in): _ _L{p
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?
El Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes El -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L
❑ 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):
31,E F"c wA" c„E116 -S, dF M M ""
w6k c: 2E c#" aF J Diu l� . f�g�6f�
� 7, Owl w„r: n� was Nd r
�vvTy'�.Z'F.a . �E E L f�IZa►l�� duNER wh S
SiV ?tw C C SS F 1-1.�c VCR t
ovrW 04 '0j1Aj P. �o rt�z ow,� nIG REEL 4T
Prufc;�rr-��
AfOr
w
Reviewer/Inspector Name
Phone: 47/O 416 ' Z3
Reviewer/Inspector Signature:
Date: D
r 12128104 Continued

Facility Number: b — [g Date of Inspection 3 !tolei I
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 210 ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 2/No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L2'<No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C RL
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Blio
❑ NA
[I NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
8'l�io
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[].Wo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑4o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 2,&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 0'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 9-TTo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑'gIo ❑ NA ❑ NE
Additional Comments andlor Drawings:
12128104

Wean to Finish
❑
Wean to Feeder
Feeder to Finish]—,;Finish]-,;5 Zo 1 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
eDivision of Water Quality
f Facility Number O Division of Soil and Water Conservation
I - - - — Q Other Agency
Type of Visit (7iCofiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: +i 8 bG Arrival Time: Departure Time: County: dAls Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: 1' Title: Phone No:
Onsite Representative: �& ►1 Nlv� &_Ed 6 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c = ` " Longitude: 0 0 "
Design Current Design Current- Desigt►.
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity ='
❑ La er ❑ DairyCow
❑ Non -Layer _ _ _ ❑ DairyCalf
. Dry Poultry
❑ La ers
Other
❑ Other
eDivision of Water Quality
f Facility Number O Division of Soil and Water Conservation
I - - - — Q Other Agency
Type of Visit (7iCofiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: +i 8 bG Arrival Time: Departure Time: County: dAls Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: 1' Title: Phone No:
Onsite Representative: �& ►1 Nlv� &_Ed 6 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c = ` " Longitude: 0 0 "
Design Current Design Current- Desigt►.
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity ='
❑ La er ❑ DairyCow
❑ Non -Layer _ _ _ ❑ DairyCalf
. Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
Number of Structures
3`
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?
h. 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[3<o
❑ NA
❑ NE
❑ Yes
LJ']Vo
❑ NA
❑ NE
12a8/04 Continued

Faciiity Number: 1 — Date of Inspection 1k 4
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: LA 6-v--b
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 WNo ❑ 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 th7at, 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 O/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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 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 E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;"o ❑ NA ❑ NE
❑NA [I NE
Rio ❑ 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
de,�.j W 09 DOW6 w �?CWA66 Leo yatVt, vi ZZ*jSPg;('1-rjj
Reviewerlinspector Name /`% Phone: fJ •'7dZ �/.�
Reviewer/Inspector Signature: Date: �
Paine 2 of 3 12128104 Continued

Facility Number: Date of inspection b
,r
4teouired 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 V/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ne ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ��/No El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes VNo
El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ NA ❑ NE
Other Issues
N
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E
[INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 yes
IJ 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?
El Yes
/
2 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑/ NNo
❑ 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
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure -Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: DO Departure Time: County: OIJSU k) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: , l Title:
Onsite Representative: _ 14 A d. ✓wC V RA i e
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
3 SZO I
3q:yo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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?
Longitude: 0 = ,
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
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 C6 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
Wo ❑ NA
❑ NE
12128104 Continued

f.�
FacilityNumber: — Date of Inspection 5 a S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: LA 6O-rJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes G6o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 12 No
❑ NA ❑ NE
'(Not applicable to roofed pits, dry stacks and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require ❑ yes
❑ NA ❑ NE
maintenance or improvement?
Waste Application
f
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ No
❑ NA ❑ NE
maintenarice/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ 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. Croptype(s) QEh'-I"-t/ oa CN) S G 0
13. Soil type(s) o/1 N o1S
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?
El Yes
VNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
L< ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
LJ ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
�v•} UPDkYC L.JUj' 4- oL4 rf.[.© juiAt. RGtL<S. ACREa
G k':>v ► LS.
o� cA L-W c.A_:±!iJ G �"o7a<a nn.� .N v 5 PL2
p�aa. Evf-NT, Ob 04((LAFF rCAT: o0,
Reviewertinspector Name JaPP fA-&4. 66I. "I Phone:(1/0) 311= jl9 xZZY
Reviewer/Inspector Signature: Date: fo(o

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check Q yes ❑ No El NA El NE
the appropirate box. ha/components
❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Doe record keeping need improvement? If yes, check the appropriate box below. E3 Yes El No El 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 [)No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ , o ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ( No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ElNA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
VNo
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
ElYes
Ueo El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

A.Yi. oa:6 TTater Qn,,�,ty.�
QpDtJ.
ViSf�11'Of SDfi��aIId Wide On
s Caii ervatji
_
Type of Visit J' Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
FFacility Number
Q Not Operational Q Below Threshold
,
(Permitted 13 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... .._... ..
Farm Name: ...... 11.............. - - — County:
Owner Name:....._._. ...1........ V.4. ... .......................................... Phone No:
Mailing Address:.. .__.. .
FacilityContact: ..............................._. Title: ........ ............ _.... ............ ..... ............... ...... P ne No: _.....................................--.......
Onsite Representative:..,..... �.......„�.... Integrator: ... ........w
Certified Operator : . .... ................... L. _ ....____ .. ....-----•--... Operator Certification Number:.........
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude i6
- Design ;Current` � �Design �Cnrreni
-CWiRP ,.'.iA..
Wean to Feeder
❑ Layer
Feeder to Finish,
❑ Non -Layer
Farrow to Wean
_
i - - -
❑ Farrow to Feeder
Other
❑ Farrow to Finish
` � Total Desi�
fr €
❑ Gilts
2'r
'I
Boars
Longitude
�` � z ' Design Current
.CattlePolaon
❑ Dairy
❑ Non -Dairy I I I`
;n Capacity
ot31'SSLW.,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes Iio
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes /No
❑ Yes /No
Structure 6
Identifier: _._........ _W .. _.... �_.......--- ............... ........ _.. ........_.�......._...
Freeboard (inches):
12112103 Continued

r
acili*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 XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 9No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes f"No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 1XNo
❑ Excessive Ponding ❑ PAN Q Hydtaulic Overload ❑ Frozen Grounds ❑ Copper and/or Zinc
12. Crop type y�Q
13. Do the receiving crops differ with ose designated in the Certified Animal to Managemen lan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IONo
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 gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 06No
Odor h sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 fd'No
Air Quality representative immediately.
Comments (ie€er m gneshon ) Eacplaiu any YES: answers and/or any recommendadons or any other comments:
-Use drawings of facility to better explar3u stdsabons: (use a"iiona! pages,as necessary)y ❑ Field CoPY ❑ Fina] Notes
r
���v�,e •q� elLewl'50 00�O
.��sa
Q All
Vo
y u r I ,Ytt. /V�fO tof_ R
4u,
�vr►
F v � �itorn Z� � 3 3
fo
ar V�i'i/
7
Reviewer/Inspector Name j� a y -ter
Reviewer/Inspector Signature: Date:
12112103 -- —� - Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes 11 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 P No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
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 j No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes /VfNo
28. Does facility require a follow-up visit by same agency?
❑ Yes No
l��No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
J7�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 XNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes )f No
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.
gYes ❑ 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 will receive no further correspondence about this visit.
dditioeal-Comments and/or Drawings
JA
A1,94X 6q
'7he'a'445 NJ66�7
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4do �Ipw -
12112103

Type of Visit jerCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason far Visit 0 Routine 0 Complaint Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facitity Number I hate of Visit: O Q Z Time: --a5
rO Not O erational 0 Below Threshold
❑ Permitted ❑ Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: H -b (2 Fa.1 County: Opt-y1 e w
Owner Name: Q r✓e % �Q �c Tr Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: l► n n `'1 ' t Integrator: C ce f rp l'r
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 I u Longitude '
Design "Current
Swine_ w _['inanity-PnntilgtiAn 7 Pa
❑ Wean to Feeder
j
❑ Feeder to Finish
j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
I
❑ Boars
Number of;Lagoous.
`Hoiding Pon ds"! Sohd Traps'
Design Current, - Desrgn Current
v _.- .0 acity� Po latian Cattie _m- Capaci6-.' PopuwU-,on-
Sprav Field Area
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? El 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 S Structure b
Identifier:
Freeboard (inches):
05103101 Continued

1
Facility Number: r] — 18 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? El Yes El 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 anv of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Pending ❑ 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 wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU'P, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
12"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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'Commenti4refer to uestron # -� Ez - ._any YES snarlers and/or any, recommendations or any other;comments.
sdsttan(sadhonaiUevsycfh.pages,as ttteessary) Copy ❑Final Notes
z❑Field
�� � J Yv1 ��-� i ✓L q Wa J] i"� ' �'� }� Y` . IG � ✓� A VtOt /1i��►'U141 �Cx {�[ �� � � �
O n 5 l o L- , 4 4 aJ d , jr it S S at,
Reviewer/Inspector Name s �'1¢'LvAR
Reviewer/Inspector Signature: Date:
05103101
Continued

Type of Visit AC� Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: '� O Z Time: 3= 3
Not O erational Below Threshold
Q Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 14 1� F_ T:; I At r County: On Sloes
Owner Name: fl al Je `7 !'r ttL �l g ��L1 c) ►r Phone No:
Mailing Address:
Facility Contact: /� — Title:Phone No:
Onsite Representative: Aa _e V ¢ � jig% hG j c,y c! / U41ln n V h � Integrator: CA -' 1-4) � s
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude a 4
DischarLyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier: I —
Freeboard (inches): 3
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes JONo
Structure 6
Continued

Facility Number: — l S Date of Inspection 2 D74
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 5Yy1.4 A ' a. z 'n
13. Do the receiving crops differ with those desi aced 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 or other 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 ONo
[--]Yes ,�'NO
❑ Yes .2mo
❑ Yes ,ffNo
❑ Yes �No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ONo
❑ Yes ONo
❑ Yes �' o
❑ Yes ffNo
❑ Yes XNo
❑ Yes ;3"No
El Yes OJNo
❑ Yes ffNo
,ayes ❑ No
❑ Yes ff No
❑ Yes ,�No
❑ Yes P3"No
❑ Yes VerN o
❑ Yes ❑ No
0Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
gC moments (refer to quae on # E, in any YES antes w ers andfar any recommeudafton`s or any other
Use drawings of facility, RARE exphuntsituations. (use addrtionalypagea.as inecessary} ❑Field ❑Final Notes
COUP
/47. Week, A-eebeand ►cte,•dS Av-e fie;ec; k&919 ".
¢Acy need _A0 6e kP� Also, pleu-4-e Use Ae
PAN AIIOG✓C'nCP Or .305 11—clacue on pvllf l-/(o q"d4
325 4rRG,'c 0t1 'Pvl! )7.
Reviewer/Inspector Name .-�OhseWai IA j
Reviewer/Inspector Signature: Date: .'% —
O5103101 Continued

Facility Number: — Date of Inspection V
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes _Q'No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ff No
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 1'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'ONo
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes -J:'No
,Additional. Comments and/or Drawings.:
i
�VIl 1 is S dw►. in 4ke �rr^,'C�Li-1,�or des,'9,1 1f
GirGle 4keow. %yfr, Wha7 SG,ia( �h4-1 ►� :r �rese►l-l/y
Opev'A4ed eis A .1.11 G;r'LlP Iyir• Whg;� seeds
T a Ian I^e-4 Tj4 xis4g4 ice Aiv;—j A
acreA a n(e�;�eo� f �h�� s �'vll G;✓GIp • when kwve
G>tc�BrMr �n¢gr Acreagt qhd keen Ae ca��l►"ca�;o� ret;ords
Fa! �Ttf� rV11 Gt Cce dr''^ -)D 41,P p,�¢.•M;�e�( olri�P �'
'T�e.-e ,•S eA row.; •�e.-\k- d✓Cti'�rhG
4c �ec�Vie ,ri -AL- -AL-GrCr,
l e-ve . /)7.•. W km l r-y LJ Jn 41A /;,ke -10 AA vx-- a
v iI OCC e-' e i"Cr 1.5 'tl\c.4 iJ"NG46rpe"01-k.S -JAe Afc'Cr Or
Pot 16 a.-`e( doerhcip P"'Ort' cewa. t►'1r • Whetle'� /)weds �o
c on4c,c4 e D;1�r-'c-1 ie d,'tcv.5S ykc-Se rk'OfPSA/I - Pe, rkAe
S, ff w% 42 e o t l d be done 4 4t e d ra ; ,.,q7 w^ 7 Ao rise kc
� 4 r%64 tN/;4k 44e b,�4
41, ; s' needr 4o be sv�e��,'sed 6 % -Ae
of.Ge.ld
•-Fa y►'ta -1 c L� �'ti.e ; � ar i 9 a -�.' o n pI e S i y y, -� kl o` �-fe P IA+v1 ,
A) c-4 e' e3+ 1 "Ld -1' h% 4 S 6GG''ti ✓i !!'
An6l rrcorofs Ore well keno1, F
05103101

Type of Visit 3� Compliance inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number 8 Bate of Visit. — G 1 Time: Go
0 Not O erational 0 Below Threshold
Permitted C7 Certified E3 Conditionally Certified 13 Registered Date Last Operated or A ove Threshold: ......................
Farm Name: ......................._ 1�1(1....................................................... ... County:................
_ Q...........a!'...................................................
Owner Name Phone No:'�,,,r3S��
..........................................................
FacilityContact:...............................................................................Title:............... Phone No
MailingAddress: ........................................................................... ..................................................................._..........................._...
..........
.. .......... ..
Onsite Representative:.! Q...�._........................... Integrator:........�,!r!�p�S..................................
�...
Certified Operator:................................................................................................................ Operator Certification Number: ..... _............... ...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' 11 Longitude ' 9 '1
Design Current Design Current Design Current
Swine :Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish 3 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total. Desigp Capacity
❑ Gilts
El Boars Total`s. W
Number o€Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Ponds / Sohd'Traps : ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes gNo
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes kNo
01/01/01 Continued

1
dr Facility Number- 4i— 8
Date of Inspection a r] o
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).............3.3............................................................. .......................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
,KNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
j�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
NfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N[ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
9No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crop type �,o. 51 v..t eiilQ►�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N('�40
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
f'No
b) Does the facility need a wettable acre determination?
❑ Yes
15�No
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
[XNo
17. Are rock outcrops present?
❑ Yes
❑ No
18,
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
R_eguired Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
t<No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
K No
(ie/ WUP, checklists, design, maps, etc.)
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
53"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
qNo
26,
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
ONo
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KNo
01/01/01
Continued

r
Facility Number: Date of Inspection Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not Iocated near the liquid surface of the lagoon?
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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[:]Yes ONo
❑ Yes CO No
❑ Yes ONo
❑ Yes O�No
❑ Yes 9No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
�JClR1AW '�y7.Ui l7![.!!!Lx W UCLLCf CxtllAlf! SIWdEiV!!J (<WC YIUUILlUII}!! }IASCJ 241 11CL.CSJilC�'f - -,
❑Field COPY ❑ Final Notes
t ` L �,
l\�cr�-Q ► 1—''�c:.� �h�s�� rs2-�-..LJr�i� t,.�-� ��`�b�.s�. � t�'r+r� ��-i�.�
CLAJ)
01/01/01

- E Dtvlsion of Water -Quality_
O Dwisi in of Soil and Water C6nservahon
-O Other;Agency:
of Visit Uompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up () Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 1 - o -f I Time: I0 : 6D Printed on: 10/26/2000
O Not Operational O Below Threshold
Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold
Farm Name: ........ ... ......1y.......Fr-aw..'X.s...................................................I........I.... County:......... d.y%..SkM................................ ..& ...............
Owner Name:......~�1......................:........lN..4.l.Arl....IC�.......... Phone No:.l� 1..1..�...�...-.9L 3 7...............................
FacilityContact: ............................................................................ .. Title:................................................................ Phone No:...................................................
I
Mailing Address:....v��� f'.. .......�7 'l'1'`:..�...�...`....... .............. � ,f.. e................... ..�.7 D 3... 4....... t........
Onsite Representative:.......47. ! ....................................................... Integrator: ............. ...5......................................
Certified Operator:
Location of Farm:
Operator Certification Number:
[I'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 16 Longitude • 4 «
Design Current
Swine Canacitv Population
❑ Wean to Feeder
[� Feeder to Finish
ya
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I JE1 Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ElSpray 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 galhnin?
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
Sp-uiture I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................
Freeboard (inches):
5100
Continued on back

facility,;jVumber: & 17— Date of Inspection F /—bG 797 I Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[:]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 structures require maintenancelimprovement?
❑ 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
j j Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
' ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (icl 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?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
defici h iic smerenoted-d&ingfbis:visit:•'Y:oiiWiii•Teceiyeiidfurther
correspondence: ab' 6f thLNish ... • . .......... ...
Colin ents'(refer to question #): Explain any YES -answers and/or any recommendations or any othei__coeunents.,. ,
Use:drawings.of facility to better euplain situations. (use additional pages as.necessary)-
'D W �,.�-.,.- D,� Icv<► S �,1 i-- v.1 �.� � tw: o,,,�.,,,.5 w, 1 � o � , �'+�as
"i's,_
L t- L' r rc o(_ �j Q -M u
.+
i rvOX +- W a..s v 1 _ -6 S wr-4v c.t_ �. �c fs 1 W s v # 41,4 ram— _
'5T3 ^G-V aaLLn,n." tw"" o - t�' -P ttd _ T• ad,V1 Scy i'Y4, y—',. r. rv;�Yh
Reviewer/Inspector Name r— 7 ' r 'i_ __:7
Reviewer/Inspector signature: Date: I— G_ d l 5100

Facility Number:_ 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 aJor 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.'Comments:and/orDrawings: ,
U ai V i 4 1 r,-a� V Q„�. �( l PAC 01
r k+ l 9 CIL41_111.) rA-- A Ls o r Ic-� P �,ond b
.t_ G-r- h OtGiL Ot' S �, 5 I I-W OLV t -A S �
�6
yJ, Lla-� v w� t-er� �J �..-W Sj�v,�► �wt.t_ ►� i S
U �+
IVIIr
A-w; Yam"- OV-1 "W-C,
v)3fi5 - 3e)0-0� Zz�
t� a sD c�c 4e,_,� 4, b--s,_ s c w-k)
J
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numbe 69 8
Farm Name: Wv,
On -Site Representative:
lnspectorlReviewer's Name:
Date of site visit:
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility items) F1 F2 .F3 F4
J Operation not required to secure WA
determination at this time based on
exemption E1 E2. E3 E4
Date of most recent WUP: ,�—kO _Lqy Operation pended for wettable acre
determination based on P1 P2 P3
Annual farm PAN deficit: pounds
Irrigation Systern(s) - circle #:Qhard-hose-traveler, 2. center_pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
V E1 Adequate irrigation design, including map depicting wettable acres, is complete
w and signed by an I or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ili. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part if. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational fable in Part 111).
PART If. 75% Rule _Eligibility Checklist and -Documentation of WA Determination
Requirements. WA Determination.required.because-operation fails. -one of.the.eligibility
requirements listedhelow:
_F1 Lack of ac.reage;.whichTesuftedin:Dver:application�f-wastewateri(PAN) onepray_.
f eld(s) accordingrtofarm'siasttwoyears:of rmgaton7ecords. --
F2 Unclear,rillegible,--or lack of information/map:
_ F3 Obviousfeld-limitations -(numerous Bitches;failuretto-deductTequired-
buffer/setback:acreage;mr25%.of#otal:acreageadentifiediriLAWNIP-:iricludes_ _
small; irregularly-shaped_fields fieIds-less-fhan 5:acresfortravelers:oHess fhan
2 acresfor.:stationarysprinklers).-
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table.in Part III.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination oT 75"/o Exemption Rule Tor WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD I COMMENTS3
NUMBER I NUMBERt'2 IRRIGATION ACRES ACRES oxl
SYSTEM
FIELD NUMBER' - hydrant, pUll, zone, or:point numbers may be used in place of tield numbers depending on CAWMP
and type of irrigation system_- If pulls, etc. cross -more -than -one field, inspectorfreviewer will have to combine fields to
calculate 75% held by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be ciearty delineated on map.
COMMENTS`- back-up fields with CAWMP acieage:exceeding75% of its total:acres-and havingreceived less than 50%
of its annual PAN as -documented in the farm's.previousfwo years' (1997 & 1998) of -irrigation -records, -cannot serve -as -the
sole basisforrequiring a WA Determination.-=Back-up:fields-must be -noted in the-commentzection7and must he accessible
by irrigation system_
Part IV. Pending WA'Detenminations -
P1
Plan :lacks :following information:,
P2 Plan -revision -may_satisfy7.5% rule based on adequate overall PAN deficit -and by
I. adjusting all field:acreage:to-below 75% use rate
P3 Other (ie/in process of installing new irrigation system):

Routine O Complaint O Follow-up of DWO i
of DSWC review 0 Other
Facility Number I Date of Inspection 11 pcj
Time of Inspection I
® 124 hr. (hh:mm)
Permitted [] Certified 13 Conditionally Certified E3 Registered JE3 Not Operational Date Last Operated:
--R
Farm Name: ........... ..............................._........................._......................................................... County- ''
•................................................................................
Owner Name: - Phone No:
-- ------------------
FacilityContact:.............................................................................. Title:.................................................... Phone No:
Mailing Address:............................ ..._..
Onsite Representative: , n,L i�-�'� Integrator: `
---••....................................................................................�'�'` Q....`...................................................
Certified Operator-..... .... I ...........................................
Location of Farm:
Operator Certification Number:
Latitude 0 4 j !GC Longitude �� �4 «
..Design Current
$wine CaPaMtY _ Population Poultry
❑ Wean to Feeder
Feeder to Finish
3
Farrow to Wean
;'
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
[) Boars
Design - Current
n Cattle .Ca act :" Po ' ulation
1 ° 10 Dairy
=j❑ Non -Dairy
Number of Lagoons ., ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid,. _ .Traps'' '. ❑ No Liquid Waste Management System "
a i it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If 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 9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes N No
❑ Yes ,NrNo
Structure 6
Identifier:
Freeboard (inches) : ............B..
..................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P(No
seepage, etc.)
3/23/99 Continued on back

)Facility Number: - $ Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type V_� IN Ck
❑ Yes P No
❑ Yes XNo
'Yes ❑ No
XYes ❑ No
❑ Yes 'dNo
❑ Yes V No
v
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P�No
b) Does the facility need a wettable acre determination? ❑ Yes 5No
c) This facility is pended for a wettable acre determination? ❑ Yes EfNo
15. Does the receiving crop need improvement? ❑ Yes J<No
16.
Is there -a lack of adequate waste application equipment?
❑ Yes
gNo
Required Records & Documents
17..
Fail to have Certificate of Coverage & General Permit readily available?
j9Yes
❑ No
18.
'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[�:No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
MYes
❑ No
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,R'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Mlo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
)qNo
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes_ro
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo-_
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
9Yes <EVINGN.
El-N-0-yiblalki0ris
Ar dgficieitcies were nbtea• during #his:visit'. • You will i eeeiye iio further
Comment {refer to question #)-Explain.any YFS answers and/or any reco'mmendatsons az any other comtnent9 >e a
GAG" 11us.� �1ILI
e+- +..�1, \ � -ta� �s G�� lot,-
Reviewer/Inspector Name
t
Reviewer/Inspector Signature: Date: S 11-00

Facility Number: Date of Inspection
J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
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 ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fi� No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [�(No
- ! jp_m Uli n7B1C_nts an Or' rskv gS ,
-•.�� ._
V r����l �`��\ � �Q CQh)
* rc!
�- Gam►-+-e�- Cr�'_-�—+-�. � ��'� �-� +-e��s-e 1��1�e
J o A, .
j1
P
--- ►r..r- CGC Laotl�
r

0 Division of Soil and_Water'Conservation Operation Review
j.a_ ElDivision of Soil andWater=,Conseryabpn, ;Coirigliance Lspectioin r t
J&© vision of Water Quality _Comp! anise Inspection = � v
0 Other Agency - Opei-auon;Rev�ew -
x T' -
� d
10 Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number j 8 Date of Inspection
Time of Inspection r,� 24 hr. (hh:mm)
® Permitted 13 Certified © Conditionally Certified [3 Registered 0 Not Operational I Date Last Operated:
Farm Name: ....H...k D....��....FARMIs....................... County: ................. x.Z.0.....
Owner Name:
.......14ARV9,q..... h.......1/. lf&.e.�.......�.R.............................. I...... Phone No: .�i.�.9-.".% L.. q Z. :7....
FacilityContact:.............................................................................. Title:.............. ................................. Phone No:..
Mailing Address:....?'-]... ....._C. E1 .y u ...... AO RTI ............................. ... iZAw. 14 1�.......... `.!.......... ............................. a 76 bJ� .......
Onsite Representative: ..... .........................'................ Integrator:.....G.A..Z ..........................................................................
Certified Operator: �1RRvE�I N.,IN. ...,\N;iAl_ 1/ (2. Operator Certification Number:,,,.� ....................
Location of Farm:
9F__5R..1..5 Q..... AJT!? :54t.:w..... F.... s ....1.: p.......................................
f............................................................................................................................................................................................................................................................. ............� ;
Latitude Longitude .3 d ' 0«
Design Current Design Current Design Current
Swine Ca acity Po ulation Poultry Capacity . Population:-: Cattle ty P
Capacity Population
❑ Wean to Feeder
® Feeder to Finish
Zp
-2'900
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
IF: Layer
❑ Dairy
.
❑ Non -Layer
❑ Non -Dairy
❑ Other
-
Totai Design'Capacity
35z o
- .-Total. SSLW 4 75 Zc�
Number of Lagoons ❑ Subsurface Drains Present Magoon Area ❑ Spray Field Area
Holding Ponds /,Solid Traps ❑ No Liquid Waste Management System
.;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gat/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
Identifier:
Freeboard (inches):. ._.._._..C2,0................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes ;No
❑ Yes ❑ No
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? (ie/ trees, severe erosion, ❑ Yes kNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 7 — 18 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 666
(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 too*
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 4N0
Waste Aaolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type Overs"'I t.clil4z,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes &ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J`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?
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 bWQ 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?
0: NO. , olatioris:or• deficiencies were pgted during this.visit.- Y;oik will-t&6ye Rio further
Correspondence. abaut this .visit... . .. .. ..
❑ Yes ❑ No
❑ Yes tl No
❑ Yes &No
❑ Yes �rNo
❑ Yes t�No
❑ Yes ,�flo
❑ Yes
❑ Yes VNo
❑ Yes VNo
❑ Yes WNo
❑ Yes kNo
Coirnments..(refer to question,#) :'Explai6i any YES'answers and/or any recommendations or any othu comments:"
Clsedrawings offacihty to better explain`situattons (Use additional pages as necessary)
- rom 4 �t 1 jP, „e,
Reviewer/inspector Name [J' 77-
--
Reviewer/Inspector Signature: y/� 1 Date: 11130
3/23/99

Facility Number: — '& hate of .Inspection 3(?
odor .Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )j�rNo
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 "�60
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 410
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes fi No
3/23/99

V/
Lagoon Dike Inspection Report
Name of Farm I Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
H & R Whaley 67-18 Carrolls
S9 1301
9 / 29/ SO Names of Inspectors Pali A Grogan
Janet Paith
_ 11.4' Freeboard, Feet IS"
2.5 Top Width, Feet _ 10
2 to 1 Downstream Slope, xH:1v 3 to 1
Yes X No
Yes X-- No
Yes X No
Excellent - Brass
Yes X_ No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X_ No
Engineering Study Needed? Yes _ X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes ,X _ No
Other Comments La&Qon,got within 2" of the top but no gt L=al dam -age

Lagoon Dike Inspection Report
Name of Farm / Facility _H & R Whaley 67-18 _ Ca oils
Location of Farm / Facility _ SR 1301
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:l V
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
{ Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors Patrick Grogan
Janet Paith
11.4' Freeboard, Feet 15"
2.5 Top Width, Feet 10
2 to-] Downstream Slope, aH:lv 33 tQ I
Yes . X No
Yes X No
Yes X - No
_ Exct-H of - crass
Did Dike Overtop? Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes � X No
Engineering Study Needed? Yes _ X _ No f
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _X_ No
Other Comments �l agooia &ot within 2," of the top but no structural dame

w
13 Division of Soil and Water Conservation 0 Other Agency'
a ivision of Water Quality
10 Routine O Comblaint O Follow-uo-of MVO insoeclion O FOIIOW-un of DSWC review O Other 1
Facility Number
Dale of Inspection Q
Time of Inspection 24 hr. (hh:mm)
13 Registered 'Rilfrtified Applied for Permit E3 Permitted JE3 Not Operational .1 Date Last Operated
Farm Name: .... f71t]Pi. r'ii�/�A. .... -�� ............. county: ......... D&S.L,.44.2........................................
Owner Name:...., )..4.CyK5 .......lilJl!f&61V..... !................................. Phone No: ........ L..l...l........
7.7. a.. ......
...I.r .. .....
FacilityContact: .Q..f� N....y�..1�4. L:N.4........................ T,itlee:p...........�.................�...................................... Phone No:...................................................
14fai1ingAddress: ..5... .Ip. ....1r1.�.GM.`.!l}....F'lQf4P..I1.....Ilra......K(�1.P�.Vi......N.�c... .7/,vd..5.......... ..........................
Onsite Representative:.... o.1.-j,N!�.... k!.0.6.................................................. Integrator:......................
Certified Operator*, ....... 941eq.....WA&&q........................................... Operator Certification Number,.....
LocationofFarm: Snii`%!ia�.,�c.l..rt� _SP /z/n 1APAev .2P, 1
'Latitude •' 0" Longitude. �' �"
General -
1. Are there any buffers that need maintenance/improvement? ❑ Yes b3110
2. Is any discharge observed from any part of the operation? ❑ Yes P( No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?: ❑ Yes C[allo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes W!No
c. If discharge is observed, what is the estimated flow in -al/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes tLINo
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes �No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes gNo
5. Does any pan of the waste management system (other than lagoons/holding ponds) require Yes*No
'o
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes h'o
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes kNo
7/25/97
Continued on back

• Facility Dumber: —
8. Are there lagoons or storage ponds on site which need to be properly closed`?
Structures (Laeoons.11oiding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (#'t): ........... l r... /..............
10. Is seepage observed from any of the structures?
I L Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes XNo
❑ Yes To
Structure 5 Structure 6
❑ Yes t?^:1`0
❑ Yes o
12. Do any of the structures need maintenancelimprovement? ❑ Yes -tq No
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. ............ ..................... ...................................................................................................:....._..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
IS. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'.'
0�-Xfl violations or deficiencies were,noted during this:visit..You will receive no further
-correspondence about this_visit:. ; - " -' : � � � � � ... .: � .: � � .. .. . • � . � � .: � . ' .:. • � � .
❑ Yes
❑ Yes , f'No ..
❑ Yes Q No
Cl Yes 3 ' ;O
❑ Yes )RINo
❑ Yes �5No
❑ Yes ;�\To
❑ Yes �QNo
❑ Yes �'o
❑ Yes LTNo
❑ Yes�No
❑ Yes `Lo
Comnients;(refer to question #) Explain aoy Y`ES answers and/or any recoi imn ndattons or any, other 1corn etits.
Use'drawings of facthty to be#terexplain `situarions (use addttionat piiges as necessary}. a E
- -- _
0.1
7/25/97
T
'
Reviewer/Inspector Name .�. w..;
Reviewer/Inspector Signature: Date: U S

'.® Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection -13-
Facility Number ��—��'--�
Time of Inspection Use 24 hr. time
Farm Status: — L,
Total Titre (in hours) Spent onRe%ieiv Z-S
or Inspection (includes travel and processing)
Farm Natne: _q _ �4,90 l 5 County' _.... __ . . _...
OwneriVame•. Phone No:
Mailing Address: !9 N Aly,
Onsite Representative: Integrator: C!2ggg
Certified Operator. _ Operator Certification
Location of Farm:
Latitude �• �� �� Longitude
❑ Not Operational Date Last Operated:
Ty-pe of Operation and Design Capacity
: Swme``4
:Numbers Poultry _nAnber
. Cattle Numlief E < 3
❑ Wean to Feeder
`'; 0 Laver
' ❑ Dairy 1
eeder to Finish
7j� 0 Non -Laver
❑ Beef '
m
Farrow to Wean'
Farrow to Feeder
i
Farrow to Finish
. ❑Other Type or Livestock
`Number of LsQootss f Holdsn Ponds r ❑ Subsurface Drains Present
"y,«
1Yd� t 0 Lagoon Area'• ❑ 5p rav Field Area 4
General
1. Are there any butlers that need maintenance!improvement?
2. Is any discharge observed from any part of the operation?
a- If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Surface Water? (If yes, notif} DWQ)
c. If discharge is observed, what is the estimated flow in gaumin?
d. Does discharge bypass a lagoon system? (If.yes, notify DWQ)
;. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mzintenance/impravemeat'?
❑ Yes 5'No
❑ Yes No
❑ Yes No
❑ Yes Rj No
❑ Yes
0 No
❑ Yes
No
❑ Yes
No
Yes
❑ No

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes 011\10
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/1/97)? ❑ Yes R..rIo
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures_{L,agoons and/or Holding Pondsl
9. Is structural freeboard less than adequate? ❑ Yes IM No
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
1.3
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
11 Do'any of the structures lack adquate'markers to identify start and stop purnping Ievels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.- Crop type ? � Z_ -- —
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only- -
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewl'inspection with owner or operator in charge?
❑ Yes Q6To
Yes ❑ No
❑ Yes ONo
❑ Yes ER No
❑ Yes UNo
z Yes ❑ No
❑ Yes RrNa
X Yes ❑ No
❑ Yes VINO
❑ Yes R No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes R No
❑ Yes ❑ No
- '.0 Yam"• p- - ,y. v - -. �Z '1^.A•".`.^ -. -
Conimeuts�refer to questton_}n Explain an�r YES ariswers:and/or anyrecammendaitans or` any Duller comments
'� �=x�2e':: " ,r .a'-"�3» .off^kWo:av- ..m,^°%
Use d>awiQQ&f r to better exgiatn srtuatrons use'addtflonal gages°as necessary)
yf�)'ri.�- Z. �5 L �1 U� %� < <CG ra��GGi � •TOj�jl�! ccr� ��- CJ�v�- `J-t•!„dj Q
�"� ,L1r,YJit3�rrr�li L,^vp . � js � �� .fir✓'-S� mc�►2 � v�� o�
a
�.
;�:-
Renewer/InspectvrNartte ,;,=-_.-^....-`*
Reviwer/fnspector Signature:
Date;
:�3'A--I
T
cc. Lrvrsran of (rarer guarrt3, water Llrtamy.3ecrron, r'aerrrAs3es-3mcnc untl 111141W)

Facilitv Number. (;7 -
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: 9 - 3 -q h
Time: %'Sf d�
General Information: l
Farm Name: /-/"f 04 'rQR' u 5 County: SL _
Owner Name: Zvi ti Gt/A 6A4 Phone No:
On Site Representative: - Integrator:
Mailing Address: 131 AA; eft. Ave- -
Physical Address/Location:�lLZ 310 4 v aivx 67, g
Latitude: I 1 Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
C] Sow ❑ Layer ❑ Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
Feeder 2, SZ.a
OtherType of Livestock Number of Animals:
Number of Lagoons: I (include in the Drawings and Observations the freeboard of each lagoon)
Facility I ection:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes d
No ❑
Is seepage observed from the lagoon?:
Yes ❑
No JR
Is erosion observed?:
Yes 14
No ❑
Is any discharge observed?
Yes ❑
Nod!
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No V
Does the cover crop need improvement?:
Yes)q
No O
( list the crops which need improvement)
Crop type: C a&Aet f2c-/MaA Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑
NoA
Is a well located within 100 feet of waste application?
Yes ❑
No 14
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
No iL
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
Nod
AO1— January 17,1996

Maintenance
Does the facility maintenance•need'imprdvement? Yes No ❑
Is there evidence of past discharge from any part of the operation? Yes ❑ No 91
Does record keeping need improvement? Yes O No a
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ NoW
Explain any Yes answers: - /� ,-, , ,��� s h. Z Z 7,G
10,
�va.�.� rrrt�n ro'z� /�f+ /� ! �•t! t��� ram, Tca�s SDI t��
Signature: _ _ _ �.— Date:
cc: Faciliry Assessment Unit Use Attachments if Needed
Drawings or Observations:
AOI — January 17,1996

Facility Number:
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record �41
Date: tl 3l
Time:
General Information. -
Farm Name: m s County: ✓ o., i
Owner'Name:-_A4,e 6 'i r Z R ` Phone No:
On Site Representative: `A : integrator:—
rrY t 11 z.J r
Mailing Address:_ '131 wY,.fiw4^'.e F t
- G4sfi�1�-,••�.-�. nib ��r��� • '
Physical Address/Location: L et)Z
Operation Description: (based on design characteristics)
Type, of Swine No, of Animals Type of Poultry No. afAilimdls - Type of Cattle No. of Animals
❑ Sow a Layer 0 Dairy
❑ Nursery ' 0 Non -Layer 0 -Beef -
Uleeder _ 35'2V
OtherType of Livestock Number of Animals:
Number of Lagoons: i (include in she Drawings and Observations.the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?-.
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed.?. f _
0 Man-made ❑' Not Man-made
Co ver Crop
Yes VY No ❑
Yes ❑ No G)-'
Yes 2' No ❑
Yes a 'No �
Does the facility need more acreage for spraying?: ? Yes ❑ No
Does the cover crop need improvement?: Yes ❑ No Qr'
{ list the crops which need improvement)
Crop type:(g144, %gr�.�t �- Acreage:- - -
Setback Criteriz
Is a dwelling located within 200 feet of waste application? Yes ❑ No G�
Is a well located within 100 feet of waste application? ,_Yes d No 0
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes ❑ No GY
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes ❑ No.
AOI -- January 17,1996

L1 i
Maintenance
Does the facility=maintenance need'i p vement?
Is there evidence of past discharge from any,ppxt of the operation?
Does record keeping need improvement) e
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Explain any Yes answers: ui► hir fteA-c- d . ;- '
FNCaSs 5... = D ti dA-
cc: Facility ss ssment Unit
Drawings or Observations:
Yes 61' No ❑
Yes ❑ No G�'
Yes ❑ No ❑
Yes ❑ No ❑
Date: 3
Use Attachments i f Needed
1.,,�.r. •9-�rrie� �,�, sd F�11 Lim
lam(" fi L,,-- r4- A42-+-,
76
Q/ S• I s r Si 4�, .E-p c"?1 r f`.,.� �r ;.� S +�'e'4?"r''y fw
S zySa�l � r1 F % kw, C1l/'r O'�^
D��Q
-- January 17

wd v
N.C, DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
Cs
WILMINGTON REGIONAL OFFICE
Received by: 6,e 5_6,5 v
maAte/T/ime: g//a a`9 (� 1 S 4�
Bblergency. amwlaint: County: CJ" ltr�
Report Received FY:X=: -1'0yx �z
Aster: ,A/ 4FC S Phame No. f2z Y j .r- V 7d__
Cowla f nan t :
.. • ..,. -
" A
T'i and Date Occurred: 2. L - �' Ce
Location of Area Affected: Sic / 3/d NA yr Zckt1& x dS . �� ---
Surface' Waters Involved: Groundwater Involved: Other:
Other Agencies/Sections Notified:
Investigation Details: ��.L (/. Sri �i-Z 3 - S� . A4
ee� G �/�.. 7d' i/fees-� �nl /s///1• •�•� _tla JI1 �a5,46�%0
`7!!y L/�f'�� '/' J !CS /!! rJ. Gld.lJ /iKLO!/�J� /•�f%1 J/�� /A7 /-�l•57
.d/v
Investigator: -Date:����
EPA Region IV [phone] Pesticides 733-3SS6 Emergency Management 733-3867 WrTdUfe Resources 733-7291
Solid and Ilaurrdous Warts 733 2178 Marine Fisheries 726--7021 Water Supply Branch 733-2321 U.S. Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

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Site Requires Immediate Attention:
Facility No.
DfVISION OF NI VIRONMEN- TAL MANAGEMENT
ANIMAL FEEDLOT PERATIONS SITE 'VISITATION RECORD
• D TE; 2, , 1995
Time: Z
fVep_(! -
Farm Name/Owner, r' 491,G V N i A ) A . v H
Mailing Address: 13, WH ' AN V
Lj
5.11-+�;
County: r9 &( "_otAJ
Integrator: Phone: `i!o
F G-
On Site Representative: l�r� j(i I/� � � - — y r Phone: 1 t D
Physical Adtriressa ocation: i�►cti L.4+s (om�Q•t- Rd - d Z (n , l e s
Type of Operation: 'Swine
I Poultry Cattle
Design Capacity: Sa.
Number of Animals on Site: 3600
DEM Certification Number: ACE
DEM Certification Number: ACNEW
Latitude: ` S- ' 2Z•R „
ngitude: �? 31 o �' �� Elevation: D Feet
Circle Yes or No.
Does the Animal Waste Lagoon have
tiff cient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
or No Actual Freeboard: o-- Ft._ Inches
Was any seepage observed from the
goon(s)? Yes oC o NVas any erosion observed? Yes a
Is adequate land available for spray?
es r No Is the cover crop adequate?�esr No
Crop(s) being utilized: Gc-��
1 /1't.w� �•r--��2�.
Does the facility meet SCS minimum
setback criteria? 200 Feet from Dwellingq Y-e or No
100 Feet from Wells?,O j or No
Is the animal waste stockpiled within
00 Feet of USGS Blue Line Stream.? Yes `r N'
Is animal waste land applied or spray
irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is anii al waste discharged into watex
i of the state by -man-made ditch, flushing system, or other
similar man-made devices? Yes
�J If Yes, Please Explain.
Does the facility maintain adequate
to managemetitrecords (volumes of manure, land applied,
spray irrigated bn specific acreagt
with cover crop)? Yes o
Additional. Comments: /L••��
•� �' �-� �- �-�' ,� X-1
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.
i 10 ' 39Ud
DH 3-1-1I nN05AD of HH 3 Id 3 To : Z I, 96 ; 6 EMU

0
•
OPERATIONS BRANCH - WQ Fax:[phone] .Jul 24 '95 18:08 P.16/18
Site Requires Immediate Attention X 6
Facility Number: 617-17
. SITE VISITATION RECORD
DATE: 3'cy y . 1995
;.
Owner: ae: Kf 41 /a X Faun Name: � .
County:
a
Agent Visiting Site: C q Phone: 2K 5'5_- �, ZZ
Opeuator: Phone:
On Site Representative: Phone:
Physical Address: "cH & / V a 3
Mailing Address:
Type of Operation: Swine I
Design Capacity: -3 SgD,.,--
Latitude: 0 '
Type of Inspection: Ground
Poultry Cattle
Number of Animals on Site: 3 S7D
Longitude: �Q
Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
r•
(approximately 1 Foot +8 inches) es or No Actual Freeboard: ,� Feet Inches
For facilities with more than one lagoon, please address the -other lagoons' freeboard under the
connnents section.
Was any -seepage observed from the iagoon(s)? Yes o6;)Was there erosion of the dam?: Yes c(]P
Is adequate land available for land application? es r No Is the cover crop adequate? r No
Additional Comments:
Fax to (9,19) 715-3559 Siana(ure of Agent