310006_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

(� Div►sion�of�Watec�Resoufces��.� _ "
FacilEty Number © ���; � ���Divrsion�of�5odland Water Conservahon� �,.� ��� �;
,..r �OtherAgencys ..
Type of Visit: (2fCom ance 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: e ( Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 1 " I C { s Integrator:
Certified Operator: Certification Number: OBI O i
Back-up Operator: Certification Number:
Location of Farm: Latitude:
-.
Design Cisrrent'�+3*
Swine
CapacrtyPop., li?�
Wean to Finish
Wean to Feeder
[-Layer
Non-L:
Feeder to Finish
�,. _; �s
Farrow to Wean
Farrow to Feeder
x,
D a IPA
Farrow to Finish
La ers
-_
Gilts
„::;
Non-L,
Boars
Pullets
. f.-.
Turke
Qther
Turke
Other
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cy ow
Cy alf
Hy cifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[::]Yes ❑ No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili umber: - Date of Inspection: v
.1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Afi�r— � Y"- Jk Z.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _12—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �2o ❑ 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 eat, 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 rNo❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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
[]eK'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q'lvo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L2-Tq_o_
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[J Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3' oo '
❑ NA
❑ NE
Rea uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ETRo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
f ] Yes [�o—
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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 o NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes�Zo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facifl Number: f jDate of Inspection:
A
�4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CalTo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
21TOn-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
To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No �A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EJONo ❑ 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 �o
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
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?
'qt 20, 6
s/",
Reviewer/inspector Name:
Reviewer/Inspector Signature: �/y
Page 3 of 3
❑ Yes Dwmo
[—]Yes �No
❑ Yes ffrNo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Phone: I(0 7%(17�#
Date: La di
21412015

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 310006 Facility Statue: Active permit: AWS310006
❑ Denied Access
Inpsectlon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County Duplin Region:
Wilmington
Date of Visit: 03/30/2015 Entry Time: 10:30 am Exit lime: 11:30 am Incident #
Farm Name: Smith -Alderman Farm Owner Email:
Owner Murphy -Brown LLC Phone:
910-296-1800
Melling Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 1128 947 Powell Page Rd Rose Hill NC 28458
Facility Status: ❑ Compliant Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 46' 50" Longitude:
78" 1910"
West of Wallace. On Northwest side of SR 1128 approx. 0.5 miles Northwest of SR 1131 along Sampson Co. line.
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number.
Secondary OIC(s):
On -Site Representative(e): Name Title Phone
24 hour contact name M Norris Phone:
On -site representative M Norris Phone:
Primary Inspector Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
inspection Summary:
page: 1

Permit: AM310006 Owner - Faciity : Murphy -Brown LLC Facility Number: 310006
Inspection Date: 03/30/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
ALDERMAN
19.50
32.00
Lagoon
SMITH -A
19.50
22.00
Lagoon
SMITH B
19.50
49.00
page: 2

Permit: AWS310006 Owner - Facility : Murphy -Brown LLC Facility Number: 310006
Inspection Date: 03/30/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No No Ne
4. Is storage capacity less than adequate?
❑
000
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e.1 large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑0
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance aitematives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 01111
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manureisludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310006 Owner - Facility : Murphy -Brown LLC Facility Number: 310006
Inspection Date: 03/30/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea
No Na Me
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
■ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
M ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M ❑
❑
18. Is there a lack of property operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
00
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
[]
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310006 Owner - Facility: Murphy -Brown LLC Facility Number. 310006
Inspection Date: 03/30/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
m ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0110
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?
1101111
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yea
No Na No
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
1101111
contact a regional Air Quality representative immediately.
30. Did the facility fail to notity regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewertinspector fail to discuss reviewfinspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
� ❑
❑
page: 5

ivision of Water Quality
Facility Number ©- � O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: empliance Inspection 0 Operation Review Q Structure Evaluation () Technical Assistance
Reason for Visit: (;Moutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: " ounty:
Farm Name: — l &(�rry
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: ntcke4lel "Crl_s
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
dean to Finish
dean to Feeder
eederto Finish
arrow to Wean
arrow to Feeder
arrow to Finish
Other
Other
Latitude:
Phone:
Region:
Integrator: %n/,t!n
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Poults
Design Current
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 (gattons)?
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ YesAEfNo ❑ NA ❑ NE
❑ Yes /[f No
❑ Yes [7f-No
❑ Yes ,Q-No
❑ Yes ,Eno
❑ Yes ,❑no
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I 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 ,F[ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes O-No ❑ NA ❑ NE
Structure 1 Structure 2 Stru se Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ­57-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes jEf No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ID -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,Efl-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 -El-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes j2No
❑ NA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? O Yes d No ❑ NA ❑ NE
16. 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes KI No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Vansfers
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
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
7
❑ 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
[A 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
j� 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 ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: a
Date: GY L
21412 11

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: il Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 3 Arrival Time: 0 ;00 ,,ti Departure Time: OZ;Cap County: PQeLXA)
Farm Name: SI►t r $ e,.lM a fn Owner Email:
Owner Name:—,4-0w n , L-L C Phone:
Mailing Address:
Physical Address:
Facility Contact:
M f% 4 f t,^� o rjs Title:
Onsite Representative:
H
Certified Operator: Ma v j`— M u n Dy
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 1713
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other .
Other
Latitude:
Region: F-P-0
Phone: /I
Integrator: A—,Pfii,
Certification Number: ! ! 000-1
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
]Non
-Layer
Design
Current,
Dry Poultry
CaDacity
POD.
La ers
Non -Layers
Pullets
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?
Longitude:
Design Current
Cattle Capacity Pop., ..
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
D Yes
❑ No
qNA
❑ NE
❑ Yes ❑ No ®NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes �q No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -,6 Date of Inspection: 17
Waste Co&ction & 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
S ti Structure I �,$Jructure 2 I Structure 3 Structure 4
,
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ✓ ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [P 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 [P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes eLvp% 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 Windowr ❑ Evide
nce of Wind Dft ❑ Application Outside of Approved Area
12. Crop Type(s): �C1c,4a l '?cr (J� C45 ; �a^a i l C9 \
13. Soil Type(s): }�+ ` U �1 I P r Q IA" _'tsrsf'Ef-
—M, t
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes M No
❑ Yes 09 No
[:]Yes [P No
[:]Yes No
❑ Yes No
❑ Yes [P No
[:]Yes L No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
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 ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
D. NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Cond sued

Facili Number: - Date of Inspection: JU J
24,, Did the facility fail to calibrate waste application equipment as requited by the permit? ❑ Yes Ep
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified -operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
M No
❑ NA
❑ NE
[]Yes
7] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[]Yes [b No
❑ Yes [ No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
® No
❑ NA
❑ NE
�No
❑NA
❑NE
®No
❑NA
❑NE
®No
❑NA
❑NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations .or -any other comments. `e�
Use drawings of facility to better explain situations (use additional pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Pro-Y9 33%0
Date: / 7 3
21412011

r
Division of Water Quality
Facility Number - 0_ Division of Soif and Water.Canservation
0 Other Agency --
Type of Visit: 40 Compliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: i z: 'O Departure Time: O/ County: 1Xy_A1_rfjRegion:_
r /►
Farm Name: _,5rn1W 1 Owner Email:
Owner Name: Lvllil ��[, Phone:
Mailing Address:
Physical Address:
Facility Contact: �U i�///Is•Lrpti Title:
c/
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Integrator: cvlti
Certification Number:
Certification Number:
Latitude: Longitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Canacitv
Pon.
La ers
Non -Layers
Pullets
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)
Design . Current..
Cattle Capacity Pop.`
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes JEJ No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: - Date of inspection: 30
Z+
Waste Collection & Treatment
4. l ,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�VNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
IdentifierJM,-.4/ 1 s G
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��� Z 37# -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
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 g] 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): CatS4( &^..JG 19t(
13. Soil Type(s): -` 01 t I,,4, t-
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
f�j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Pq No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
R_eguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LfA No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of inspection:
Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
V9 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
In 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
t 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
EP 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 #): 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):
�4c'q S rev 1'tL-w_) " c 4e_ e-b 15/124
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

y
Facilio'Ni mber 3 Q
—V Division of Water Quality,
0 Division of S-oil and Water -Conservation'
0.Other Agency
�.
IType of Visit 5>6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit o'outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .V eparture Time: County:
Farm Name: L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region: 1-d4�
Facility Contact: Title: 'nA Phone No:
Onsite Representative: G%C Integrator: /' L
Certified Operator: Operator Certification Number:
/7_ ate`'
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity., Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other ...
❑ Other -
Back-up Certification Number:
Latitude: = o =' = Longitude: 0 ° = 1 = i!
Design Current Design Currei
Wet Poultry. Capacity Population Cattle Capacity Papat
RLayer 11
Non -Layer
Dry. Poultry—,
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coyd
Number `of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
91 o
❑ Yes
No
❑ NA
❑ NE
El Yes
No
❑NA
❑NE
Page 1 of 3 12128104 Continued

Facility Number: — Zo
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Strut e I St re 2 Structure 3 Structure 4
r: Identifieel'o�
Spillway?:
Designed Freeboard (in):
Observed Freeboard [in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
[} Yes /No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure a Structure: 6
❑ Yes /No ❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El yes /!o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 D<o ❑ NA ❑ NE
maintenancelimpinvement? //
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 JNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes )No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I o
Cl NA
El NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
y �
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/7JP/f" rnnfinun�l

Facility Number: 3 Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes. JE2rVo ❑ 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 JZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PTNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PMo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �rlNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes XfNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V(No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 7rNo ❑ 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 A 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 VNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
AL
�/ �• . � ��f f'i� ...� ram,
tpla
?a G %
1,3 14
Page 3 of 3 12128104

Other _
❑ Other
Time: County: Region:
Owner Email:
Phone:
�o
Latitude:
Phone
,.yNo:
Integrator: /
Operator Certification Number:
Back-up Certification Number:
0 Longitude: 0 = «
Design " Current " ✓Del
Wet Poult r'3y' Capacity Population Cattle
❑ La er
❑ Non -Layer
,Dry Poultry,
'Division:.of water.Quauty .
Facility Number # Q Q O Division of Soil and Water Conservation -
0 Other Agency
F
peof Vlsit �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistanceason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I `1//y/dr/Arrival
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine ` Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
❑ Boars ❑ Pullets
❑ Turkeys
❑ Turkey Poltlts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy.
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
i
.:, F...
- Numberof, Structures L
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?
_I
❑ Yes -V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�?No
❑ Yes
[INo
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 Date of Inspection [�
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 'V No ❑ NA ❑ NE
Siructure 1 Structure 2 S cture 3 Structure 4 Structure 5 Structure 6
Identifier��JM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RfNo ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ 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
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UoNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t 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
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Vr No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comm` _
eats refer to neshon # Explain any YES answers and/or any recommendations orany�other Comments.., • ; ,�
Use drawings of facihtV'4o better explain-situahans (uie addrh©nal pages as necessary.) s:
,,,n1 d- %C or :S li d /e _'Go ,
ReviewerlInspector Name I Phone: O- �3s`l'd
Reviewer/Inspector Signature: Date:
> , I -f a I2 I04 Continued
O' _ J

Facility Number: — Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �ZNo ❑ NA ❑ NE
20. Does the facilityfail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. " ❑ WUP ElChecklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑Yes �14No 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
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
YNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XNo
❑ 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
9KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
__,,,!/
I/No
El NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
11
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9fNo
❑ NA
❑ NE
-----------------
AddiEional Comments and/orDrawings.
Page 3 of 3 12128104

Facility Number
-.015ivision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit '.,�Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (D"Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , parture Time: County: Region:4 `:�
Farm Name: /� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ITitle: Phone No:
Onsite Representative: a' lI?� (�'�� Integrator: A!
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o = r = Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non-L;
Pullets
Turke
Other
Dischary_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Caw
❑ Dairy Calf
❑ Dairy Beifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 ;No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
ElNE
❑ Yes
El No
❑ Yes
'LJ N
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104 Continued

� � n
Facility Number: �j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �A"No❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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
I0tvo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ Ko
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R<o
❑ NA
❑ NE
Other Issues
�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El2 Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No❑
NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility Number: — Date of Inspection
'.0"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes �o ❑ NA ❑ NE
Structure 1 Structure 2 St ru a Structure 4 Structure 55 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed ElE 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 f:ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes/[J 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 0-fft ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P-Mo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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 -Er—No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2,90 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes _[Emo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes flNo []NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
:Comments (refer to`queshon� #} . Explarn;any Y9ES answers�and/or any recommendations o"r any otlterecommeists.
.�. -a-. _�-
Use drawings�of facility to betteraezpla�n situahons�(use additional pages as�necessary).
-
w'
Reviewer/Inspector Name Phone:
Reviewertinspector Signature: G Date:
Page 2 of 3 12128104 Continued

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency 11
Type of Visit "Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit JOr'R-outine o Complaint 0 Follow up O Referral O Emergency 0 Other [IDenied Access
Date of Visit: ! Arrival Time: Departure Time: County: % Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 4 Title:
Onsite Representative: -L"
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
�o
Latitude:
Owner Email:
Phone:
Phone No
Integrator•
Operator Certification Number:
Back-up Certification Number:
= « Longitude: = o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other -- — ----
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
El NE
12128104 Continued

1� Facility Number: 3 — 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ d—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(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 ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acc table Crop Window El Evidence of Wind Drift ElAp lication Outside of Area
12. Crop types) S6 lQ
13. Soiltype(s) /Vr)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):
' r /.S 1,e7 V00J1
to-G17� l3 AUL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: � Date:ne=�21:
Page 2 of 3 12128104 ' Continued

Facility Number: -- Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ❑ No
❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes ❑ No
❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
/Yes ❑ No
❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
3 Z,7 �IftZopgl In,?
/C
. r 7 I Wton w
0 �I �$C� S tuPh45- .
1 yt }
• ��u� ��� 5 .� use .
IJOG a a At 1 _ + Lol(rGG
a v K Z � S�
IOLp
CLId
Gs
�l21
Page 3 of 3 12128104

vision of Water Quality /
Facility Number (� Division of Soil and Water Conservation
— C)Other Agency
IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral .Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: Region: Wl
j�Farm Name: 6 1'!Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ✓
Certified Operator:
Phone No:
Integrator:
Operator Certi ication Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = = d Longitude: = o [= , =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1. 1❑ La er
1, ❑ Non -La er
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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: =I
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?
9/ Yes
❑ No
❑ NA
❑ NE
❑ Yes
(;3No
❑ NA
❑ NE
2dYes
❑ No
❑ NA
❑ NE
S
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes )21No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: —U Date of Inspection Cxa
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
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 property addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? �`'
❑ Yes
❑ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):
- (A-4f���� area C/1 / A v %` ; �r/ecz .�- he a�l��°rS �� l ��O a.
by �� ���/ arrrv4� �/- a ��rc �se� ��s�c � Cva ,r
/f Q '%�%a r !s«Col �� o o 4ai?' 94
ua� lc%��2Q r� Cayt7Cir�
✓ere � a ��>=
Reviewer/Inspector Name — -- — --� -- - - - — I Phone:
zzlu
Reviewer/Inspector Signature: _ Date:
Page 2 of 3
12128/04 - Continued

Facility Number: '7 Date of Inspection
01-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
fo-a
o/�� jo jay corc d F3 0 — Zeel J�/ U/'-f
AL
Jr
� l� �4• G Cc� �✓GC
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Page 3 of 3 �52 allKra� 12128104

Facility Number
_0uwision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ,QoGompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral ( Emergency 0 Other ❑ Denied Access /�-
Date of Visit: Arrival Time: Departure Time: County: 06C ,� — Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:' Phone No:
Onsite Representative: /Zcez�_z Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 00 = d = « Longitude: 0 ° = i = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream ]Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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 .• fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[-INE
❑ Yes
[:1 No
ElYes
E No
❑ NA
❑ NE
❑ Yes
Xo
❑ NA
❑ NE
12128104 Continued

/ rFaciiity Number: ,3 —0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,❑,' o ❑ NA El NE
a. If yes, is waste level into the structural freeboard? El Yes /� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RrNo ❑ 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? [ 1 Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 0 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 P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,n No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [YNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
QWo
❑ 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):
Reviewer/Inspector Name f L Phone: —�82
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 31Q Date of Inspection
00,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IE5No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El 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
Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P'fVo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
qNo
❑ 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
Q'N'o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J '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
[PKNo
❑ 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
❑,?Qa
❑ 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
O 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
Pl o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑'I (�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

u
Eacil�tY Number
_D
KDiAsion of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
r
Type of Visit # Compliance 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: Departure Time: County: —'rA.1 Region: fr
Farm Name: 1,5m,y .-i�Lo��r,.�l.t1 ��,Pm Owner Email:
Owner Name: ,,fl�fPiS/_T�J4 T Phone:
Mailing Address:
Physical Address:
Facilitv Contact: Title: Phone No:
Onsite Representative: /1� SIntegrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = ![ Longitude: = ° = i 0 «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer - -
Dry Poultry
Pullets
Poults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures: al
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 JZ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Vj No
❑ NA
❑ NE
El Yes
;6 No
❑ NA
❑ NE
12128104 Continued

l \
Facility Number: —
Date of Inspection Zi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Structure 2 Structure 3 Structure 4
Identifiers -rt * 4 S/h27N_
Spillway?: /00
AllO AV
Designed Freeboard (in): 0.5
g.Jr _ ,&"5
Observed Freeboard (in): 2.1
g f Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 7rNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ 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 ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �&12ZILZOA Lwi v
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? PfYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre deterrnination'4ryes ff No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes /� No ❑ NA ❑ NE
At 5o E 5 1 G ANr60 /"ErcG� 23 ZN24r' �5�, d�VLt &P eAl GzSy�,p .�i>r Lril
�1/O � mPJn�G. �✓F_n1 � 5 ���F_ On c c�.a� Q !�N �f�
1 � AFRm upA 1.0 A,
a"r 4ss0s ;F,-Q Fes,400
Reviewer/inspector Name Lj, =A' �r Phone:
Reviewer/Inspector Signature: Date: per'
12129104 Continued

i �� 4
-[Facility �Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [Dyes )21 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. VT Yes ❑ No ❑ NA ❑ NE
Waste Application W1 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
JVNo
❑ NA
❑ NE
❑ Yes
)z No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
'z NE
❑ Yes No
❑ Yes No
[-I NA El NE
❑NA El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
l No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
Addtttoiial Comments:and/o"r Drawings WtM0
ik�lv�0� s�zz f_s T �Pa ff�wcp .,
uv_ Via.
y v Lin► E At NECOFa foe J'Ze1_ 0
3•
z0 INV iVRN � � L,�,gnl�� �?i' Yid � ��✓c�uo�- ��h�2 �i2vPs, 5��
L�n7/�?fnJ.- sign l� �-1�O2r'�v�I,g� Co�ry��c'N� nPAGE /VfEDE�,
e01-'A ,o /VI-7
1} LodA r F_ 6RF_E/,3p,ca'0 FIND 10u1n Prime N=Cto ,D S Itra/Z
,4g5, PNq
%�fAO 7A rG S' S�r0cr 5/2/vs &'Z; -.y /�G� ps, k .r 17?6
�o >�Re /z/� s/zAosA.V'0 /�ZDoS
00a,0-5, r4X 9- 9/D- 3,50-DV-, /_�I e fi4 , 0 e_-vzs�c�,�
&V /%iA, /. Z oO5* 12128104

ter. QuaIitys
I and Water Conservation'_ -�
�r. ..
I r _. -. ..
Type of Visit O Compliance Inspection O Operation Review PrIagoon Evaluation
Reason for Visit O Routine O Complaint WFollow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: i? 0 Time:
0 Not O erational 0 Below Threshold
M"Permitted OCertified 13 Con
ditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: ................ ...... --.............. County:. 4__k................................ ........
Owner Name: ----- ------ -------- ------------ --- --- •••----....... •. ........ Phone No:
MailingAddress:........._ ............................. .... ........................ ........... --. .......................
Facilitv Contact:
Title:
Onsite Representative:.1'1
Certified Operator:
Location of Farm:
. .. Phone No: _. ....�_ ..
Integrator: -p .. _ .. ......�..._ . _W _-
Operator Certification Nwnber:.
Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude Longitude �• �' �"
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 roan -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4.. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Stur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..vrj... ....................................................................... ...-- .... .............. ...................................
Freeboard (inches):
12112103 Continued

�2ts;Number.' — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed��? (iee/// trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. 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 ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13_ Do the receiving crops differ with those designated in the Certified Animal Waste 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
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Com�ruerrts{r%r to qu hon,) F.iipiaua 2uey�Yl�s answers and/or anyreconimenaanonsor.anyoil er comae
Use dtawutgs of facility to betterexplam s�taafaons. (use adthttonal Pages as necessarY)*"'[],Field C Final Notes
u a
fi
/� ;62e
67u 7Zsla D71l ��-e
Ae
ReviewerAns ector Name
P s O Gib7Mc
Reviewer/Inspector Signature: Date: a� 4
12112103 Z Continued

s y vuaw ia�c�e4j 32?ar_
of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Viitit Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: EO
Tune:
(Operational O Below Threshold
)dPermitteckoCerdfied 13 Conditionally Certified 0 Registered Date Last Operated orAboveThreshold:
FarmName: .......................................... ....................... ............... ... ... .......... ..... ............ _ County: .».�l��k .........._ ...._ .... .. ..
OwnerName: ------• . .......................................... Phone No: .............. ....—•----.......... ............................................
Mailing Address:.._ ...._ .._............. ... _ ...._.� .
Facility Contact: .._ ... _. -... ... .......... .............. _... Title:................ Phone No:
Onsite Representative: a 1..�.1...................................................... Integrator: .......... ...................... ....... ............. ......_____---
Certified Operator: . ......................................... .... _ ...._.�...... ._.......W_ ........... Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Norse Latitude • 4 fic Longitude • ' «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes O/NNo
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
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2(� /Structure , Structure 4 Structure 5 Structure b
Identifier: _�._�.. ` a.o...... _...5r=.fLe........ ND .................................................... ......................................
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection L`fJ
"5. Are there any immediate threats to the integrity of any of the structures observed?��(ie/�—trees, severe erosion, ❑ Yes dNo
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? ❑ Yet No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes 7NO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Aaplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 7No
11. Is there evidence of over application? If yes, check the appropriate box below. ElYes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type S&a Sp GJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes U�4
14. a) Does the facility lack adequate acreage for land application? ❑ Yes X
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving cropneed improvement? El Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes 7No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes dN
d"
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
reads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
_Commeaats (refer to ques on #} 1F c Am.auy YES answers and/dr any recomtdendations ar any other comments:
'Use drawings of fat>tity to better exglarn sitaat<ous. {use additroial pages as necessary). FieldyCop ❑Final Notes
Y
of- of o NAY who fb ry, iZcN1ovED P?atr�
O ?XGK ✓P §b6+ ?Ary W A ML k (TELIb.$ WC R E
'� iN1 QYl Ei.).�i r 11z N I �06� CAW- INAY T,
06T PLAO 60 .P JJO Eat:
Lrri/1C �EE�DS �� 1�QpED'o FsCc.os `�, ✓, ro
Reviewer/Inspector Name:.
Reviewer/Inspector Signature: Date: iq p
12112103 Continued

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

r
Type of Visit JO Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit: �Z Time:
1Vot O erational Below Threshold
Permitted ©Certified ©Conditionally Certified © Registered Date Last Operated r Above Threshold -
Farm Name: Sm 2l� d —4QM. Count°:
Owner Name: 6RM S _ Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title: Q�Phone No:
r�� v
F Integrator:
Operator CertiScation Number:
Number of Lagoons © Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area '
_ _.
Haldir g Ponds / So JE1 No Li uid Waste Management 5 stem
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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 �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �z No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:-- 6far-69 ALn,
Freeboard (inches): (QJr
05103101 Continued

Facility Number: 3 1 — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
111117
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, arid the situation poses an
❑ Yes
PNo
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
2(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
lic Overload
11. Is there evidence of over applicati n? ❑ Exces be Pondi g ❑ PAN++ ❑ Hyd7bu
❑ Yes r
�VNo
olltm
12. Crop type LER R G a z !� it d ER S
Bi l�aJs
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA )?
❑Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ANo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
Yes
El1
I/� No
16, is there a lack of adequate waste application equipment?
❑ Yes
Vf No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V(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.)
ElYes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
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
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.
Comutents (refer to`,gttesitun) E�cplain airy YES;answers andlo`r.any reommetrdsU€ons or anvother comments.
Use drawings of fa6lity twbetter explaw situations. (use additional pages as necessary) �
�eld C'onv ❑ Final Notee r
..
�AR� REAS RDu>J� Sin=�H FC'Or��A� 090 tj NEE
F6net-r-sri F-Q r Es 6RA65. mpA 0EC-0 10 R- r SrF vrP
� �Prss.
r®So�L o� Re � o � As7z1__F—(
(RIE5�CA Lope rCA *31DFF) 5 r A-Ca0 Ncco s Pr Cgp,-r,
CA-ra� �a52�
Sc Dfr' JSPFET[i code Ep-P" ��7 {�[�r� ��CP�
C 0VCR, 1� AF J
�k 4�
r
Reviewer/Inspector Name - -
Reviewer/Inspector Signature- Date: /f
05103101 Continued

i
Facility Number: — Date of Inspection / O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes VNo
❑ Yes VINCI
❑ Yes I,Q No
El Yes �FN
El Yes /❑ No
'AdditionatComuients and/or Drawings:
�P+Q ARFRS Tf)
i RS r � P� ;'StF fr_7F
�tFc_o s LJ2� =v
Pr�� EA SS S rvu
' 2 O sq
�or &- SAsn
�Lt �0 �� �.E _
F Fi(-D 5 / W1 YEA.,
CR-OR (-SO4eOEAO rcAr—N1).
u �d �5FAPAM)& s P_�
��/ �l` DOlil
u�Pp�-ac�z ado �, r
D©mF Fp �S2aN�-� /�P,e�� 2
�l
L�s
7'1-1Fc/G y Gl/AS��NAGysZS�/ajnz -
16 , ---- a, � 7,--- &
�F 19(
4�
— )
05103101

= Division oi' Water Qpality-.n
M Q Dvrsion of Soil and Water: Conservation,
Q:Other Agency
Type of Visit 6COmpliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
'
Facility Number 3 Dateof Visit:
© Permitted l3 Certified ❑ Conditionally Certified ❑ Registered
Farm Name. `M Adcr�ir% A rr` ....^+...............................................................
Owner Name: i�rf•-der �D1 �''1 r
Facility Contact:
Title:....
Time. Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: U�.l"'�
...........................................................................
Phone No:
Phone No:
MailingAddress: ..................f....................................................................5......�..............................................................................~....r.~. f... ..........................
RjAow ccv-4e ', 00 %c,
Onsite Representative- .,p,��1.... .._..+r ; ka� ^�f Inte rator• v� rr
�.. f......_�........[?.................................... g......(.....q...1....!1.............................................
Certified Operator: ................................................... ...... . ..................................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
Desigii< Current
Capacity = Pooulatioa
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
'. Boars
Design: Current Design Curie U
Poultry Capacity Population Cattle Piililulad6n
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW-
"Subsurface Drains Present ❑ Lagoon Area
Number of US-_ ❑ g ❑ Spray Field Area
Holes Poafis /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? /Yes ❑ No
Discharge originated at: ❑ Lagoon Spray Field [I 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) Oyes ❑ No
c. If discharge is observed. what is the estimated flow in gal/thin? 0,5
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes El 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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
Structure 6
Identifier:
Freeboard (inches):
5100
Continued on back

Facility Number: 3 j — Date of Inspection O�
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 ❑ 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?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
v;ski yiolaiignjs:o def cae�c�e vv re pQtecl 4trt . g �;hjs;v�s�t! Yoit will ee�iye o fn�thg
coriesporidence about: this visit .... .
Comments {i<efer tb question #) Ex lain'- auf YES answers and/or any-recominenclations oraay other commi
...
I'Uie'draw,ngs of facili tcr`;better . lairt'situations. (use addrbonal: es as necessa
tyP _ i ry}
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PKlo
❑ Yes ❑ No
❑ Yes ❑ No
e fa.t%il " nd -X ebs eyved 1,9 G� r4l►�t I&
I 7�
sree
e'Pf 0/' A ft;t-t-4) 0,A-0e. ',As OT-0
re,RXrid��d,'-{eti L-ih,,'fti 41.e deetlqA9ew,, aw.,.ed 6 nnA at-servM ei.1;^talvvr'�G.
wets4c_ wAs arrc,:rd h - he wd--ers 0 44eS11 .fie ►�t:��
eF�ar s and a�sOO9;riaUlelod�►r. �nnt,/oi�+-�TP�`c�„�es 4
dwct~f
gr•% �-�e6A
14 less4"n �.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: i jZ (J S/00

r
of Visit Compliance Inspection Q Operation Review O Lagoon Evaluationon for Visit AarRoutine O Complaint O Follow up O Emergency Notification O Other j] Denied Access I
Facility Number Date of Visit:
0 Permitted 13 Certified 13 Conditionally Certified 0 Registered
Farm Name: S� � i d �ma -
».....................»'--•........................................................... ...........................
Owner Name: VG!,-4'r r ` r of 411
.... .... .......................................-----............................._..........
Facility Contact:
Title:
'El Time:
Not Operational O Below
Date Last Operated or Above Threshold: ........ ......... ».....
County:
Phone No: ....................................
Phone No:
MailingAddress:...............................................................
Onsite Representative: .... 6g4... F,
G!i. l f7 ''1.�..�rc.+'�1 �i�1 -, Integrator:..», `A�, »..»....._.__.
.................................. _ 7.
Certified Operator: .......................................................................... Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • A « Longitude • i 94
Design - Current Design . Current Desagri ' Cnrireat
SwinePoult]tlCa ci Population Population te
. C
- a act Po tiElation
- . Wean to Feeder ID Layer ❑ Dairy
ETFeeder to Finish 3 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean u
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
Gilts -
❑Boars Total :SSLW
N
uinbeir oIF. Lagoons ❑ Subsurface Drains Presen 10 Lagoo4 Area 10 Spray Field Area
- -
:$ol" Ponds / So6d _Traps ❑ No Liquid Waste Management System x.-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes"_ffNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Jallo
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes oNo
c. If discharge is observed, what is the estimated flow in gal/min? h f q
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,,ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )2=40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes —0 No
Stru •ture 1 Str c to 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier �''�'��`~ !! ss^? L- » Fi'r
l.........................................._...........................................................................................................
Freeboard (inches): 7-3 3 !
5/00 Continued on back

Facility Number: 3 — Date of Inspection I /�IZ�ii101
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ONo
' seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
V
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 A!j No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes )EfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 'ONo
Waste Application
f
10. Are there any buffers that need maintenancelimprovement?
❑ Yes , No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yegqs -]2fNo
12. Crop type 19e t ir1 owz,.sedd,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ,fNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes j2'No
b) Does the facility need a wettable acre determination?
❑ Yes P'N10
c) This facility is pended for a wettable acre determination?
❑ Yes eNo
15. Does the receiving crop need improvement?
❑ Yes , f No
16. Is there a lack of adequate waste application equipment?
❑ Yes _ZNo
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XffNo
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 ATNo
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 ,!fNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yeslo No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes B`No
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes INo
;�'c1q•yiQla�iQnjs;o� d$fic�encies wire P d�x`ing �h�s;v�s�t: • Y;o>j� wi��•>�eea'iye t�ti furt�gr • •
corresporitience a�wuti this visit .. • -' . -' .. -' . -' . .
Comnients-(refer torquestion #): Explaui any-YFS answeis and/or any=recommendations or aay ocher conimeuts. _
Use,dawings of facility to better'eaplarn`situations. {t>se additional"pages as;necessary)
rq . Aj�e� ao vse we ed aG-'eS .d t1 f7cealGvla4e- -all Lee 'Mc,
vlb Aa-' -Or V:5-" -.1 4t 1A4¢d e4cfet, Fjave c,
AV-w;--.A bvh�� Sp1/ Sar+.t���J ure 4orke•, ;-o.,� , keep -X�?tZ-2.rS VYd _
& Gih 2xCe�j�`L� S�bcnd 0 �rr�svdr� pry - �� 3�►'L't
s-
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/�

Facility Number: 3 j — Date of Inspection
Odor Issues,,
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below Yes []No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,ET'No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 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 o 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 'P'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
5100

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Time of Inspection 0 24 hr. (hh:mm)
Permitted [] Certified 0 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
Farm Name: I
.... ..................... v -- `•.......................-...................... County ............`..��.................................... .
OwnerName: ................................................... ........................................................................
Facility Contact: ................. Title:
Mailing Address: ......................... ............
w
....................................................
Onsite Representative:
CertifiedOperator:..............................................................I...............
Location of Farm:
Phone No:
Phone No:
........................._.............. ............ ............................... ..........................
Integrator:....... ......... �iy........
Operator Certification Number:,,,,,,,,,.
Latitude `=° =11 Longitude =e =L 11
y . DestgnCurrent_ Design Cuireitt' - iDes�gn Current
_: - :.
Swine Ca act Po ` ulahon . , .Poultry ' Ga acrty---Po ulation Cattle C.a act Population .
N ❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
z
❑ Farrow to Feeder [] Other
❑ Farrow to Finish
Total Design CapaC i
❑ Gilts
❑ Boars _ Total'SSLW
Number Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System µart
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes $No
Discharge originated at: [I Lagoon [I Spray Field [I 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 [�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structur 3 Structure 4 Structure 5 Structure 6
Identifier: S 1 S +�U
Freeboard (inches): n.. { ...........................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IxNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: /-3 — 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 evidenT
er application? ❑ 'Excessive Ponding ❑ PAN
12. Crop type � 19 . SO i V\Cke a1 sS
;4No
❑ Yes
NfYes
❑ No
❑ Yes
)Fj No
❑ Yes
12(No
❑ Yes
�5No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the.Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in -effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: �'Vo yiolaftdiis;or• deficiencies were noted di}rfrig Jl�is;visiC . 'Y;oi� ;will-r' eaeiye iid further ;
corresporic#eirce abauti this :visit: .... ...... ' ... '
❑ Yes b<No
Cl Yes 10,7'(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
[]Yes XNo
❑ Yes VNo
❑ Yes 9No
Yes ❑ No
❑ Yes No
❑ Yes �{ No
❑ Yes No
❑ Yes No
❑ Yes tg(No
❑ Yes 0 No
Comments (refer to.question #) Explain any'YES answers and/or any recommendations or any other coihments =- r s
Use drawin` of facih torbetter'ex lain situations use additional a es as necessary)M W
9 tY P ( P g
e-A.
U��Q
�,e �"�G—s , ��� �� � � v t t--� G +-. �a s►�t `f L [ �j Gam,.--� ._
�25k'��y`�
"U-. sal et t - �s U�et_ c — �-41 t�
� Ga + cs- J T42�,(F Ce L.,c.J mid d� d `fiY
Reviewer/Inspector Name I..
Reviewer/Inspector Signature:
Date: S
3/23/99

Faciiity Number: 3 Date of Inspection � C,
Odor Issues
26. Does the discharge pipe from.the confinement building to the storage pond or lagoon fail to discharge at/or below Kyes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T 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 XNO
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 C�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 k.No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes t�fNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P�No
n -A:dditional Cohimentsan or rawings
GO G
5 ,
Sa1�
3
G" G v$"-��
3/23/99

F
1 Division of Soil -and Water;'Conservatton`- Operation Review
i 0 Division of Soil and_Water Conservation ,Compliance Inspection
® Division of WateryQualtty 3Campliance Inspection = '
q..Other Agency_ Operation. evtev6... _
nN
g
z
V
10 Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review I® Other �
Facility Number 3 1 (, Date or Inspection
Time of Inspection 1 S 24 hr. (hh:mm)
18 Permitted © Certified © Conditionally Certified J] Registered JE3 Not Opera Date Last Operated:
Farm Name: ...........S-+ _�Gterr.tir. fir,.-� County: 2erl..ji..�
OwnerName:........ Qu f ....................... .�.......'�.�.................................................. Phone No:.............................................................................
Facility Contact: .................... ...................................... .................... Title:
MailingAddress: ..........................................................................................
Onsite Representative:..„ "` 6' Z. r
..............................................................
Certified Operator: ...................................
Location of Farm:
I ............. Phone No: ..............
Integrator:!, �!.'� .. k Fti— CA, r,n S
�' .... y......................................................
... Operator Certification Number: ........................................
A
.............. ............................................. .......................................................................................................................... .............. ............... ....................... I ........ I....... .
Latitude �0 6 i Longitude 0 4 44
=Design Current Design Current Design Current
yo Swine Ca acity Po ulation Poultry Capacity Population : `Cattle Capacity Population",[ ''
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
-Number of Lagoons- ❑Subsurface Drains Present ❑Lagoon Area ❑Spray F�etd Area
HoldingPot�ds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imaacts
1. Is any discharge observed from any part of the operation? Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) CgYes ❑ 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 Stricture 5 Structure 6
Identifier:
Freeboard(inches): .......................................................................................... ......_.......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

4
1Gacaity Number: P — la hate of Inspection
$. 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
EM
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
19 Yds
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19- Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20.. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oc/ 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes . ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [0 No
❑ Yes ❑ No
❑ Yes ❑ No
0: Rio violafioris'oi- deficiencies •v�ere nil`tea during this'visit'. Yoit will receive �iti fuirth. ;
CO' res oridence' abaFuf this visit.
Comments (refer to question:#): `;Explain any YES answers and/or any recominendattons'or any other coRtments.
Use',+irawings of facility to better explain situations {rise adcLhonal pages as necessary) -
a.. a
2 w� s r) d: b Lj a �. �1 o b s c �1✓e d s�o Y �..� i t,� `
r V�c� Ewa �iascrvice�
t,JG,sI Ic�J; s G, �,cld aknd e►n46,mot5 arctdWa d1C11 tj1 6 �v�tdf
r
10. in W Ci S
ThrrC �vA� or•d�11ar G;V�pp�� �PS! c3 T
-�1 y 1+1�
i+nCr+� 1 Dn[O 01�oy
C�y! !mot' �-YZ:s AtJh 4✓a S f hrdat,�j W�1S}e q/6+pctL7 ��S
Jer 4 iniO � )h e' WOOd 5 - ir kC 57rr-r j W 4 < jq +nLt/1 hf' q'b 01,4 �
4 lvafGGS
- otc+'Se r�,'dC, -tkcl I L-VOLVS �aUrtdcv P surc �a tA•,4�K�-a;�
oJood 6uFF�S �' ;+, �L,c GgsC aF bd;�- s'�-vccai6y-�o gvo�d �,�nblc�s
Reviewer/Inspector Name Sao hCttie (f is (Tf3 g 6(3 'ZQ
Reviewer/Inspector Signature: Date: 1 Z I-7 -_
3/23/9%

0D
D
Elb
nn of Soil and Water Conservation -'-•Operation Review
on of Soil and Water Conservation :Compliance Inspection
nn of Water Quality - Compliance Inspection e
Agency =Operation Review--
Routine O Com taint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
E: Facilitv Number Date of Inspection - _ I Time of Inspection GO 24 hr. (hh:mm)
liPermitted Q Certified 0 Conditionally Certified [3 Registered JE3 Not O erational. Date Last Operated:
FarmName: ....- .:.. `d ti..................................................... County:............... -.~................................. .......................
OwnerName : ................................................... ........................................ ........................... Phone No:.. 3 .1 ...� ..............................
FacilitvContact:.............................................................................. Title: ............................................................... . Phone No:
MailingAddress: ............................................................ ..........................
..................................
Onsite Representative:..���`.....lrC- ............................. Integrator:
Certified Operator: ................................................... ......................................................... .... Operator Certification Number:..........................................
Location of Farm:
Latitude 0.0` ��� Longitude
Design Current
Swine CaDacitv'Pooulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current 'Design '_ Current
Poultry Capacity Population Cattle -Capacity Population
❑ Layer 110 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons" I ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
_ HoldingPonds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (Ii' yes, notify DWQ)
c. If discharge is observed, what is [lie 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
A
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
WNo
❑ Yes
XNo
XYes ❑ No
Structure l
Identifier: :5'--1
Structure 2
5--'�
Structu e 3
�
Struc uric 4 Structure 5 Structure 6
AM
Freeboard(inches): ............?LH..............
.............. d.......... :.
.............. 6...............
...........33..... I...... ... ................. I........ ..- ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X No
seepage, etc.)
3/23/99 Continued on back

Facility Number: �j -- D11ty fit- [nlpectioll
6. Are there structures on -site which are not properly addressed and/or manaLed 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 rnaintenancelimprovement?
S. 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?
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those desi-nated in the Certified Animal Waste Management Plan (CAWMP)'?
14. a) Does the facility lack adequate acreage for land application"
b) Does the facility need a'wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, map,;, 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 chat -Lye'?
22. Fail to notify regional DWQ of emergency situations.as required by General Permit?
(iel 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: Nd •violatioris or deficiencies mere h ed- diWirig -this:visit: • Yoij :wail •r'&6*4y dd futrthi re • '
:: • corresp67idenke'.about this .visit.. - ' - ' - : - : -. • ::::::...... ' . ' ........... .:. '
gYes ❑ No
❑ Yes b<No
❑ Yes ,,No
❑ Yes ONo
❑ Yes NrNo
❑ Yes ZNo
Yes ❑ No
❑ Yes KNo•
❑ Yes 9No
❑ Yes [KNo
Yes ❑ No
❑ Yes VNo
❑ Yes M No
❑ Yes No
9Yes ❑ No
❑ Yes MNo
❑ Yes r'No
❑ Yes b�'No
❑ Yes t5No
❑ Yes UNo
❑ Yes Z No
Comments (refer to question #): Explain any YES answers and/or any recommendatioirs or any other comments.
Use.drawings of facility to better explain situations. (use additional pages as neceskary)::
ILIZI
eAX ss- ���► �1
Reviewer/Inspector Name
Reviewer/Inspector Signature:
31!!;L3
Date: l
Q
3/23199

` Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours`? ❑ Yes t 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), inoperahie shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? El
No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional omments'an orDrawings:
pL-
Lj
3/23/99

Division of Soil and Water Conservation Other Agency
ter= .fig
Division of Water Quality
Routine O Cam Taint O Follow-up of DW2 ins ection O Follow-up of DSWC review O Other
Date of Inspection. !t7 14
Facility Number
Time of Inspection : � 24 hr. (hh:mm)
13 Registered tj Certified [3 Applied for Permit PPermitted JE3 Not Q erational I Date Last Operated:
11
Farm Name: SIv� ...... L{J4�r�hn....�1-zt,........................... County:........... 1.tx::..................................... .......................
Owner Dame. t Phone No:....t°l��?i...,.' 2-(R.(�.
' t .1JRC ....... `f.� Yn 1........................................ ........................................
Facility Contact: ,,-.._.....�i....... f :..�.t ........... ...... Phone No:
.. �. � --�--• Title: .............................................................................................................
,l
Mailing Address:.....q. T......t..Q.W.t.......,......
.......:............?.......�.{......1..r.............. .......... ......5.........,....!(.�......................... ..tiC...
Onsite Representative:_ .L.V1..... �l�f..f :.......�.`. 421. ...I-?A1Yk L Integrator:.......A.0 ...
Certified Operator...............................•................................................................................ Operator Certification Number...------......-----...
Location of Farm:
.......Eta .......Si ...... 4 ........s.R ...l � . ....4..:.. ...,x,►l t �....R`! !ri'L .. ..... .Lt.3....................................... I................... �
Latitude =•0`C 41 Longitude =• 6 "
Design Current
Design . Current Desi6m. Current
FSuvvme Eapacrty <Populatron
� 'Poultry
T
Capacity; Population Cattle CapacityPopularon
G
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
tdEl
Non-Dairy
Farrow to Wean
[] Farrow to Feeder
❑Other
y� ,
❑ Farrow to Finish
x Total Des>Ign CapaC>ly
❑ Gilts.
'.
Total SSLW
❑ Boars.
.;
Ntimber of Lagoons / Holding Ponds
❑Subsurface Drains Present
❑Lagoon Area
❑Spray Field Area
_
No Liquid W ❑ aste Management System
s _
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2. Is any discharge observed from any part of the operation?
Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field Pi Other
a. If discharge is observed, was the conveyance man-made?
Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
P No
c. If discharge is observed, what is the estimated flow in gal/min?
Q, S
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
P Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
Yes
❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
0 Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
91 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
PNo
7/25/97

Facilfty Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
5M Yes ❑ No
Structures fLaQoons.Holdine Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? 10 Yes ❑ No
Structu , Structure 2 \ Structure 3 Structure 4 Structure
5` 1\ Structure 6
Identifier: ... n.�. !�...{.T.�r... ........5M 1'f!� 91A......A...�.:.�LA \.........A.�'Uc�.��.. .......�.�.-�C90).. .A. 'g5
Freeboard(ft): ..............11i...........................LIA..........................Z................................L.1....................................................... q,.!................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? P Yes ❑ No
12. Do any of the structures need maintenance/improvement? 00 Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
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?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
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• No.violations•ot: deiiciencies:wer`noteid•during thisvisit. You:will rece'ive�no-furtlier .
cofrespWWence about -this. visit:: ' :
Yes ❑ No
❑ Yes P1 No
(� Yes
❑ No
❑ Yes
No
%Yes
❑ No
❑ Yes
R No
Yes
❑ No
❑ Yes
[VNo
Yes
❑ No
❑ Yes PNo
Yes No
[� Yes No
z. j94 L ft"rl . bYEVO, 1 � t e, at PH �° IV) . WAS�� 'hn � 0)0 gjh l 1� tU 3,rmi AYCG., i
kvk ho �sc.[na+rge �o c.1a 10{ - s 1-e �i)a r (volt sAn� t�s {� �r�ViSe an�►f�
s evz�a - Veq �iyv6 6 xh.
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i 9
a�serveel,
fi,�asioy� are v : ti ;'ear} Z b J i �& 5�ouj� be- �- r- ytd- CA sk,3,AJ bOkXqA
ate. maj,& �s "Se�eJtj.
roar o 0 (Cvo nc- s 643 6 �roPt✓(Ose j • 7/25/97 �
Reviewer/Inspector Name
Reviewer/rnspector Signature
Date:

Facility Number: Date of inspection: O
Additrona,, gni iients and/or`. Drawings
°I n hSu tt i r to -yeas s"4, (Q� + A7-1 COo. to-yor bve(s 4
c,"ul) f eWVec (r. c- 4- _�IYIArK. i vur.
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Wi` G 4-
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inE ih� We%'iGana1 a�rc�• _
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1(�. UoJurl6ke_Cr o�t�estrS �� -�rC�ck �( �-S. iJUP ca(t5.- ��mr► c<nnc���.
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I
a,r
4/30/97

0 Division of Soil and Water Conservation [] Other Agency
[a Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review '7Other _j. a
Date of Inspection • ; .
Facility Number .'�_•
Time of Inspection #:! 24 hr. (hh:nun)
13 Registered �Certified [t Applied forPermit13 Permitted 0 Not Operational Date Last Operated:
Farm Name:......... JM, C .........1 .4x`.....3a<4!�r..................... .... y: lh--•--............................ ..........................
- � --- ....... .......................... County: ...✓.:....:....
Owner Name:1R- Phone No:.. ,....
5................................................... ! ls......................................................... .
tt�tt
FacilityContact: �lr�..... Za.t�..................................... Title:................................................................ Phone No:................................................
1 Z.�'� ..........
Mailing Address: .....!....:t71�71..........��.....`...tW........................................................�St...i�.p...iC.......................................... ..
Onsite Representative:.......Dfn�nh�-------..r,b�c1............... Integrator:....111�t1�
.......................................................................................
Certified Operator. .................................................. •----------................................................. Operator Certification Number;....... tk.;.91.1............ ..
Location of Farm:
Clh.Y.�n ...G... !... 5....... ...mm.....Ix.�.ea s .. ' t:.....a.... gS3....il �.�.y.... o x�i ..!ni.�s...2►uY �4 .vs�S�:.....t7.......5.K.111 L........... �
... ................. ........
Latitude Longitude
r;4 Deslgn Current ,...y; r ;Design Current; r . Design''' Current ••,
Svrtne 'Capacity:
Population:
❑ Wean to Feeder
Feeder to Finish
1 13
❑ Farrow to Wean
❑ Farrow to Feeder
;
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes • ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Continued on back

Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes ❑ No
Structures (Lagoons,Iloldine Ponds, Flush fits, 61
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi fiec
Freeboard (ft):........................................................................................................................................................
.............. .............
....................................
10-
Is seepage observed from any of the structures?
❑ Yes
❑ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12..
Do any of the structures need maintenance/improvement?
® Yes
❑ 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?
❑ Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .................................................. .................................................................... ................... ....................................................................
...................
...........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
1
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representaiive?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit"
❑ Yes
❑ No
No.violations or deitciencies.were-noted-during this.visit.-.You.W411 receive no further
correspondence about this.visit:.:
Comments (refer to question #). Explain^any. Y:iN S answers andlor and recortimendatrons or any other comments
Use iirawtngs of factlltt{y to better`explalin situations (use additional pagcs2as necessarv} ,
I
3./ft/j2• Z~ft?e rr.alCUnG Q� y P Clink c, cot in (r,Tc, )IKt 4&gI1. �oi 4).t.s4c t1w��`Ott irp
4
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J._jct ku -�e��c� G. �1t?r_w, c�- ovwr,) ktJer (z,-p?e\ �c pYct�M iv��re
{ KC6..se, Cr(v� : n ai1LA Wall S6.JQ ILte1 W i 4_ aA, aj r seAeJ. Not evOwL" T
iA9 as � i ►� 1'►c.4 I� ; �.r�
7/25/97
7
Reviewer/Inspector Name f t h
Reviewer/Inspector Signature: Date: Iqff

NO.323 P.
Facility Number
Date ofImpeetion
Time of impeetiion 24 hr. (hh:mm)
p Registered w Certified p Applied for Pem4t r Pertnitted ot 0—jWrg 9-ongj Date Last Operated:
Farts Natue: County: DupUn WIX0
Owner Name: Prone No: 910-5323636
p'ae lity Contact: EaulxAi smutthA.,,.,APhone No;
Matting Address: -gV—ft rJLZ .Rd..A,.,....�_d .__.._ ____.. _ .___— Rose MI Xlw._
Oncite Represeutativea
Certified Operator:
Location of Farm:
Iofiagrator:]ldnrp}>�.Zi'rano�i i. a .............
Operator Certification Number: _..._.,...
Latitude ®�®��� �ZiLougitude ®a
►wipe '
Wean to Feeder
Feedert0 tms
p arrow to Wean
p arrow to Feeder
❑ narrow to Fin
Boars
.I�, i� iy• �i�i. IA
f �,' Ii?.fy� l iwl�ll i Ji
w
li t ItZ
r;,r ,',., 4f1t�{ r 'i q++�+�1",
O airy.
t7 Non -Dairy
o
C'wn rca
n Pay Maja
nit h;YMOM
l A i
1. Axed=aanybuffmtbalueed main#enanceJuni foYement?
2. Is any discharge observed from any part of the a ration?
DiwJ%L ge a:igi.ited at: H Lagoaio 0 Spzay Field p Other
& if discharge is observed, was tl i� conYeyaneo ram -made?
bA Ifdisohargo is observed, did it teach Surface Water? (If yes, notify DWQ)
e. If disdune is observed, what $ the estimated flow in gd min?
d. hoes discharge bypass a lagoo 4 sytncm? (If yes, notify DWG
3. Is there evidence of past discharge from any par:E fthe operation?
4. Were there any adverse impacts to the 'waters of State athm than fmm a discharge?
5. Does any part of the waste management system i. er than lagoonslhoUbug ponds) require
maintenanoc/improvtment?
6. Is facility not in camplianoc with any applimble p *ack critak is effect ut 1he thee of design?
7. Did the facility fail to have a certified operator v responsible charge?
7/25197 '.
❑ Yes ®No
®Yes 0No
M Yes p No
❑ Yes p No
® Yes Q No
X Yes ONO
0 Yes ®NO
m Yes ❑ No
p Yes ® No
p Yes ® No
Continued on back

MAR.24.1998 6:18PM ENVIRONMENTAL MGMT NO.323 P.3/4
31-6 7 Date of Inspc+0U
S. Are tome lagoons or storage ponds an site wW deed to be properly closed? Eyes p No
9. h storage rapacity (freeboard plus storm sftmse� less than ed&pate? Byes p No
571nM= 1 structure'
M $U=wre 3 Sixuct M 4
Spucture 5 Stmcmre 6
W=Uf=. Pxitnaxy (New) Secondary (�',ew)
NewAlderm=7- AMermaa7-9O1d
Aldarman4-6O1d Aldeennanl-3O1d
Freeboard(ft):
,,...,..,, .............;..........
,:,........ ......... .,
10. Is seepage observed from any of fhe structures;
i
p s Yew No
11. Li Cr4siAoay oX aqy Outs 16rzata to the integrity c
f any of the s#ructnCcs observed?
®Yes p No
12. Do any of the strachrms need mahmmance/m; c�ovement?
11 Yes ❑ Na
(If any of questions 9-12 was answered yes,
Imd the pltnation popes an
Immediate public health or environments) 11 great, notify DWQ)
13. Do any of the stx ewres lack adequate minin u 4 or n>ammum liquid level markers?
way annlication
0 Yes 0 No
14. h there Physical evidence of over application?
Q Yes M No
(If in excess of'WMP, or rmAY entering watei
of do State, notify DWQ)
is. Crop we
16. Do the receiving crops differ with ftse dt�p of ed in the Animal Waste Managemnn?PlaajAWMP)?
17. Does the facility have a lack of adequate acreaj:� for land application?
18. Does the receiving crop need improvement?
19. 11 9= a lack of available waste application e(
20_ Does facility require a follow-up visit by same
21. Did Revfcwcr/inspector bil to discuss review/1 dspecuon with on -site represemtive?
22. Does recocd keeping Reed improvement?
For CerfAed or Permits Facibes On
23. Does the facility fail to have a copy of the Ann r}aI Waste Management plan readily available?
24. 'W= any additional problc= uatcd which caiw �e noncamplianco of the Ccrtiiiod AWMP?
25. Were any additional problems noted which on je noncompliance of the Permit?
Q . IXo,viaLaUuns.Or dericiewies•wece.nai;edAuriag thin visit;. You will.receive no ipt that; .
cAirl`e'sptinderiee azioatc ikiis•v�si:: .
0 Yes p No
O Yes 2 No
® Yes p No
Yes 0 No
MI Yes 0 No
0 Yes to No
p Yes tl No
Yes ® No
a Yea p No
0 Yes 0 No

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(G Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection q
Facility Number
Time of Inspection 14 : ! 0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..._ .. _ . ..._
Farm Name: .. S aaa.� .�.1'1 _ . � � dy �r..,.t 0. �.. �.1�!r^ 1....... ...........
Land Owner Name:..Qc�_f.'!� ..,.:.- r.+ 5_................................
Facility Conetact: Jo kl..... G sra ., .... .,•...... ,, .. Title:
county: ..................
PhoneNo: ...1 .... _.... _ ... _ ........._ .............._......_.....
Phone No:.�i,1
Mailing Address: p ���...1. r.. C-.._.._. _ .........
Onsite Representative:.... . E&iti rs.e ^. _....................... ..... Integrator: rr1p
Certified Operator: .... ..-..... _ .... ............... _....... .. .... _ .......... �.. .. Operator Certification Number:..l. `.�� � _.......
Location of Farm:
1.D.:!�.._�::o�.r�'�:a-.i.f._...S�.I. ... ..... �� ... �._....��.�.�.1�-:�..a^..^..-..t�:..... ..Q.:. .....�-k....._ �.+� ... ..l�S .... ....... .......
Latitude 4 4 ®" Longitude ®• 0
Type of Opera ion and Design Capacity
Des�gn� CrrrenE �Desr n Cunt
11-
Swine g� Design Current i
.OUI.^: x ? Cattle �F£ gyp, a ; ,,
: : w W—,, _.. ,;.Ca acr Po ulatian y y._ _ _Ca aer Pa ulatron „>Ca acr .. Po ulateoniv
❑ Wean to Feeder IQ l.a er I .g NJQ Dairy
❑Feeder to Finish 1101 (1 ❑Non La er IDNon Da
Farrow to Wean x� �. 3 �� :
Farrow to Feeder =k TatH De gtt�C p cit
y I �
Farrow to Finish
........ Total SSLW�
❑ Other
2a s.. .n�, 3� � � `i.-°� i, _3^K, � ,-" "� - � ,n",
?
�Number�of Lagoons / Hadmg Pons ❑Subsurface Drams Present
`;� `"� 4 �� ❑ Lagoon Area _ ❑Spray Field Area .. .
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than tagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes E,No
❑ Yes 0 No
❑ Yes
12 No
[--]Yes
ED No
11 1 k
❑ Yes
N No
ELYes
❑ No
❑ Yes
R No
❑ Yes
ErNo
Continued
on back

Facility Number: _33..._ —.,...�._.._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
19 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
Yes
❑ No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (frecboard plus form stora e) less than adegte9
�! �..r....,� �>w
® Yes
4-a
❑ No
'sf-.3-
Freeboard (ft): Structure I Structure 2 Structure 3 s Structure 4
Structure 5
Structure 6 i
3
8
`� `
10. Is seepage observed from any of the structures? 1 3
❑ Yes
Eff No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
id Yes
❑ No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
N No
Waste Application
14. Is there physical evidence of over application?
❑ Yes'
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �a i L..i. _----- .....__ .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
J No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
IN No
18, Does the receiving crop need improvement?
❑ Yes
JNNo
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
® Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JR No
For Certified Facilities Q&
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
IN No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,[ No
24. Does record keeping need improvement?
19 Yes
❑ No
Comments (refer to question #) Explainany YES answers- and/or any recommendations or any other comments
Use drawings;of facility to betterexplaln s�tuatzons y(use acidihonal pages as necessary)
.,
3 . in) a s �c e-ttl, t e 2-k ,. 1 a.. c �o-v_, � -V v
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Reviewer/Inspector Signature: n8j A , . r - n Date:Qt
cc: Division of Water Quality, Water Quality Section, Facilitv Assessment Unit 4/30/97
y19)

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Inspection-6 7q 71
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4/30/97

Site Requires Immediate Attention 0
s Facility No.IZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: lG� f , 1995
Time: 1-) S'Z)
Farm Name/Owner: 3 /�u sati
Mailing Address:
County: --
Integrator. Phone:v !l 5
On Site Representative. f ��G�-- _. _ Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: 3 ? a- Number of Animals on Site: 3 (.- -7 -1-.
DEM Certification Number: ACE DEM Certification Number: ' ACNEW
Latitude: 34 ° q6' al " Longitude: ? �r ° Lb 9 D- " Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard:' a Ft. O Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion,observed? YD or No
Is adequate land available for spray? 'e5;br No Is the cover crop adequate? Gs or No
Crop(s) being utilized: 4,geff '�
Does the. facility meet SCS minimum set
I 1L_erc1__e
criteria? 200 Feet from Dwellings Y s or No
100 Feet from Wells? 5 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into Waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ords� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on speciifi"�
c acreage with cover crop)? Yes or No
Additional Comments: ?J cev� ���m�P A'e _ .1 A,JZ0`P �^f
Inspector Name
D - „ otJ fi)
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
• Facility No. _W:7�
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: /a )
Farm Name/Owner:snai
Mailing Address:
County:
Integrator: /ti Phone:
On Site Representative: I e e Phone:
Physical Address/Location:
Type of Operation: Swine - ✓ Poultry Cattle
Design Capacity: 3 ( 7 Y Number of Animals on Site: ? G ?) _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: "I ° q . Longitude: Elevation: Feet
Circle Yes or No'
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot t 25 year 24 hour storm event, `
(approximately 1 Foot + 7 inches) 9 or No Actual Freeboard:4_Ft. —7— Inches
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? ' s r No
Is adequate land available for spray? (Ye� or No Is the cover crop adequate? Lj�;?,or No
Crop(s) being utilized: 62,411KI /fit
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS -Map Blue Line? Yes or No
Is animal waste discharged into waters o��--f��the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oppflb If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage. with cover crop)? Yes or No
Additional Comments:
n
0 . 1. Lff�_dd
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
-
Site Requires Immediate Attention: e J
DIVISION OF ENVIRONMENTAL MANAGEMENT Facility No.
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator:1
On Site Reuresen
Phone:
Phone:
l
�Il
Physical Address/Location: AV
L4 U
Type of Operation: Swine Poultry Cattle
Design Capacity: 36-,2D Number of Animals on Site:�-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 2° -,L 0 Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: � Ft. 0 Inches
Was any seepage observed from the agoori(s)? Yes o Was any erosion observed? e or No
Is adequate land available for spray? e r No Is e cover crop adequate?(9 or No
Crop(s) being utilized: Q
Does the facility meet SCS minimum setback criteria? 2{}0 Feet from Dwellingsff No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 6 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional
f-5 6 `v
Inspector Name -
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention: Ae5
` Facility No.
f DIVISION OF ENVIRONMENTAL MANAGENFNT
ANUMLU FEEDLOT OPERATIONS SITE VISITATION RECORD
i •
Farm Na
Mailing
County:
is
Integratc
On Site kepresentative: _ uY m zzry,r Jc�.--a raone:
Physical Address/Location: _ zfxc ?�� j�`~ Cp --
DATE: , 1995
Time:
Type of Operation: Swine Poultry Cattle
Design Capacity: �� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 1$ ' 4-{ ' 2� �" Longitude: ZF ' �' Z/- i� Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o No Actual Freeboard: Ft. 6_ Inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erasion observed? es r No flMacy'
Is adequate land available four spray? e �r No Is the cover crop adequate? G>'sr No S�
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wets? Yes or No
Yes o CINO)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes of No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with Jcover crop)? Yoe No
Additional Comments: lFeM S '24"l2 //7 O ,"_0Ce5 S
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?
. Inspector Name 11
cc: Facility Assessment Unit
Signature
Us:. Attachments if Needed.

Site Requires Immediate Attention: y�
Facility No.3/1_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ -1 ¢ ., 1995
Time: y
Farm Na
Mailing
County:
Integratc
On Site �.41114a4.11CL�Y4. i await.. I — -
Physical Address/Location: 42t V.
Type of Operation: S wine ✓ Poultry Cattle r /1 r ,f:,h r C�
Design Capacity: Number of Animals on Site: (J
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 4- ° 44P' S3 •J5 Longitude: �77) ' 10 ' b r Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
1 (approximately 1' Foot + 7 inches) Ye or No Actual Freeboard: 4—Ft. Inches
Was any seep
aae observed from the lagoon(s)? Yes o Was any erosion observed? 6>r No
Is adequate land available for spray? es r No Is the cover crop adequate? es r No
r� 1
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or( oo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No r/
Additional Comments: T e S� 24Gti7
. L L";,5
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT ,
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: 1 , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
94_4
r*Rme,
Inte2mtor. , Phone:
On Site Representative:'Jo22h R-.k-u'5c>n Phone: ci 16 - 532-Z(e I (O
Physical Address/Location:
Type of Operation: Swine Poultry Cattle '
Design Capacity: 3 �P Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: � 4- ' _�k' S5 Longitude:'71 - _ 10' Elevation: Feer
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes ot9 Actual Freeboard; L45�_FL d Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Deor 1.4Ri40r—
Is adequate land available fo^spray? 'es>i^ No Is the cover crop adequate? Desr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from W e1s? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o CNO)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
Inspecior Name
cc: Facility Assessment Unit
'T
Signature
Use Attachments if Needed.

f
r
It
Site Requires Immediate Attention: ,� J
Facility No. r ✓ /
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STI'E VISITATION RECORD
DATE: , 1995
Time: C.
Farris Name/Owner: rm {{
Mailing Address: Let C05 457
County: nr 7 I,�
Integrator: Phone:
On Site Representative: -A-o� 56/] Phone: (W iD
Physical Address/Location: b Q03 (0 �[ w a . � 1,cAf
S[ i 2 8 3 m,' _f 2 m oel /CAI -
Type of Operation: S wine Poultry Cattle �1 h� 5r1 r7
Design Capacity: (p M Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34- 4Ca ' 4$. 5�' Longitude: �I $ O Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Spor No Actual Freeboard; `2- Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No)Was any erosion observed? Ye br No
Is adequate land available for spray? Yes or No Is the cover crop adequate?- Yes or No
Crop(s) being utilized: 2S 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ye or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Strew? Yes or e o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices?. Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover cr;N.
or No
Additional Comments: �' (G ee05 r 0, Ec�
Inspector Name
cc: Facility Assessment Unit
A�_-
Signature
Use Attachments if Needed.