310016_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

ivision of Water Resources
Faeility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaintt00 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: �� Arrival Time: j� r Departure Time: County: v M Region: &�I*
Farm Name: rvv✓!.W se SLfc- Owner Email:
Owner Name: r 1y15 e'er- �d, Phone:
Mailing Address:
Physical Address:
Facility Contact: C p t Title:
Onsite Representative: l
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Nan -La
Pullets
Other
Poults
Design Current
ro
Discharges and Stream Im,-pacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop:
Dairy Cow
'Dairy
Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes NA ❑ NE
[—]Yes
❑ No
Q_NA
❑ NE
❑Yes
❑No
[3A
❑NE
❑ Yes ❑ No
❑ Yes Ea No
❑ Yes s2 No
ETITTA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

10
Facili Number: Igi - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ej-? [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �a' ❑ 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 ❑ NA
❑E N
waste management or closure plan? 7
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 4EjNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Cf'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [J No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrecS land application? If yes, check the appropriate box below. ❑ Yes t; "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
E'I�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Fj No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[frNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Ef o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[J No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ['rNo ❑ 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 [k'1Vo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: • - Date of inspection: -s!
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3-`v ❑ 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 Z24o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�'Wo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
L;.Xo
❑ 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
C;Mo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Eff 'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�Go
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C_01-U AO
5'C-ey7-©
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
wo -3a--0�SS/
Phone
Date: ' �{��'i-0
21412015

�I -
t % -' ivision of Water Resources
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompli�tee Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (070,U,tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: X/ ('(//j Arrival Time: p 1> Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 9.J /—I(,, �0n
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Title:
Latitude:
Phone:
Integrator: S
Certification Number: 7.�
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I :::d
I El Non -La er
Design Current
Dry Pnnitry Capacity Pon -
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes [. No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
��No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FacilaNumber: IDate of Inspection: 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [LMo ❑ 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: I' 7—/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �{
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 CfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F3/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes rNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ff�:
[:]Yes rNo
❑ Yes LJ 'No
[:]Yes [fNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �jNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili 'Number: J I- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ErYes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[2Ton-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 'S ?-013 e0k 0 1112, i s
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 E3- o ❑ NA ❑ NE
❑ Yes 'vim "o ❑ NA ❑ NE
❑ Yes [a-i10 ❑ NA ❑ NE
❑ Yes No
❑ Yes
E]'Co
❑ Yes
ff No
❑ Yes
e No
❑NA ❑NE
❑ NA.. ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer, to question Explain any.YESsansweandlor. any;adcfrdonahrecammendations or any other comments
Used rawins�.offacifacility betterYaap,lafsituations_ useadd�honalpages as necessary) mp _
e m
(-, qpo�.
'z�, C,,r�tnfl [, ,,.pl � lln� �n S rkd'e iG -ek In D Pit ` 7a&^S y-°��h o a(al�,
p1S , f[A5 s� �Lf �4 /G c9+ st c.. p �t�-�*v Kt I � ��S i�ri'i,�� fog*-c� ��i� s.
2-5 (aJoni l] j Ql� 1'��� �1 A
n�S.
gCk c'r 5+f ' e- (_'t c—S Q --- "r 0 a,., d (Q 4--L r
9 *- 5 (W t —
G�fr 42 ^-r�-'L 1r<<vs a ^ { l yo-7 6354
Reviewer/Inspector Name: _06f'- V! � 7 L-{- Kl
Reviewer/Inspector Signature: 5_1e�
Page 3 of 3
Phone: �1 7 b 6
Date: nq�_
21412015
(I

Type of Visit: QrCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (,d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: /yPL1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ruw
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: &57
Certification Number:
Longitude:
_ q Design C�rrent`� "" �` 'Design Curreut Design Current
`a, - - ,mx,,' pie.' �'s "t•; x.„ �
::�
r•a"�''
w Swine• Ca aci " "=Po :' Wet PointCa�aci �I?o
P _ ty p rx �,,, rY -.� P. ty
- P ""
C ttle' �Ca aci PoY
P, . tY P•
Wean to Finish Layer
Dai Cow
may
Wean to Feeder Non La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean - .', Design
Current .
Cow
Farrow to Feeder _ - D • .Kozel Ca aca
jropm..
Non-D '
Farrow to Finish La ers
Beef Stocker
Gilts Non -La ers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys-
Uther. Turke Poults
fl
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: I Date of Inspection:
rWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ja /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
7
Identifier:4�f-r—�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Zo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/
—
9. Does any part of the waste management system other than the waste structures require ❑ Yes I 1<0 ❑ NA
❑ NE
maintenance or improvement? TTT
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑xo ❑ 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
` U
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
r rNo
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
TTTT
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
io
❑ 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
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
o
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: jDate of Inspection: 5314L jig
Z Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check eYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
Dion -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 lass assessments (PLAT) certification? ❑YesVo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. 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?
Comments (refer to question #): Explain -any YES answers and/or any additional;recommei
9S-1 ) As 5woG6 �o A Fo- LA&zzJ 2-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [5-14 ❑ NA ❑ NE
❑ Yes 0NNo ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes j o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: 91,P/ I qI -I-ya
Date:

Division of Water Quality
�. Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (
Reason for Visit:
Date of Visit:
Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
1 Arrival Time:6� Departure Time: © County:Q f Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �ptii fr �'f 11.�- - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: p n
Certification Number:
Design Current Design Current
Swine . Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Wean to Feeder ]Non -Layer
X Feeder to Finish _jSZq0 M
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other -
Other
Design Current
Dry Poultry CaDaCity Pon.
Layers
Nan -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharces and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop..
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes &No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E"No ❑ NA ❑ NE
[—]Yes 10 ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I— I 2 "
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 50 q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Arc 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 110
❑ 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 rNo
❑ NA
❑ NE
acres determination?
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 F(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [N
❑ 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? 1f yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNCco
❑ 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

Facility Number: IDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
'25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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 ❑ Yes
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes
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
permit? (i.e., discharge, freeboard problems, over -application)
3 1. 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
E/No
❑ NA ❑ NE
ZNo
[DNA ❑NE
[�]No
❑NA ❑NE
No
NA NE
❑ ❑
EA/No
❑ NA ❑ NE
NA ❑ NE
9NoT�
o
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional Vases as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone*'42--
Date: 6
2 12 4 1

ld Division of Water Quality
`Facility Number 3 - rtp 0 Division of Soil and Water Conservation V-1
0 Other Agency
Type of Visit: Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: `` Title:
Onsite Representative: Db d G' 141 J?Z1__ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Phone:
Certification Number: q 12.5-7 3 b
Certification Number:
Design Current Design Current
Capacity Pop. - Wet Poultry Capacity Pop.
La er
Non -La er
Design . Current
Poultry. Capacity Pop. -
Pullets
Poults
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design-- nCurrent
Cattle Capacity Pop.
Dairy Cow
Dat Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes Q/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes E�� o ❑ NA ❑ NE
❑ Yes [No ❑ NA NE
Page I of 3 21412011 Continued

FaciVty Number: - Date of inspection: t
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ 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: I — k Z ~ 15
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 y�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 16 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [3/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LJ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes [ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ][�fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 o ❑ 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
[T-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ewc,
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej__No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E N o
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [E'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 No ❑ NA ❑ NE
i
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a,- Date of Ins ection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. k§ the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes WNo ❑ 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 E3 No ❑ NA ❑ NE
Other Issues
29. 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes El"No ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ 44o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [./ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes 64o ❑ NA ❑ NE
Comments (refer to question.#): Explain any YES answers and/or any additional recommendations or, any -other comments:
Use drawings of facilitv to better exvlaiti situations (use additional pates as necessarvl.
Reviewer/inspector Name:
Phone(RV) 9q b _1 9X
Reviewer/Inspector Signature:
Page 3 of 3
Date:

V✓ Division of Water Quality
Facility Number 3 4 - (0 0 Division of Soil and Water Conservation_j
0 Other Agency
Type of Visit: 7Routine
pliance Inspection 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: Arrival Time: ® Departure Time: 35 County: _0L f t t t,,/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: `� d U(Y AT kZN5 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
15 <Z
tN
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Other
Pouets
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
_Dry
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

l
t, Fdcili Number: jDate of Inspection: 1 5
' �aste Collection & Treatment
4. s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a 'S i` j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _iy
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes YNo
❑ 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 ❑ 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 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6/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 P410 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [:]No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes YNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes F(No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes N�Zo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record ]seeping need improvement? If yes, check the appropriate box below. ❑ Yes [2- ❑ 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 ��/o
❑ 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

Fdcili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3"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:
❑ Yes No [DNA ❑ NE
❑ Yes T
❑ Yes f2/No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes D'�;/D NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CyNo ❑ NA ❑ NE
(Comments (refer, to question:#): Explain any YES answers and/or any additional recommendationsor'any other comments t% ° R+
Use drawings of facility to better explain situations (use additional pages as.necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ja4•l 1u
Phone: G%A5 2M 713V6
Date:
2/4/20 l

Facility Number b
(� Division of Water Quality
O Division of Soil and Water Conservation
O..Other Agency- W
m.
lType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit G;Routine 0 Complaint 0 Follow up r0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� Departure Time: County: &PLZ10 Region:
Farm Name: q- Z- a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 0604�— ATYzs
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0'= Longitude: 0 0 0'=
Design Current.; Design ,Current µ..x Destgn Current;
Swine Capacity Population Wet Poultry 'Capacity Population p ty p � ry p ty �� p .Cattle � ��� Capacity'Population .
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
s
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giits
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Discharges & Stream Imoacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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?
<=1
❑ Yes OfNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
❑rNo
[I NE
❑ Yes
El Yes
� ❑ NA
❑ NE
ElYes
o ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:
Date of Inspection
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: l — I Z S
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 51- S_ 35
5. Are there any immediate threats to the integrity of any of the structures observed?
Elu Yes
,_
No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenttlo
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
WNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
FNo
IL
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 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
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
7 ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA ❑ NE
�No
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
Comments (refer -to question-#); Explain any. YES. answers andlor any„recom endatrons_or;aiiy other comments
Use drawings of facility to better explain situations. (use additional -pages as, necessary):.'..
Reviewer/Inspector Name V6 - � � fi °�� Phone: —
Reviewer/Inspector Signature: Date: g !
n 1) .,r a 12128104 Continued

i Facility Number : Date of Inspection 1 I
Recuuired 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
0 No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
e o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ro
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L'J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0"NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[D"'No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�<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
I 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 EXo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Poo ❑ NA ❑ NE
dditionalComments and/or Drarvtngs:
_.
Page 3 of 3 12128104

�r
`Fac>i>Ity Numler.,
Type of Visit 0 C pliance 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 ❑ D vied Access
Date of Visit: Arrival Time: Departure Time: County: DL r Region:
Farm Name: Owner Email:
Owner Name: Phone:
Marling Address:
Physical Address:
Facility Contact: /� Title: Phone No:
Onsite Representative: Off& 47,1 X'Al S Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = i = [I Longitude: = c = 1 = f{
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
[I Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
fNo
El NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

�j+ rFacility Number: 3 — Date of inspection aG
t� Waste Collection & Treatment
MNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L7 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes Q No El 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 El ❑ NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ET/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 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
I�No
[I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
Yes
ElL7N
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
011�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
ElNE
18. Is there a lack of property operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Comments'(refer to,questioii Explain any -YES answers and/or any rec©mmendations or=any other com®ents =. ,`
Use drawings of facility to better explain situations ;(use additional pages as necessary):
Reviewer/inspector Name d/-,' tm a ]✓(tLt I Phone: 7
Reviewer/Inspector Signature: Date: It 0
Pnav 2 a 2 12/28104 rantinued

' Facility Number: '3 — � Date of Inspection z.
r —
n
r Required
Records & Documents
I
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
ElYes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes
4No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
J✓ 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 InspectionsTNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�io
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facilityfail to conduct a sludge survey as required b the permit?
g Y q Y
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NJ,
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
kNo
❑ 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 ❑ L� 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 ONo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes &No ❑ NA ❑ NE
t1d'ditional Comments and/or �rawings:',.�e , ,... ;�
Page 3 of 3 12128104

Type of Visit QS �,(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: i� ti� a Arrival Time: 1 Zda Departure Time: County: L7 UP klo Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: D.0Cr LA"C - _ , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
t IT 0
❑ Farrow to Wean
❑ Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = i = Longitude: = ° ❑ I = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I EE]
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
r
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 ]of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
ElYes
dNo
❑ NA
❑ NE
❑ Yes JNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 1— 1 Date of Inspection ti 8 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L-A Crzo fJ 2-5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (7 So
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.) dwo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E:fNo ❑ 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 MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need El�,
Yes I� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
ElE Yes
�0
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑'14o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,L—'',I/No
L� No
❑ NA
❑ NE
Reviewer/InspectorName 1 W [-q 0rv> { Phone: 1 -710M, i 1366
Reviewer/Inspector Signature: Date: o _j
Page 2 of 3 j 12128104 Continued

Facilit+q ]Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El 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
VjNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
dN o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[J"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,—Ko
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
CI 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
�YNo
❑ NA
❑ NE
General Permit? (iet discharge, freeboard problems, over application)
�,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
EJJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
o
WN
❑ NA
❑ NE
Ad ditional'Gomments and/or Dra'rvmgs:
Page 3 of 3 12128104

Fm—
Facility Number 3
O'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit CrC_,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: DOJCr AT)LtL2S Integrator:
Phone No:
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 = 4 = « Longitude: = 0 0 d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ 1-a er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 71
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 LIJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
eYNo
El NA
❑ NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection d�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _A&-,,>i ` #~ i/ -1 A6-W J1-`7,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /No
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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? El 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 PC ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ffNo ❑ 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
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo7
❑ 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):
HbOf- M *4H G. T0CK&- AuY) aw+ VAL_A vErtAG,k WttI4 KECoU5.
00 ap-0.4 RAVE QtP '�?Io£ bAJD FACCurty NUW�.gE{L .
0PoAt(-- CrLOP `I'-Ct. O Fan-- FOIL ALL. & PAMS
Sgljn Del 6-r ?SAT Op- vp o4 rz h y (tin o 2,66-7
I
Reviewer/Inspector Name Phone: 'F% %% —
Reviewerfinspector Signature: Date: 1 ) p d
12128104 Continued

�J
Facility Number: Date of Inspection tl J
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,LJ_'/N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Doeecord keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
ElNA
ElNE
ion ❑ Week]Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
PY Y
LJ Waste A XtIocking
❑ Annual Certification
❑ Rainfall Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EJ NNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E NNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Yes
E�
2 o
Ell NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ITYes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C?<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q 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
Ko
❑ 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
�"
❑ 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
El-N,6
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑1
❑ NA
❑ NE
Comments and/or Drawings:
12128104

JO Division of Water Quality
11, Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: De artuurre Time:: �QQ ounty:
Farm Name: �/�} �/-1�2/Y15 �G`G 1 %-�F7r V��• ` r� wner Email•
Owner Name: `✓'qgmL Phone: _
Mailing Address:
Physical Address:
Facility Contact: / /� Title: Phone No:
/
Onsite Representative: �'i 1y 20"j 10Depf 6 G!l7- 047"IJ5 Integrator: Z2146
i
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: �/0tJ
Latitude: 0 c = 6 Longitude: = ° ❑ 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish -�
Farrow to Wean
❑ Farrow to Feeder #
ElFarrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Lay
❑ on -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?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: ILI
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes JCJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
El No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

•� tv.
Facility Number: — Date of Inspection Q
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: .S1—qS1 :5JS_S$
Spillway?: _ 10O _ NO
Designed Freeboard (in): . 5� /-?
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j fJ No ❑ NA ❑ NE
(ief large trees, severe erosion, seepage, etc.) C
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes -'No El NA El NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 ❑ Evide��nc�e11of Wind Drift ElApplicationOutside of Area
12. Crop type(s)Soi�Q < ray &Rf+l, C.fl 156 T 4+�'
13. Soil type(s) F �D. 44-1 / L`R/f6/AJ�.4
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No [INA
A
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
11
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/d
[� 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):
27 Al/< _� P447 � �n�,E�T,4 o�J rrs� F o�Ds
AL
ND ��. � �r/ ��LL, ��m /`fr✓� ✓� �C'�F2�5 � D f� E� Cynod .
T
Reviewer/Inspector Name f p 1 Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 / - 2-clop 12128104 Continued

Facility Number: '— Date of InspectionI t/L
Re4uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 00 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
XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes y
No ElNA ❑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 Id
El 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? (iel discharge, freeboard problems, over application) /
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo ❑ NA ❑ NE
Page 3 of 3 12128104

N\
Fadlity�•Nvrriber /&
__ _J
13 Division of Water Quality
0 Division of Soil and°Water Conservation
Q Other Agency..
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral ( Emergency 0 Other ❑ Denied Access
Date of Visit: 19- Arrival Time: i0 Departure Time: County: Region:
Farm Name: 7f ? Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:S
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
Title:
Phone:
Phone No:
Integrator: x r G✓/►`
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' = Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I �, ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: a]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LZNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

ie •-
Facility Number: — (�
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA ONE
❑NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .��,,—�/ _ S 2- S—T
Spillway?: /y0
Designed Freeboard (in): 161,5
Observed Freeboard (in):
❑ Yes 0 No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ANo ❑ 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 0 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 )ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No
❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
'A
❑ 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 ❑ Evidence of Wind Drift ❑/Application Outside of Area
Crop/Window
12. Crop type(s) �012J►/. fi{/i>T �r�� f��L14G� 1
13. Soil type(s)[t.F /C>/�h/f./nl �/ +L�GI4NTOrsJ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes Y,No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes XNo
❑ NA ❑ NE
in'ts(refroesan#Exlatan:.,ye}Y5� ns..? er�r' a- .... ._ cmmsomne.
�
- �Z
0'n 6F'002r -J; aowf_.o to
PAJ E5 rgp�GUs y�( s r�vvfQ,c�G�
J
Reviewer/Inspector Name phone;�-
Reviewer/Inspector Signature: 2 p Date:
12128104 Continued

Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes V�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ZNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 2fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Rf No
Cl NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes No
ElNA
❑ 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 ;21No
❑ 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 P'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑ Yes XNo
❑ NA
❑ NE
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
Does facility require a follow-up visit by same agency?
❑ Yes XNo
❑ NA
❑ NE
//II133.
■.SHE:" r... . .. ! _"_.. L.� ..a... �... .s"u'i44"ie•i..X{— ... ...s..".. `f. -. _. _. x. _., nS.x"c <...i. 3iak.Y"AAs.L3 X.%?ia.$... ..u?14i1'.r�...
Z`� 1nJ 7F�2oC�s5 �f �oZ� ���� F�
12128104

Type of Visit .0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit "Routine O Complaint O Follow up O Emergency Notification O Other E] Denied Access
Facility Number Date of Visit: / o Time: 9.1- 30
0 Nat erational 0 Below Threshold
,0"Permitt4oCertified 0 ConditionaUy C'e�rtified J�1/Registered Date' Last Operated or Above Threshold:
Farm Name: ill :1_ fmla S3 .� :Il _ -!- . Lk S County: 14.1 Q) q
Owner Name: . _ �_ ...» .. M _ ..... _ ._ . __ .._ 'Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
'
Onsite Representative: A-01 -,tl AoeiY_L- -------------- - �
. . n-----------Integrator: __ _-,�.........
Certified Operator: , Operator Certification Number:
Location of Farm:
❑ Swine 0 Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • <
Discharges &StreamImpacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;21�0
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 gallmin?
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 pio
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 o
Structure I Structure 2 Structuue 3 Structure 4 Structure 5 Structure 6
Identifier: M /" / - . _.. . _. _ . _
Freeboard (inches): c�
12112103 Continued

Facility Number: — Date of Inspection
5. Are thereiany immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
No
Z'" seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes
�^
Na
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
?No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
2rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
0'N'o
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelrmprovement?
❑ Yes
�Vo
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Pro
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type le'rmzar-t c no,, )"WOe-, i-i.& +,IA) hPt� Ala 4 WA /4.
13. Do the receiving crops differ with those designated in the Cerdied Animal Waste Management Plan (CAWMP)?
❑ Yes
0Io
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[�No
b) Does the facility need a wettable acre determination?
❑ Yes
PNo
c) This facility is pended for a wettable acre determination?
❑ Yes
0%
15. Does the receiving crop need improvement?
❑ Yes
U90
16. Is there a lack of adequate waste application equipment?
❑ Yes
;;No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
0.90
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
$ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
J;M
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
-do
Air Quality representative immediately.
— —- s,is Yr s —
cam cr�€�rrta q ►. r Y a o a a
Use dravun s�oi fikir1tito better--, Ha i sdaatsoas. {use addshoasl gaS as iY) ❑ Field Final Notes
A.
ell
�ca/�s /7�117� orb y
ReviewerAmspector Name
2-0
Reviewerlinspector Signature:
Date: K//41/U
12112103 / Condnued

Facility Number: — Date of Inspection 6
Reqj&ed Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, neaps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes �No
❑ Yes E�No
❑ Yes EfNo
❑ Yes d] No
❑ Yes eNo
❑ Yes ❑"No
❑ Yes ❑'N' o
❑ Yes OlNo
[:]Yes qNo
.gYes ❑ No
❑ Yes 13No
❑ Yes ENo
❑ Yes �No
❑ Yes ETNo
❑ Yes ONo
12112103

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up Emergency Notification Q Other ❑ Denied Access
Date of Visit: 1 r7 i Time: ✓' zO
Facility Number ;� I 6
Not O erational 0 Below Threshold
Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ��' '~` S r i _5 A C 14 SeC L S57 County: Our I
Owner Name: ��'' m 5 Phone No:
Mailing Address:
Facility Contact: yn1 L Title:
Onsite Representative: _ 13 �
Certified Operator:
Location of Farm:
Phone No:
Integrator- M vex e !2:!9 S,-D W "
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 K Longitude Da
Design Current
swine Ua aetty rD ulanon
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number of Lagoons
Holding Ponds / Sotid Traps
Design Current Design Current
Poultry, capacity Population Cattle CaDacitv Po ulation
❑ Layer FEc]
Dairy
❑ Non -Layer Non -Dairy
❑ Other I I i
Total Design Capacity
Total SSLW
ILI Subsurface Drains Present IILI Lagoon Area ILJ Snrav Field Area I
No Liquid Waste Man
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes
- --- --- —b�if discharge is observed, did -it reach Water of the State? (If yes, notify DWQ) ❑ Yes
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: 3 1- Date of Inspection 7 1 0 3
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 Annlication
10. Are there any buffets that need maiittenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVtirMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the faciliry need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
=: 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ U UP, checklists, design, maps. etc.)
19. Does record keeping need improvement? (icl 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. rail to notify- regional DWQ of emergency situations as required by General Permit?
(ie/ discharge. freeboard problems. over application)
23. Did Reviewer/inspector fail to discuss review•,inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes I No
❑ Yes ❑ No
❑ Yes ❑ No
�0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments ftefei^ fn question # . °Eiplam.aay YES answers°and/or say recommendations or aw- other commerrW -
Use drawingsoffacility to better explain situations: (use additionale pages as xtecessary) ` : D Field FinalNotes
{ -Copy —El
T;%-,-.`"i'_..i-ss.+.-....r.r�rY-:.F1H ?SCI�r�F�Y.-w�.—a`L.:Y�"�� d.f<-.s:'S- �F-.•a�-�•.cr�Hm".�... ._-+.rf�e�:-m.� _. }er!.+.Rw-• �--^s„d�
h'1�. I�;n��►z repo�leo�-��►a-� .0 -'► V2-0,C3 R r,s-eb,- se L4�L-tV
It'}lal
e n;i,nolj Las_4e 6eL4�C00 1e,15 je .
p.
o4
r�lc►-{�Ft�GjO}
a L),In0.41ebv+cr-7-Io _.qeivn -I s Gfeekpvbi;c d
41,e 1u, = Cn4,04've.5
b rep r< ,
R ��p y
Reviewer/Ins actor Name �` "r:t y iE,
P-5t1�+J x .w I -rWWtt
Reviewer/Inspector Signature: Date:
0510310I Continued

a Division of Water QualityM!
W
N f Division of Soil and Water'Conservation
OtherAgency
Type of Visit f5-Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number j Date of Visit: t: aY- Time:
Not Operational 0 Below Threshold
® Permitted M Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ___ am_ &IM � �eL it5e c Z S"k '5� County: 41, D I m
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: if -T Z4 4Ia i -_
Certified Operator:
Location of Farm:
Phone No:
y�,PhoneNo:
Integrator: - //lori )K
or 01
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' 6
Design Current
awloe
N Feeder to Finish
❑ Farrow to Wean
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer I I on -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management S stem
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: -lf discharge-is-observed,did-iCreacli Wa e�of!he 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)
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 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 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: Z-57
Freeboard (inches): J sip
05103101 Continued

&: r-
Facility Number: — G Date of Inspection .`'`-`i"`"'
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)
T 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?
❑ Yes 4 No
❑ Yes ® No
❑ Yes Z3 No
❑ Yes NNo
❑ Yes C5No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type _ &WNk It h&el/'A 1Z)gel-74 le d
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? Cl Yes [3-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?
I@ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[M No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[0 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
[F,No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
QRNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(LNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[RNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes g[No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 59 No
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E[No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:(refer to;yueshon #}� Explain any YES answers•andlor�.anyrecommendations or any£other�comments.-_ � •
U drawings use adtlitronal pages
oftacibtV to>fttere�cplatn Sfeiateons ads necessar3}
.?. . _.: .: ,. k�: ��� _-` _ r ❑Field Copv ❑Final Notes z�9
1 /t4 Wk -ke /W4. Ao/_ I10f! 44VIM61W Z Re 4P1A1,0 (eferE
Y'e'fr, (IMCY � ly z oa 1� d-4 ii(de 40L 12'/� AS /0ss," >64 f
G r�R7u� 641e e a V -1— die A.,ww_,f14 Tt�t f 54& .0 �e f/.�a ✓ /f a� Q� � 73+
J0—
��� e6ecAi %jfe@� Sl#ee_, 4 ir/"c4.
3
Reviewer/Inspector Name'.' " .x
Reviewer/Inspector Signature: Date:
05103101 ` `_� Continued

Facility Number: 3L — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes r91 No
❑ Yes ,y®, No
❑ Yes w No
N07� � �� ✓eon .CISO �e�GrS -� 62- +Z/ PS' ,�t���P� an /�,sr
/ls , APoo'
—14e ��y '�LO ,,t`ece wr` l�tgh Gtme �fdi 5� AL
L.(nte �C//l {e �
-, &,'14 4W- 166" ZPOA 6�000ef
05103101

Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .6 Routine O Complaint. O Follow up O Emergency Not cation O Other ❑ Denied Access
Facility Number 1 J
Date of Visit: I Ol Time: 2
Q Not Operational O Below Threshold
© Permitted 0 Certified 13 Conditionally Certified 0 Registered Date
Last Operated or Above Threshold:
county: „L1p
Farm Name: ......�-�. .. oa.�..v�3 �FC'f;ov, I Y,'k l ' Sc 4;v, 2 Si+eeP1;el ............. ............... .�_..
Owner Name:.. T M...F-° 1.i... arr G s e....ff..:.I ,.It
............... ................... Phone No:................................................................
Facility Contact:.....................:........................................................ Title:...-----........................................................ Phone No: ................... ............... ..........
_:.
MailingAddress: .......................................................................................................................................................................................................... ..........................
Onsite Representative: - f g `� �� _..
s...........''�fa�2................................................................... Integrator: ..7...........................
Certified Operator: ................................................... ................... ....... ' ................ - Operator Certification Number:.....:....................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • �� �44
Design. Current Design Current Design Cnirent..
Swure .Ca aci ' Po ulation Poultry Ca aci r Po ulatian Cattle Ca rid Po elation
"a ❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
_El Farrow to Finish Total -Design Capacity -
Gilts
m soars Total.SSLW -
Number of Lagoons ❑ Subsurface Drains Present 0 Lagoon Area ❑ Spray Field Area w
Holding Ponds / Solid'Traps;; ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J6No
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 oNo
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 ❑ Ycs;,AJ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......s.....................
t S� SS.Z..SS............. .......... ....... .................................................. ............ ................ ........ ..................... I .... _........
..I..l...........................
Freeboard (inches): T 3 4 $
5/00 Continued on hack

FatyNumber:1.31 — !(a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Jj 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 -.8 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
,!fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ra No
Waste Apylication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
EfNo
11. Is there evidence of over application}}? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload
❑ Yes
Ej No
12, Crop type Co ►'1 W heA.T Ca e 115 ,�..-► vda �e,TvIr- a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Manageme t Plan (CAWMP)?
❑ Yes
,0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
•0 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?
JjYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
f'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Z No
18. Does the facility fail.to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
2(No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J2 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
.0 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
8 No
No •yio Boris Rrdeficlendog r?vere notes% ¢ n, tbis'v}sit; • Y 60 witl •zre0iyc 46 fu>} thtr° .
comes ' deice: about: this visit` . . .
Comments (referrto queshbn #) Explain any YES answersand/or any recommendettons or.any, other come.
-.i , -
Use: drawings of facility;to tietter exphiin situations (use,additto ial_ Pages t�s necessary) E 'F
pS. A1eeA Ta i^,tpelave slmykd and eersvle A food ►rm4v6i 5♦<ald ;-1
kePf-
ReviewerAns ector Name
p
Reviewer/Inspector Signature: Date: D
a
5100

it
Facility Number: 31 — ! Date of Inspection 4j
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ,fYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
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 PNo
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 R'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ET No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [:]No
do _ omments an or rawmgs: - - -
0
5100

Facility Number I ate of Visit: 1 ( R UOo Time: / Z : 3� Printed on: 7/21/2000
JQ Not Operational Q Below Threshold
0 Permitted 13 C]e'�r%ftifiieed [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ...................
Farm Name: `...1�,it�'/lgs ��L 1 �i i..........................................s�G S CountV:.�' If."l ......................
............. ...............�............ ..-�.......-.....................................
OwnerName: p!!!t'..... F e."::11< .......................................................................... Phone No:.......................................................................................
Facility Contact: .......................
Mailing Address:
........................................... Title:
Phone No:
QQ----��
Onsite Representative: rh1 „ e'1.��'''� i �¢'' i 1... Xintegrator: M V �t 19tx......a'.
}........... 1
Certified Operator:_ ................................................. ............................................................. Operator Certification Number:..............................
Location of Farm:
Iff Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude �' �4 4C
Design Current
Clipidty Population
Wean to Feeder
Feeder to Finish
SB O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Np��: Of lAgoons 2 Subsurface Drains Present10 Lagoon Area 10 Spray Field Area
y
Htf!ldittg Ponds / Salid:.Traps ❑ No Ligttid 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 I Structure 2 Structure 3 Structure 4
Identifier- ) ` 1 2 _S
❑ Yes ONO
❑ Yes /'& No
❑ Yes IN No
n It
❑ Yes PJ'No
❑ Yes allo
❑ Yes 19 No
❑ Yes 19 No
Structure 5 Structure 6
...............................................................................................................................................................
Freeboard (inches): 37
4qs
5100
Continued on back

)Facility Number: 3 j — Date of Inspection 1 Printed on: 7/21 /2000
4
r 5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, [] Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?. ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance!improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste A lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [IHydraulic Overload
❑ Yes
❑ No
12. Crop type A i vq m i 1 ej Ca'r n a ^22 Julq f7 "t I^
13. Do the receiving crops differ with those designatell in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15- Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reguired 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?
[Yes
❑ No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ElNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
: 10-viol'ati6ris:o� delicient*$ -*i� re pafed• dirrttig Ns:visit; - Y:oir will-r' &6 k •rio futther
orieshoncTerrce:A"ftht visit.:-:-:-:':::::"::::::':'::'::':':':::::':':':':'::::':':
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain 1&situations. (use additional pages as necessary):
te5—CS';4e SAIL
, IUeed la -pop, des ;9o'
1 , ae Svre 4o de.s►`9Pwle pYeye-~ 6•e/p " se}i] sa-.yle(js
i.
i';cld• '76 ;s SZtoWh ix Cov'rLe ye I►, L'I'zSTe bv� zg)� �S /;1� cll jf
d �-�� �d RS q4 v►>Mp1 • c�'iot,�/ �0'I oybr ra�-,.tsyv1 L..ral%Rn ten" 2'S.
;eldS �r I S acU�s. ;+�1 waste PIa�O� feu ja, a'aares on V-,.a
IReviewer/Inspector Name � PIC L J J Mg7g : S I
Reviewer/Inspector Signature: Date. — t 5100

Facility Number: Date of Inspection Oa Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes X1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,� No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals'feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an orDrawings:
AL
w
5100

Division of Soil and Water Conservation.- Operation Review,
_ 131
Drvtsion of Soil and Water Conservattoti-:Compiiance Inspection
Division of Water Quality - Comphi mee Inspection
Other=Agency - Operation Review. -
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 11-10-
Time of Inspection) 17-'00 124 hr. (hh:mm)
0 Permitted E3 Certified © Conditionally Certified Cl Registered 10 Not O erational Date Last Operated: ..........................
Farm Name: ..AM. F0.rlA1S Sec-1J.a.n....k....s.4 ..�......St�i!ott.2.... � „5 County: --•.- 4 ? ............I ...............
Owner Name:..!h�......................................'.t5..................................................... Phone No:...�r7-tiJo?.�.�i'��......>°t5. Li�F1.............
Facility Contact: ...... ...t•.Cq-........... &........................ Title: ............. OTAL.................................. Phone No:.�
MailingAddress: ...... --��..-..{.-...................................................I.........................:.................................................................................. .......:...---............
Onsite Representative:..... v`t........... A.+tr..................... .... Integrator AEF.......................................................
Certified Operator: ........ ..1.e.T. i... TAlf.:4t ...................................... Operator Certification Number:...,. �. ...................:..
Location of Farm:
Latitude • z ji Longitude C�• 6 6.
Design Current Design Current Design Current
Swine Ca acio Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
® Feeder to Finish JE1 Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity =
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area JEI Spray Field Area
Holding Ponds/ Solid Traps: ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes V No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes A No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 2q No
c. If discharge is observed. what is the estimated flow in gal/mi0 e,/`�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes -g No
2. is there evidence of past discharge from any part of the operation? ❑ Yes tffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'RNo
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: SZ's 51- t
Freeboard (inches): .......o2o ................................................................ . ..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [ Yes 0 No
seepage, etc.}
3/23/99 Continued on back

It Ti
Facility Number: 3 — Date of inspection 11-1D-g
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(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 19 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes E4 No
Waste Ar3nlication
10. Are there any buffers that need maintenance/improvement" ❑ Yes g No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes JK No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes [� No
b) Does the facility need a wettable acre determination'? ❑ Yes &No
c) This facility is pended for a wettable acre determination' ® Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes IS No
16. Is there a lack of adequate waste application equipment? ❑ Yes IR No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all -components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard. waste analysis & soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [,No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [Vo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes N No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 5Q No
24. Does facility require a follow-up visit by same agency? ❑ Yes C&No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 1A No
0: �' ,CII 6Iati6ris:or defcW.ni.cies -mere noted• dixrtri9 this:visit;- Yoir :WRI eeeeiye fio further: •
' corris tJndence. Aoi of tfii .visit' ... • ... • . • . • . • . •
erits (refer to question #): Explain any YES answers and/or any recommens#ations or any outer comments.
drawings of facility to better explain situations. (use additional pages as necessary):
}�, 5r -SJitI Stiault( /birreree[=, a resjoey.si61� r1�aNxa►' I
x) Sea anA)ys,s wmpap d rek-Z 4PA", ahcwld ►t1a-� --tp (�crCiciJ�, PAIN *3�-
keep Ta--1 -%5 ;� fec"AS wi+K roar
�y[.} �Or�w• is rKdrd -Gr
W$ +a�I[ ACf[s,�P_ p� rw�►.n �f�ri. ��i/� A 6A9__ /yv,ap ShDwlt phiP
"7
ACY�ye, J� ` 1 ! r
Reviewer/Inspector Name rCL✓ �` S 14r",6.,td,
Reviewer/Inspector Signature: Date: 10' 7q
3/23/99

t[ aeility Number: 3 t — 1 to Date art' Inspection
Odor Issues
yes
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below J4Yes
J*No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Pj No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
j� No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31, Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
® No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
01 Division of Water Quality
j%kRoutine O Com laint O Follow-up of DW ins ection O Follow-u of DSWC review O Other
Date of Inspection tl
Facility Number
Time of Inspection (10 24 hr. (hh:mm)
0 Registered Certified 13 Applied for Permit © Permitted Not Operational Date Last Operated:
Farm Name: t c�1 �- +`` .....County:...., v 1........................................................ _........` 7.....
OwnerName:...........` '!..................................................................................... Phone No:.. �.....-p.."...�—�5.........................
Facility Contact: . Title: ........ Phone No•C ' ,,,
Mailing Address: ...IC�...... �`'. ` f W t�to�!^Q.\1g, ��� d '41
?.... �`.........''�........... #........ ..................... ....
�. .... .. {
Onsite Representative:...:' ..�- �:L..!`��t..K��.S... .......... Integrator:........... .......................................
.... ..........
Certified Operator;............................................................................................................... Operator Certification Number:................. .........................................
i,MtiO3 of F rm•
e
wltr7 X?..n ........... PA
.................------.. .._ ............ ..-----.------....---..................- .---.---------
Latitude 0' C ' Lf Longitude C�' r � 6 64
I WE Mstgn tt rCurrentDesiQ Current w
:.
Destgn Current
. :.
S�vtne
Capacity _Po`pulataon Poultry Capacity Population
Cattle Capacity Populatian
....
❑ Wean to Feeder
❑ Layer
10 Dairy
Feeder to Finish
15 f G
❑ Non -Layer
j
JE1 Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
,,
❑ Other
ElFarrow to Finish
Total Destgn Capacity'`
❑Gilts
'
•x
❑ Boars
To
SSL1?V'
v
Number of Lag / Holdi Ponds ® ❑ Subsurface Drains Present
❑Lagoon Area
❑ 5pray Field Area
„
❑N o Liquid Waste Management System
y
General
1. Are there any buffers that need maintenance/improvement?
9LYes
❑ No
2. Is any discharge observed from any part of the operation?
❑ Yes
V(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 Surface Water? (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
i(No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
IINo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
IM No
5. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
E( No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(p No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
IA No
7/25/97

fi Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Loons`. Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L.--
Freeboard (ft):.._........ .1..'. .......................aZ.................. ................... ....................... I ..............
.....
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
❑ Yes gNo
❑ Yes
1No
Structure 6
...................................
....................................
❑ Yes
No
❑ Yes
No
Yes
❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 9 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 14 No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type .... M.n........ ...I ... ___' . ��..I.,... kk_�`�.1 .5
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.vioilations°oi deficiencies:were,noted-duriiig this.visit.� You',wrill receive no°ftirttier
c9& pundeilce vi o4t this:visit. ;
L9Yes ❑ No
❑ Yes 19 No
Yes ❑ No
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes M No
0 Yes ❑ No
❑ Yes )4 No
0 Yes ❑ No
❑ Yes Q No
a, --to j- C64' e b e ed L..1.e►-� AL
[a� 4 � ►tee , � a o� - [ t� �f p.-e ..� ,` g vws
4 r �t6 vbs ' hoT 1 , Y 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Facility Number:. 3.a..... —_._ . Date of inspection:
Additional Corifi
nents and/or Drawings
4/30/97

k0 DSWC Animal Feedlot Operation Review
~I® DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Comelaint �ollow-up of l)4VQ inspection 0 Follow-up of DSNVC; review 0 Other j
Date of Inspection 9 q�
Facility `lumber rr�
Time of Inspection 24 hr. (hh:mm)
Total Time [in fraction of hours
Farm Status: [3 Registered [I Applied for Permit (ex:l.25 for i hr'la niin)) Spent on Review
® Certified ❑ Permitted or Inspection (,includes travel and processing)
0 Not U erational Date Last Operated: .........................................................................
.....p..u. �.:�. �,
Farm Name:..P.N1.......�±::.Y.::-�::5,......�sw..c.,..... L........5..1..�-.t._...�......................... Count_.`.. .................... .. .�... .. ........... �j..t..�.�
Owner Nan3e:... .u.�r �.1 . .... .w�.t.. p .Y..n,:.I............................ Phone No:.................................... ...
010 Zgq 7 Za £f
Facility Contact: .. .rtu..�e.....`!s}.nS...............................Title:................................................................ Phone
Mailing :Icidress:...,G....4.2r..... .G..r .i i .A.:Y ........ ......................... 4, q:!! l..l�.t.Gl . �1,�...., � . ... .�$.. �:j....
Vj..... ................ .........
Onsite Representative:.... .x ,t.s..lt....A ........................ ..... Integrator....k,,,.
Certified Operator :.................................................. .............................................................. Operator Certification Number:....... yy_
Location of Farm:
lain..... �n..r...t)n.t..u.,�
Latitude
Type of Operation
�.i.rl�..... ..t �:.....4..K,.1..1..1..:j<..,....A..p..rx..i..�,n a.. .........................
Longitude
m.�.......... wo..r...........
• ®:'
Design,.. Current.,.:. Design Current'...:Design::,' Current
Capacity -Population ' Poultry.—" LLCapacity, Population Cattle__ Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[] Other _
Number'of Lagoons 7-HoldingPonds ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Ig
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes f9 No
2. Is any discharge observed from any part of the operation? ❑ Yes B No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P� No
b. It discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 9 No
c. If dischar le is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) El Yes ) No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 5allo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes I.No
5. Does any part of the waste management system {other than laboons/holding ponds} require 0-Yes ❑ No
4130/97 maintenance/improvement?
Continued on hack

Facility Number:..? 1......—....�.._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
ERNo
Structures (Lagoons and/or Holding Pondss
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JRNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
1. -i
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
& Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
9No
Mf rite A plication
14. Is there physical evidence of over application?
❑ Yes
ENo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type asz s SS..__ ......... ..... _....... _._.... ........ ..... ._............... ....... ................. _- .. ...... _.....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
QYes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
&Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
J.No
20. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Ej No
For Certified Facilities OnLy
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J?No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
❑ No
24. Does record keeping need improvement?
JR Yes
❑ No
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b e n a L tom, p a v, ; �, ... R�! i 0. 1 (-J
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. r w f I • �? .. r n 4J a I! f f 1 P_ I r_
Reviewer/Inspector Name
f
sf
Reviewer/Inspector Signature:
Date: % ! t `l
cc: Division of Water Quality, Water Quality Section, Facility Assessment Vnit 4/30/97