310007_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

BCljltyNumbern` DlEseonSand ater ConservatiW
the Agency
Type of Visit: C pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: i 4 t� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:aN>J`� (L6 i,is✓
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: C[ 6 V
Certification Number:
Longitude:
esign Current-b-Design D'Current
Swine
Capacity Y~ Pop Wet�Poultry Capacity Pop " Cattle
riA
Wean to Finish:
La er Dai Cow
Wean to Feeder
tI jNon-Layer I Dairy Calf
Feeder to Finish
��. y� Dairy Heifer
Farrow to Wean
x ;, Design"-C �rrent D Cow
>
Farrow to Feeder
�, D �Poul Ca�aci _Po , -Dairy
Farrow to Finish
La ers Beef Stocker
Gilts
Non -La ers Beef Feeder
Boars
jPullets. ¢ Beef Brood Cow
= Turkeys
Other'
w ,a
Turkey Poults
Other
Other'-
-
- _.w^'. ,»mow-. :,u "..wa�• : - - ...w...e._..:.,; �.aw3:�aas.4-�
Discharges and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facill Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CNo ❑ 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: '4'ew
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1 �] 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 UNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Ay lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VIN�,03
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �Noo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1=J No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENO ❑ NA ❑ NE
Page 2 of 3 TT 21412015 Continued

Facili Number: r'I - 7 jDate of Inspection:
24.. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z�l ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes l No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes [2] No
❑ Yes 0 NNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes
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
❑ 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
cz�
S�'� 'resi 176...E wsTi-f �tAT(-' ZU l.Cvc.us
go�- (-_LCvr-N1 C9
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
F kj(-
Phone:1 j b 22
Date:��O/
'2141AI5

U Division of Water Resources
Facility Number ❑ - m 0 Division of Soil and Water Conservation J
0 Other Agency
Type of Visit: Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q S` Departure Time: [--= County: L.r_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Emx)0'? 19RbV"�%) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Certification Number: 19 C& 0
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
K) 141D Non -Layer
Design Current
Dry Poultry Canacitv Pon.
Layers
—.Non-Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
eNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NE
Is there evidence of a past discharge from any part of the operation?
El2. Yes
VNNA
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
� No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 3j - 77 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 I1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l JACy64-4 ( Z
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 [XNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen at threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C�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 f o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 7No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a Zack of properly operating waste application equipment?
[:]Yes gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box YS10111
❑ Yes o ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 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 [] N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: 3
24 :Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �WNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �`No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes No ❑ NA ❑ NE
❑ Yes [!�No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
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
❑ 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
[jNo ❑ NA ❑ NE
fNo ❑ NA ❑ NE
�No [DNA ❑ NE
E/�No ❑ NA ❑ NE
Ey<o ❑ NA ❑ NE
Comments {refer to,question;.#): Explain: any°YES answers and/or -any additional recommendations or any. other -comments.
Use: drawinp,s of facility'to better'explain situations .(use additional:pages as:necessary).w -
�.� 0;69 NCw UMPAOY FGe_ SOIL, S.1qMFLE A-kJf, �CAm UP
u rG A I�zEt� S�Gc-7 s i r P ►. HF,QL-- AW::> St­6 i02 T
ro St Do rJOT U S t= CyC=L-0 U PTs(- A5-v L I S C6 T 13AG4.
Zf% .ink i� clatJ ljo F 9C MoJ6 3 oo-o
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Ufa
Fmtlity Number
o Division f Water Resources /
® O Division of Soil and Water,Conservatton
Agency,«
Type of Visit: C5 Co
fiance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: © Departure Time: County: Ulptai Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
DPAY Y 91Z6X.JJ Integrator:
Certified Operator:
Certification Number: 1 -1 l
Back-up Operator:
Certification Number:
Location of Farm:
Latitude: Longitude:
.Y" R .+T.,. ,y r3af.a.1 lYnd.�e'F.y�a
ent��'-^�/.`R
Design C'nr�rent�
.�
Swine
Capacity Pop Wet Poultry -, Capa��ty� Pop 'Cattle-- Capacity "Pop
Wean to Finish
La er'j Da Cow-
Wean to Feeder
Non La er I Dairy Calf
Feeder to Finish
r5 Dairy Heifer
Farrow to Weansigns
Cui=re[Dry Cow
Farrow to Feederul
�Y
-owiPo 1`1 Non -Dairy
Farrow to Finish"
La erg' Beef Stocker
Gilts
Non -La ers Beef Feeder
Boars
Pullets Beef Brood Cow
w Turke s F
Other. r� TurkeyPoults
�: -
Other
10ther f~° q
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[—]Yes ❑ ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes FZ/No ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �L CA 6yV
Spillway?:
Designed Freeboard (in): n
Observed Freeboard (in): 3 a
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 environments hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNo
[3NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P14110
❑ 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 InspectiWNoZ
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []YesVo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection: .
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E C ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ZT40 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes
V ❑ NA ❑ NE
and report mortality rates that were higher than normal?
7No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
M 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
[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?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
�No ❑ NA ❑ NE
9�o ❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of faeility to better explain situations (useadditional pages as necessary). -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone((
Date:
-1319F
Page 3 of 3

ti
Yn S ✓
® Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co pliance Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: (>Al,}IJ� 'b(LQI+JN
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 10 14p(3
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Phone:
Integrator:
Certification Number: Gj-30
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
L
F
Pullets
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I!J No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: onll
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S3L _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ 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
V o
❑ 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 I threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�
❑ 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 I I�1VO ❑ NA ❑ NE
maintenance or improvement? "`77.
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 ZI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rV
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Required Records & Documents
ZNo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes NA ❑ NE
❑ ❑ 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes '0 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
/� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes rNo
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ElYes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Yes [% "NNo ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ 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
IVo ❑ NA ❑ NE
r❑ NA ❑ NE
N x ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional na2es as necessarvl.
Reviewer/Inspector Name:
Phone rjD
Reviewer/Inspector Signature:
Date: _1 / 1 i 1 L
Page 3 of 3 1 21412011

(0 Division of Water Quality
Facility. Number
0 Division of Soil and WateuConservation
0 Other Agency
Type of Visit: 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tz i Arrival Time: 9gb--1 Departure Time: 9 O County: V42LXK) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: D-AraIR s"WO Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder p14DO DSO
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Certification Number: 19 G 3 a
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry.Ca aci . Pop.
Layers
Non -Layers
Pullets
_Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Heifer
—.Dairy
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [21 No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 17 Date of Inspection: allit,
Waste Collection & Treatment
4. 1 s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:,��,.j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 UfNo ❑ 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 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA
�ro
❑ 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 EfNo ❑ 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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes u 1V o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes dNo
❑ Yes [EfNo
❑NA ❑NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
Ej/No
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
[—]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: 21 M b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo ❑ 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 a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E�No
❑ Yes dN0
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes (21/No ❑ NA ❑ NE
❑ Yes [fl/No
❑ Yes Ld o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendationsor anyother'comments.-
Use drawings of facility to better explaih situations (useadditional pages as_necessaiy}�`:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

CO Division of Water Quality
Facili"umber - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co
lance Inspection Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3,5 Arrival Time: I j[?QiQ 1 Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: q,,� J ��1�.1 }.a
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder �Q
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop,
La er
]Non -Layer
Design Current
lets
Turkey Poults
Other
Longitude:
Cattle "
Design ., Current -:
Capacity'y' < Pop -
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
art::
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
hTo
❑ NA
0 NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facitity Number: - Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA o-j 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '-4(4 40
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 WNo ❑ 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 1hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ld"1"' ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Re4uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F��J/No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: jDate of Inspection: V 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 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes tNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes I__i No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Z
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Z
2/4/2011
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Division of Water Quality
}
FaliIil Number Q Division of Soil and Water Conservations n >/
0 Other Agency
Type of Visit ,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: oZ ti I 1 Arrival Time: Departure Time: County: l T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: SDA400 .9R-Oi'')"j Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 0 d Longitude: 0°= i
Design Current Design Current Design Current`s.
Swine Capacity Population Wet Poultry, Capacity,, Population Cattle Capacity Population
❑ Wean to Finish
Eff Wean to Feeder
rL4�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other <
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry,
❑ Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures n l Il
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
vVio) ❑ NA
El NE
El Yes
El NA
El NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structu e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGoAJ U%g6tJ 'L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 3 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE'
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E /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 environmentaZo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ❑ 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 L4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
� ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
ts(reler to question; #) Explain any YES answers and/or any_rec
�a= ..,�-_`. L
erhnspector Name d j ' jJ �` ' Phone. Der/Inspector Signature: Date: l
Page 2 of 3 I2128104 Continued

r
Facility Number: —r7 Date of Inspection t it
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes zNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA [INE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [IYes VN ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �N ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes i ❑ NA ❑ NE
27. Did the facilityfail to secure a phosphorus loss assessment (PLAT) certification? Yes �7No ❑ NA ❑ NE
p } ❑
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I[J 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)
WN
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional -Comments 'and/or Drawings:
Page 3 of 3 12128104

.777
Dtvision of Water Quality'""
Facllity-Numbersion of Soil and Water Conservati
-Other.Agency
Type of Visit d Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ti 1 Arrival Time: Z ?yv Departure Time: County: INJRegion:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: ,73p"Oo e ZLQ"'4 .j Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =] o E=' ="
Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
o k� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharp_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
❑ 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 1 of 3
❑ Yes Lam! No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
NN El NA
El NE
❑ Yes
El Yes
�Vo ElNA
ElNE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number:
- � 3 i — �] Date of Inspection ► fi7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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: IJkP==jI i LArNga 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 20
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EN. ❑ 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 E(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El"No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
L No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
to
[INA
❑ NE
17. Does the facility lack adequate acreage for land application?
El
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo'
❑ NA
❑ NE
t_0ni. nents`(refer'to question ##) .Explain any YES answers'and/or anyarecommendations or any other comments <
Use drawings of facility to better explain situations. (use additional pages as�necessary).
AL
qV
Reviewer/Inspector Name
� }- "- Phone:
(9I6 -13V
e.
Reviewer/Inspector Signature:
Date:
t
Page 2 of 3 1 12128104 Continued

Facility Number: _ Date of Inspection 1
Required Records & Documents �f
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PPNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
dW15o
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
21 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ TNNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 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?
El2 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
23 N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

Fice`i ty Number
3�
dDivision of Water Quality ;
;O Di4silonF©f Soil and;Wa#er°Conservation ,
OtherAgency. ..„
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit Q/Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: la 3J Departure Time: County: fbL*LXa.! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _VA1.1131? A�?t� I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
ini
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = ' = Longitude: = o ❑ 6 ❑ 1i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
ym) 1 ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ PuItets
❑ 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
❑ Daily Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
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 4o ❑ NA ❑ NE
❑Yes
❑No El NA
El NE
❑Yes
El No El NA
[I NE
❑ o El NA
❑ NE
❑ Yes
❑ Yes
Xo ❑ NA
❑ NE
❑ Yes
Z o ❑ NA
❑ NE
Page I of 3 12128104 Continued

yK
rcility Number: Date of Inspection I Sft109 I
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iA 6oW ! LA 1,,cm,.1 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 3 (G _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes d-tx o ❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
t 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
ENo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
o ❑ NA
❑ NE
Reviewer/inspector Name j �-q" I Phone: `'JLC) qCo ,
Reviewer/Inspector Signature: Date:

acility Number: 31 — 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �N0 ❑ NA ❑ NE
20. Does the facility fail "to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If es check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
P g P Y�
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes o ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes Zo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ymo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Ld"No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ZN o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes d�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E�t o ❑ NA ElNE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number �j `� 0 Division of Soil and Water Conservation
�--.... 0 Other Agency
Type of Visit pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit grMoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 2 a Arrival Time: gOt7 Departure Time: r�� County: L)U PL%±Aj
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative. �RWa-w
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [—] o =]' = Longitude: = ° =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder 6 aD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkex 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
El NE
❑ Yes
El Yes
Zo ❑ NA
ElNE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: E Date of Inspection I :UAbIdY I
e
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: CA Crool.J l LAC=, 0'J '2L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 33 ,_,{
5. Are there any immediate threats to the integrity of any of the structures observed? ElCJ 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 �fNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Z ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
V1140 ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
o ❑ 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):
�C-[avv1MjEurn CGC-}TZ.I�] G (,A(ran� SVA^WVAR' GT To CCA&a-fY StoP LEVY `
Reviewerlinspector Name d >J (✓ Phone: 3
Reviewer/Inspector Signature: Date: d

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

t�.
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
co liance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of visit: Y Arrival Time: f w0 Departure Time:
a� o� County: U Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: D14>., w 7i mgAtj Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4=, Longitude: 0 0 0 I 0 {[
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
© Wean to Feeder 116400 I FM
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Nan -Layer
Dry Poultry
Pullets
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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoAi
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
ElNE
❑ Yes
❑ONo
ElYes
L/J No
❑ NA
❑ NE
No
❑ Yes
(
❑ NA
❑ NE
12128104 Continued

Facility Number: 111. - -
Date of Inspection 2 a7
{� Waste Collection & Treatment ,_,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA Cr- ­ vJ
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O 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 environmentalat, 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 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI IVo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri#i ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[3No ❑ NA
7ElNA
L�JN El
LI N NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A,
I
Reviewer/Inspector Name o R V— Phone: 910) 14 L - 91
Reviewer/]nspector Signature: Date: Z. o
12/2R/nQ Cnntinuod

Facility Number: — Date of Inspection f '
'r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ VvTUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D o
❑ 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
eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�BNo
L�J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'<
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Vo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E:Ko
❑ 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?
ElYes
LI 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
B' o
❑ 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
QKo
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElB Yes
No
❑ NA
❑ NE
Comments and/or
5
12128104

FAciHty Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit (n WRou
npliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit tine Q Complaint O ollow up O Referral C) Emergency 0 Other ❑ Denied Access
Date of Visit: I 7lS biv Arrival Time: $ S Departure Time: County: 1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 2wvj ? Bi Wrj _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: 0 ° = ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
© Wean to Feeder l o ,-t r e pa
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ec
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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daia
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E
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 Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[j'No
ElNA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 —
Date of Inspection I e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA eg-an,.) L LA&20.? 7—
Spillway?.-
Designed Freeboard (in): 11 + S'
Observed Freeboard (in): Ae 30
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 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CJ 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El 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 Drifl ❑ Application Outside of Area
12. Crop type(s) 13``C-_&4AAuD*, C C0 J G C.
13. Soil type(s) N o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ 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 [2*No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Q"
'�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ENo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a 1.) ` Ir- SLKL.0 Tt> Dc f oco _ am—
Pu,T D-5 ►,0 c_ .
). Sw-tC.&4LATetL
Reviewer/Inspector Name - J ou 0 u Phone:
Reviewer/Inspector Signature: _azDate: I CP
1'Z1251U4 t.'onnnuea

Facility Number: — Date of Inspection I
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,u,[1 o ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
d Yes
❑ No
❑ NA
❑ NE
❑ Waste Appli ation ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El 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
E! No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
El NA
El NE
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,Er,
No
El"No
El NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
E; o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L3 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I
El NA
❑ NE
29.
Dad the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�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
L1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
0"NNo
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit trCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 30, Arrival Time: Departure Time: County: � !lPGL�% Region: &') -�
Farm Name: O!�� �/Q?t&w /Akm Owner Email:
Owner Name: a�o�� Phone:
Mailing Address:
Physical Address:
Facility Contact: /} Title: Phone No:
Onsite Representative: _ i l h14,V y &,944 /J Integrator: _;��D�f�✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = i = Longitude: = o =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population .
/O E7 ODO ❑ Layer
❑ Non -Layer
Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other - - - - —_
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turke Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ 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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NE
❑Yes
No�❑NA
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
I2/28/04 Continued

'1
Facility Number:
Date of Inspection 3 O
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:�Z
Spillway?: /✓o /�c
Designed Freeboard (in): l9,5 /.�
Observed Freeboard (in): 2 r 2 N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;ZNo ❑ 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 H 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 > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
l3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Wr No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
21 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
10 No
❑ NA
❑ NE
7)6e,rZ.���aQr-�mPilovf, / .✓y /1/��/� o -��� F o.� r. �G a�N '`� % so07E Gr/.47FA
AAW40
rf p
Reviewer/Inspector Name Phone: v- 395— 3 �d Z2
..�
Reviewer/Inspector Signature: Date:
12/28104 Continued

Facility lumber: 13— Date of Inspection �o J
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 )z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 21 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
.fNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ 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
)A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Y No
❑ NA
❑ NE
Additional Comments and/or Drawings:
mz7 Soo
/�i2 �itl� it �. COO 5 �/F�L �%fJIi✓�.4z�✓
�,—po ��� �-�i�c- S ��2 G/tG�ls •�
/�5
12128104

"" � Q DrvisroAn�of Sod and Water Coaservatton - .�
�.e� x��� }� ��.�.. � .�'—�- - � Q�Other'Age�,: �' _ �' m ��f��-,^ � »•� n ,� � � a ,-,,
_r -K' � �_ s`- ---s_—... ._ .ems• >_ v �*. �
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit g6outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: ; �S
rO_NotOperafional Q Below Threshold
JgPermitted#Certlfiied © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
��........
..._..._...............
Farm Name: .... .?I`ilex....iiZt✓...... Rid. ....... .......... _...................... County: ...... ...................»............._._.._
Owner Name: .... ...... _ . ... .._......... Phone No: _._._......... _ ..... __ �.. _. .
Mailing Address:..._ . ....._.......__ ...... _..... .W _ ..W._ _- - -- —
Facility Contact: .................. ......... ..._... ..p............ ............... Title:.._.... __.. ...... �APhone, No: _
Onsite Representative: .._aW......._...._................................ Integrator:_.-!!lJ........... ............... ............... ..... .......
Certified Operator: .................. ............... . .. ....
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude
�Desag�u� Curraeiut _ Design Cuireaii
Wean to Feeder
1 o y 0;�o
qG90
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Discharges & Stream Impacts
Longitude • 4 is
CaAacty:
1. Is any discharge observed from any part of the operation? ❑ Yes ;9 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 PTfqo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ...I ...... ............. ..........._. `L ..... _ _ .._
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5.. Are there any immediate threats to the integrity of any of the structures observed?(ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes XNo
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 PNo
8. Does any part of the waste management system other than waste structures require maintenance/mprovement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Amlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ISCQYUuDP• U-A !>MAL(, CYft W (7�u e"CED
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes X No
b) Does the facility need a wettable acre determination? ❑ Yes P(No
c) This facility is pended for a wettable acre determination? ❑ Yes )Z No
15. Does the receiving crop need improvement? ❑ Yes X No
16. Is there a lack of adequate waste application equipment? ❑ Yes ;eNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ZNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;1No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesXNo
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 fi!rNo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
rIrE[.VS LOOK, Gnat, (..JSTH FJ6W ptRAKUDA WD Ot ,$E[p CQAQ,
MR. &Z'Owo Ac.[to.-moo NEw W UP W-r-m Tk_ &JEw ge(Lrwo#• Na.) Eirztg ACW%E.
?CcO(LOS Look CAD Wt> ACMAGE fAATC4 P2op(ea_ - .
Reviewer/Inspector Name
ReviewerA Spector Signature:
Date:
12112103 Cbnknued

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

0Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit Z Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint C)Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 30 O I 'rime: 1 3 Z 3
Facility Number .3 7
Not Operational 0 Below Threshold
Q Permitted [3 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 0 cy 1 &121 L . 6- etv .+n Fq v w� Count: E) vie IN w
Owner Name: DG+" t " 1 `9 Brc [ r Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: L31 0-14 L �✓"� 'f
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: �Yor.✓'* J Dir 4f4 Ir 0 1,
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 f CC Longitude ' ( µ
Design Current
awine L a achy rD uianon
Wean to Feeder 1 O*DD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I IF] Non -Dairy
❑ Other I
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I 2
Freeboard (inches): 37 38
J Spray Field
❑ Yes
XNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
2rNo
❑ Yes
❑ No
❑ Yes
ONo
Structure 6
05103101
Continued

h
Y
Facility Number: 3 1 — *] Date of Inspection 3o OZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADnlieation
❑ Yes JZNo
❑ Yes Z No
❑ Yes -fI No
❑ Yes 0No
❑ Yes _ONO
10. Are there any buffers that need maintenance/improvement? ❑ Yes JErNo
11. Is there evidence of over application? ❑ Excessive Ponding XAN ❑ Hydraulic Overload OYes ❑ No
12. Crop type _Fee^%v44 6,14W
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?
12ryes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Required
Records & Documenj§
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Oyes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ETNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
21'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JETNo
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Eomments (refer to question {I I III 115 any YES aB=" eend/or any recommendat,ons or any tiElie"r commea` s' ' "
1� )
Use drawings of facility to better ezplain sitII ns. (use addtttonal pages as necessary,El Field Copy ❑ Final'Notes
Mr . 8,L-,.,, s�Y s 41.tqq k e h,, .r seed e of 4 � � 9�rC berh Va'r ; rn KI r40y iP ip�r.
fYfr,9r11-­11 r)eeAS aoGyIPGI� rv>�lt h,s-�c���'cA .5pc 'ul;sq 70 eylsvre
IS4. 4-t_' � 44:5 1S Rc"104--b{e itq -t c c,0e (A>1c-e IV14k Ae- 1ni �agc,r,1�ljow�hcQ
S G�j✓en -Fee bg-A�✓O�� i✓? 4he fla-'i • -IF elh 1m4eile"lc -t kuedS 7c be
�
Added to pig•-, o>j^?) pl4h r��d-�o be mod��;�d( fo a d;A'Fer�'"4r'-4;'1�t-,
CI l l e -vet'I ' - k e p l -i��te -� d A M r"4)S� ae t"'�t �i-f � Sivm 1 d '(a -h is 'I c o "4 ?"I V rOy
Reviewer/InspectorName
ReviewertInspector Signature: Date: S 30 2-
05103101 Continued

Facility Number: _?I — ty Date of Inspection � p
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 ONO
❑ Yes _JRTIo
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
Additional„!C,oinments and/6r,,l)kawings;,:
/S+
zs. M'e'- kta.s oi PI-7r, 4o 4r � �o es4n bl ok coas+Q l def�l vda
it,, ecA&I, f v,(d over a W 4 t v►1c wh f l e 6 v iv\) Se^-% a fl
grass /h 4L e Ae4A vk74 .'I svG1-t4iwne qs he Caul e, Rb1 A GocrAaI l�
ec-611 rzSIaf - Ml- Brown, "mod fc-0464 411,0 Ile hots 17etd 4roJ'41e
3e'4in5 A yee di 54'M V�d -AL" rrr e r►-x M." ooazA s erisvrge
4tt44 4he er®P i,,t ` (se- Aetrt rv4-FekeS YAO deligia-ed ;h 440
) e plan ^rtd-LIG-,z f lie n�-t��oo��1� Gl]owei- ce ;
wo►s
-Ike 3;Vetn Gfar .
1Y. An old nePi a l Ptqq p i-Vid cA4er 4Lza,4 ;hale it
W11 tc we-8,qb ),e ac-Per sl,owl 3, 851a4Gl i.,fe#a,d
4It; s QlrA -
IAI. I�r• �3r��vn �aS Iv►Gcx�'rec•}iyp�U'GC�/�e 4'h Somme
of 1'I.,S 5��"11r<> 6 vsed 411e o,Gfea,)e �'rdM oele-iis�jOQd^4te
_IV- 2 Far ct-'04 ken ;(-A A Ce ttf be a CCo"--S . M' . )3f10W'N i)Q494J -/U
en'SUIT -AA-1 41\e Ger'W4 'Ac sea5c r"s l�co�'v(�d a•, �%� ��P>a? �' .
Mr. tweets 4, reGa/d� w h, cin � ot9vor► � r be ►�9 Pam►^-t f'e!�
4,,^q rwd use plc Ca-'re0 wa,S4e c4nal S?'S out JL,e
�R4-2'��c,,
GaG �v1> e.pplied _ ►'> r. gown C4 Ise ileed S 4a
use o ��s'�e anal •sus oia�ed w:�h:� (op a�a s o� �
o0p 64 �. �rcwv� cI pr #¢d 556 . � q Ai A OP
plAJ44 gvP11able n4 eaY,), �v r-;eld S Q,1 AR 20C\ I - 2462 rye crar,
He, t ttd Onco*feG}l labeled 47,e --7Ra4- -Z qs 'F;etd- 9 a►n[l „sed '7.,54c><e3
044kef 41,ah 4,Iq L+fGreS 41v /;eId 5 . -5: h di1 GuSse A0Et� AAA i;!
won ; S 71; Gh �tr.�d -dam A •e -leM Al . ew -, : s 41 ?
� u �6514e/e P n /'ye . "1 �e fc�'e � oWr'alopl: e�-t•'�� o
OCCy
i . ce•,�;K„Fd� e
��;?re is l.`�}le 6er•��d� in �;etds 3�(� �tnd, -7�
6e � •ryt veto and r,Tzat' F e l d s 3l c- 4 t, a !Deed 4,9
prcpe- Crap ��td elt•�;�ti-fie Co�y�e-l;�Jny o� 9�j����5.

ArDi 'ion of Water Quality -
0 Division of Soil and"Water Conservation
O:Other Agency
type of Visit lecompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit'fi!rRoutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: 61 Time: q 3�- - — Printed on: 7/21/2000
O Not Operational O Below Threshold
0 Permitted ❑ Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ................
Farm Name: 16-ft ' 0 t.V #1 re4 r e-x County: P.y 1..................................... ......................
.. ff.....................................................................................••
OwnerName: delA.o.n. `j.....In,...8,r 0 L Y)................................................... Phone No:......................................................................................
FacilityContact: .............................................................................. Title:..................................................... Phone No: ............
Mailing Address:
Onsite Representative: pn
CertifiedOperator: ................................................... ..................................:
Location "of Farm:
.......................................................... f................................................ ..........................
Integrator: 8-0tv'1 s 04 cAeo.b..'. G.*.................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 64 Longitude • 4 49
Design, Current .` . Design Current .,C
C8Di1dtv:: Population Poultry Ca acity Po ulation Cattle Canaciity Poi
Wean to Feeder
f-,
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
tL Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
- Wiifibei.of lAgoons ❑Subsurface Drains Present O Lag -on Area 10 Spray Field Area
<<Halmg Fonds`/Solid Traps ^ ❑ No Liquid Waste Management System
Dischar es & Stream ImPacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. II'discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier. .............................................. z'..............................................................................................................................
..
Freeboard (inches): 30
5100
❑ Yes ONo
❑ Yes 1'No
❑ Yes ONo
h lq
❑ Yes XNo
❑ Yes j2 No
❑ Yes J�TNo
❑ Yes ,!TNo
Structure 6
Continued on back !I

Facility Number: 3 —r7 I Date of InspCetioll l5 O Printed on: 7/21/2000
5t 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
closure plan? ❑ Yes'ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes,ETNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes j�rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 01No
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 El Yes � No
12. Crop type �!" wto, t<4c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes"WrNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 01No
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?
(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?
yiolatiQris :or & iciendes •mere noted• during this.�isit; • Y;oi m itI ree ' ME iio fuffte
ctirresporidence. abatiti this visit: .......... ....... .......................................
❑ Yes_,EYNo
❑ YesEI'No
.Jp 'Yes ❑ No
❑ Yes J2vo
❑ Yes_,2fNo
❑ Yes 'P'No
❑ Yes ONO
❑ Yes &Tqo
❑ Yes _ONO
❑ Yes J37No
❑ Yes ,EfrNo
❑ Yes ErNo
❑ Yes _4�ff'No
1 S "T L. c a oc c �a� e f.►1 �dq G ro p rl eMSca,ri-
i.,�Pro,rcvr1en�
gefa� 1 �, aid z,, ol* In 6eYer es• ct6 r;`rh Ga4s dal r.t,kv >�a 16e Qq
f�. Be suee �a tAse ct t,,a.sf� ana/y r�.s 6O
�'a��1��,Gh e�enas{vr �altvla-�i how n�it�• ,�►'��o yn�
Reviewer/Inspector Name 144[! t.. Y� i� ' � ' c '
�'l s',1-.If'i:t_ _s_ k w J_ },.tea
Reviewer/Inspector Signature: +f"L- a i Date: I 5'O% 5100

Facility Number: 3 — Date of Inspection {o jr%�Q f, Printed on: 7/21/2000
ddnr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor Wow ❑ Yes �fo
liquid level of lagoon or storage pond with no agitation? J
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0190
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 J3No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ;"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,E]'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or ravings:
a
w
5100

Divisioof
n
--
r _ _
_ 3
T - Division iif Soll and Water:Conseivation
ice"' S w
Y
' OOther Agency x �. `,.r ,;
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit.
pQ Time: Printed on. 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified j] Registered
Date Last Operated or Above Threshold: ...............
4.Y. n ....... L.Brown �toYl-' ,?... ............
Farm Name Dann
,
County:....... U .Jl••...............................................
T
OwnerName:.......�..1DQ.X..1.Ya1 .........................Seow.n.............................
Phone No: ................ ..................... ..................................................
Facility Contact: .................................................... ... Title
Phone No
.Mailing address:.....------•....................................
..................................................................................... ..........................
Onsite Representative:.............................................................................••-. .-
Integrator: ...... •]f.�4A�n...�.................................
Certified Operator:..-.-Dapn.{ .............Ly...... E,Efow..n ...........................
Operator Certification Number: .....................................
Location of Farm: j
Swine []Poultry ❑ Cattle []Horse Latitude ' �� Longitude 4 it
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 00 ❑ Layer JCI Dairy
❑ Feeder to Finish ❑ Non -Layer I JCI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 10 d Q
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -an Area ID Spray Field Area
Holding Ponds / Solid Traps I ❑ No Liquid Waste Management System -
Discharyes & 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 convcyancc flan -made? ❑ Yes 1KNo
b. If discharge is observed, did it reach Water of the State'' (If yes, notify DWQ) ❑Yes [� No
c. If dischar-e is observed. what is lhC CStifflatCd flow in gal/nlin?
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 bdNo
Su-uCturc I Structure 2 Structure Structure 4 Structure 5 Structure 6
IdentiFier: ................ �3.�,,,,....... ..-..---........5••f......................
Freeboard (inches):
5100 Continued on back

la
r
Facility Number: - Date of Inspection r "`T Printed on,• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J 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 (ANo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes " No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes %1tgo
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
1 I- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
i
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
1VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage &General Permit readily available?
Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�rNo
19. Does record keeping need improvement? (ic/ 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
0 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
I? No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(e/ discharge, freeboard problems, over application)
El Yes
4 No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
qNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
4No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
�, NO , i atioris.oe- &ridetims •Were n6ted- dirrirlg Ois"ASIC - Yoik will reeeiye do further
corieso &idea_ &' about: this visit :::::::::::::::::::::::::::::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
tr I r1 Pf 0(. ts5 Q � Corrt.��t,�: r� s�k,�-p.sb � e. QC.r'c. oc�t/,-ri�+rl�, o!� _
A,
f t ivn 18Ari oot�-
Reviewer/Inspector Name 0
Reviewer/Inspector Signature: Date: VIO V 5100

A.
Facility Number: 3 — Date of Inspection Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge;Wor below
❑ Yes
VNO'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4NO
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover?
ElYes
�No
5100

Facility Number 31 r`J Date of Inspection -9
Time of Inspection : 3b 24 hr. (hh:mm)
aj Permitted ❑ Certified © Conditionally Certified E3
Registered ,] Not O erational Date Last Operated:
Farm Name: ... a.nrt�I..........:..t-.'........ tO.V.!�1f.1_......�•A�AV1......-... .... County:............_�.hS��i�!1...................... _.........._.........
f Q 1
Owner Name: _... DAAA.1 .......... • ...... .......I ..1' W.}!1....................._._................. Phone No: _... .. .-. _��%.'.,a....................................
Facility Contact: .Dian [t�I.............B: RV.!t.!'N..............Title: .... b�11%)..-....-....-.........._........ Phone No: .................................._....._.........
Mailing Address: ....� �±"� ....... MA;1'_ �h.......• RJ..................................... ..................... 'e-�% ............ ./l! Ac ...................
Onsite Representative: .... D4.!!Lt'.ir. ...............................lf.Q.1N!i.... Into razor i ll..........................................................
1,�....................... g ..........
Certified Operator: ................................................... ............................................................. Operator Certification Number:.....A4.3.0....................
Location of Farm:
r...................................................................................................................................................................................................................................... .
Latitude ���°�• Longitude
Design Current = _:::'Design:. Current Design Current
Swine Ca acity Po ulation Poultry Capacity Population ' Cattle-, Capacity Population
Wean to Feeder 10 LMO , ❑ Layer ❑ Dairy
= []Feeder to Finish = ❑Nan -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ -; ❑Farrow to Feeder Other � -
❑ Farrow to Finish
Total Design Capacity
❑ Gilts,
❑Boars .x T0fiiFSSLW
Nuinber of:Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
0 -
Traps ❑ No Liquid Waste Management System
Holding=Ponds l Solid _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'! ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes X No
c. if discharge is observed, what is the estimated flow in gaUmin'? IVIA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes P9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes C9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 28
14
Freeboard(inches): ..................................................................................................................................................................................................
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes 70 T` No
seepage, etc.)
3123/99 Continued on back

Facility lumber: — Datc 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 maintenarce/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
e
13. Do the receiving bops 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?
.�.
❑ Yes KNo
❑ Yes Dq No
❑ Yes � No
❑ Yes ;KNo
❑ Yes 5Q No
❑ Yes P9 No
❑ Yes [XNo
❑ Yes A No
❑ Yes U No
❑ Yes V No
VV
❑ Yes � No
❑ Yes X No
❑ Yes JK No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes KNo
❑ Yes O No
❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes [9 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0: N.0 yi. 'a i6fis :or• ftfl:dencies -were not (j. diwing this. visit; • :Y:oilwill r. ee6 *Ce ii6 further
- - corres oricieMe: ahauti this :visit. ::: ::: :
Comments (refer.to question #)i _Explain any YES answers and/or -'any recommendations or any oilier eomiments-
P.
Llse dcawtngs of faciLty Yo->ietterezplatn situations {tee 4dditi6 fiali pages as necessary)
-- e
x
!'kCi'iZ"ireo!je_
Arms kee� ryv1 Cdren�ert �fac��S.
� is bet de4er";,,e-L 054
Reviewer/Inspector Name 19I�1r.�� fi1/.'
Reviewer/Inspector Signatu
V4- WAl)
Date:
N 10) 395--31&P 3/23/99

Facility Number: I — 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 KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OkNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes U 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 5(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 ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes &4'No
32. Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover? ❑ Yes A No
AdditionaLCominents.and/orDrawings-.,.
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
1MRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Date of inspection 1010I 4-4Y I j
Facility Number
Time of inspection �d 24 hr. (hh:mm)
© Registered U Certified 0 Applied for Permit OPermitted 113 Not O erational Date Last Operated:
FarmName: ....... .......K,t,............................................ County:........---..............................................
OwnerName:........ ................ Y............................................................................. Phone No:.........1.1.............d`�'
`''�.............................................................
Facility Contact:...................................................... ................... Title:..................... ......... Phone No:
_V05'011� i�..-i '� . �� e ��...`...................... ..........................
Mailing Address: .................................:...:..................................................
Onsite Representative: +r.L. �- .. . integrator:....-.-Y.-.t..� :...�&�....... .............
Certified Operator:............................................................................................................... Operator Certification Number,
L!!EL625 of Fa
iJ.! h .......... ....... . e.....A °�.. E'.... �' �........... 6..... ................. R...I..........
a`
..... ....... .... ... .....
T�,.sr� r. �-� 1 ..�13....,.......... ..►-� ........ 1t3...j.............. ..... ,.5... ,�..... ..►-�...................
Latitude • 04 " Longitude 0• 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes �1 No
2. Is any discharge observed from any part of the operation? ❑ Yes %No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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
maintenancehmprovement?
b. 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 Jallo
❑ Y�ers Wo
\'F
❑ Yes allo
❑ Yes EtNo
❑ Yes gNo
❑ Yes O No
❑ Yes *o
❑ Yes )4No

.; Facility Number:3 —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (LaQoons.Holdine Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Q No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �^..............................................................................
......................................................................
Freeboard(tt): ..._.... ....................... :0..... ..........................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
VI No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RfNo
12.
Do any of the structures need maintenancelimprovement?
Yes
❑ No
(If any of questions 9.42 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures tack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste ADnlication
14.
Is there physical evidence of over application?
❑ Yes
PdNo
(If in excess of WMP, o runoff entering waters of the State, notify DWQ)
15.
Crop type..................................................................................................................................................
L"r .... r­ .........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
VNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
H No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
(g(No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Vi No
22.
Does record keeping needimprovement?
gYes
❑ 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
9No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JZ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(R No
0-No.violationsor. deficiencies'were-itoted-during this:visit. You.vuill �ecei�e-_ir_o,furtlie' :.
_ correspkldence. Aboid -this: visit:: _ : . , .. ' . = ' . .
< e
01� 1r
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �, Date: r}_C—C(V

'4
❑ DSWC Animal Feedlot Operation Review .�
} s
DWQ Animal Feedlot Operation Site Inspection170
„
m. �,..w, N.r.,».
ro Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up or Fswc review '0 Other
3 i �� Date of Inspection
Facility Number
Time of Inspection 2��, 24 hr. (hh:mm)
0 Registered 0 Certified [3 Applied for Permit OPermitted 113 Not Operational I Date Last Operated:
Farm Name: .......... D&Y\tC1aI.... �- ....6r.oWt�....... r..................... ............................ County: ........ X,�Vx....................................... .......................
Owner Name:....... DaYinv.�.I.....�..,........ (�1?� Phone No:....�q/a�.Z. '...........................................
Facility Contact: . D4mn, Title: O ... Phone No
Mailing Address: )[LC"
`r
Onsite Representative:....... ....... knr.
.... BrDhNs.................................................
Integrator :........
��-�L
Certified Operators .......................
Location of Farm:
............................. 4 ......
Operator Certification Numbers...... .�.
�..x tr......Z.A.0...cus...... - � ....sx;..... &�.... .. ►11�...Turr'- IM- ...... tz..l.1Q....:.... �...... s....... l l .
} ter,
....�?l:?�C.s...` ... .... � ..... .�.... .....' �'..�.+1..�i�..ti.1�3.�....�.Mar.�.....1.e.��:...c�n...S�.113B..1!�r.
r"i « �t�rt►� i s 4.� r,n i (! 5 c3 r� eat
..na!luuc E E L- i I
Design Current
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry
Design Current
Capacity Population Cattle
❑ Layer
I
I
❑ Dairy
❑ Non -Layer
❑Non -bait
❑ Other
Total Design Capacity
Total SSLW
H-) -
Design . Current.,
Capacity Population
v
M
Number of Lagoons / Holding Ponds C-� ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste ivianagement System P
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Di>eharge 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 Ual/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design`'
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes RNo
❑ Yes 'j No
❑ Yes No
❑ Yes J No
❑ Yes 1M No
❑ Yes
RI No
❑ Yes
No
❑ Yes
M No
❑ Yes
01 No
❑ Yes
(9 No
Continued on back

Facility Number:
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes EjNo
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes U No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............�................ ..............
Freeboard(ft):.............Z............. I.... .........7............... ......................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes U,No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Ryes ❑ No
12. Do any of the structures need maintenance/improvernent? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 9jNo
(If in excess of Wy�MP.. or runoff entering waters of the State, notify DWQ) 'I
15. Crop type..........>�r1E:x?:!lUaa.................................q. ................................... SC4� 1 1 � t lf!L......
... - t?....................SG AYa.......... ..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [91No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes iN No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
Q1 No
20-
Does facility require a follow-up visit by same agency?
KYes
❑ No
21.
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ 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 09 No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes E4 No
[] • No violations or. deficiencies' were noted during this;visit. • .You.will receive no farth'eir
correspondence about this:visit:
atents (refer, to,questivn #):. Explain any YES ans*ers and/or any rerornmendattons 6r
11 BIZ crwiorn o-+ru_% or, 4,k, inmw Wal(S o�iyW4-- (a 0,15 s�^ A be 41W W*, C14 caJ �
trvse-46. Bo*G w-kxs on 44- (ayon�s 5itov�fl bc- re5ee3J.
#g- �cscJG t� I�.t-n,.�aa, cxo� � be. Ct,�novt�•
ZL �Wk I kt,5� CUA3 IC65 , 10^ a.ta� s6u�, bpir, Cel`P i ed Phan • Fclb rwm s i r\ 5prr.y {,^`cGCr�
5 Col f is w I'�- vi & �c. v i 2� Ot\ 'OA - Gt 4k tAl TJtan 04\ AVA � n ti tre c�lnutt
Cro W4, Wh f` - 'i
3. �i�`4&14n or\ '! 'k i5 ' 10\ skwld bp. Npt oA si4. 7/25197 Cert-
Reviewer/Inspector Name -
. ;. -fib',.-if .,
Reviewer/Inspector Signature: _ R Z, _ Date: