310051_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

av�sion of�Water Resources .-�� s � � ,.
Facility Number -;� ODiv�"stun of Soil=and�Wate�Conservat�on: t
+m'
Type of Visit: Com ' nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: J O Departure Time: pD p County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: // Title: Phone:
Onsite Representative: f C/'` i 1`i l/ Integrator:
Certified Operator: Certification Number: 2Z O 2 L
Back-up Operator:
Location of Farm: Latitude:
Design Currentj'
SwineCapacity
Pop Wet Poultry '
N. Wean to Finish
Layer
to Feeder
'��j INon-Layer
Feeder to Finish°
Farrow to Wean
Farrow to Feeder
D., .;Pou!44
Farrow to Finish
Lavers
.....a .. . �.
Boars Pullets
Turkeys
Other .�,�r Turkey Puults
Other Other
Discharees and Stream Impacts
Certification Number:
Longitude: )
Dam Cow T
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? [:]Yes �o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [3<o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 3 jDate of Inspection: 41
Waste Collection & Treatment
4.4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 14
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 ❑ YesZ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes rNo
❑ 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. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZrNo ❑ 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?
0 Yes
[r] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L_LI No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
;
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Zo
❑ 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
YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspecti;/;qb
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: Date of Inspection: T
24. Did1he 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 2'5o__[3 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
ReviewerlInspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Eal 10 [3 NA ❑ NE
❑ Yes [] No NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes UINo `❑ NA ❑ NE
❑ Yes 1'_2 ^[] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes jrN NA
Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Phone: TO t 7
Date: 6 t�
214/ 015

I W Division of Water Resources
Facility Number❑ - O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit: t3 C�o/m�Hance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance V
Reason for Visit: ('Routine Q Complaint Q Follow-up Q Referral O Emergency O Other Q 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:
On site Representative: Q(_;At>- AxTcH 'c 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
Boars
Other
Other
Latitude:
Phone:
Certification Number: a ao 2-7i
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
roue
on-U
.fillets
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ffNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
t
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: L.4cf mml I (..,kmv
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
V
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 WN
, ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:],Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNJO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
❑ 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
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I rJN : ❑ NA ❑ NE
25:,Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ef rNo
' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA
❑ Yes 21�No ❑ NA
❑ Yes o ❑ NA
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Vo ❑ NA
pk�❑ NA
u o ❑ NA
No ❑ NA
Comments (refer to question #) 'Explainany YES.answers and/or, any additional recommendations or any other comments
Use drawings of facility,fo better::explain situations (use'additi©aal pages as necessary.)::'
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
Phone
re: Date:
/4)2 15
�] NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE

Na Division of Water Resources
Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Co7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: , " Arrival Time: Departure Time: L — County: W9L_L_ 1y Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: S (U t-'r r'L— 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
Boars
Other
Other
Latitude:
Phone:
Certification Number: 9-7— O Zrz,
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I :::::]
Non -La er
Pullets
Other
Poults
Design Current
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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-DaiEy
Beef Stocker
Beef Feeder
Beef Brood Cow
D Yes U(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Zl.
o
Yes
o
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number. jDate of Inspection: f( ;
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: (A LPN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E., No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes VNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes &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 r7(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. 1s 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
n o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
['J No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZIN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F/N o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Inspections/
❑ 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

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
a<
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J/No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
YNo
❑ NA
❑ NE
Comments,(refcr to. question #):.Explain any -YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to.Iietter explain situations (use additional paves as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T1V —1 3 99
Date: �p
21412015

- Division of Water Quatity
Facility Number - O Division of Soil and Water Conservation
'' O Other Agency
Type of Visit: 0 Co pliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: D (loqVRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ot; L'L
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Y Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design
Current
Wet Poultry
Capacity
Pop.
La er
I I
::::]
Nan -La er
Design
Current
Dry Poultry
CenaCity
Pon.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Cattle
Design Current,
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA 0 NE
[:]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Wacd�ity Number: - Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No 0 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: (,q I
&tZW UR(,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity yo`f�any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes❑
VN
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
yNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspecti;_No0,D
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes 10
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FaZity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo
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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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
E2 /No
❑ Yes
ZNo
❑ Yes
/No
❑ Yes
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
(Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better exalain situations fuse additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone] A
Date:
1
r-

Division of Water Quality
,,Facility Number �❑ - � 0 Division of Soil and Water, Conservation
0 Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j l Arrival Time: ® Departure Time: County: 1J1.1PtZO Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 3R,�,,J� fAajcu, Integrator:
Certified Operator: Certification Number: 72AZ7/
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish �j p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
F7f6lther
Certification Number:
Design Current
Wet Poultry Capacity . Pop.
Layer
Nan -La er
Design Current
Pullets
Other
Poults
Longitude:
Design -Current
Cattle Capacity_ Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
..
f
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there discharge from the
❑ Yes
Yes
❑ No
<No❑
❑ NA
NA
❑ NE
❑ NE
evidence of a past any part of operation?
❑
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Vo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: S1- Date of inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 L_I 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 0<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rN9,
❑ 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 <No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �Zo
❑ NA
❑ NE
Rectuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes . To
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 64o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate 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
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:
;NoX[j NA ❑ NE
No 0 NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 WNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
❑ NA
❑ NE
❑ Yes
!Q No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
FNo
❑NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or, any, additional recommendations or any.other comments :
Use drawings. of facility to better explain situations (use additional -pages as necessary).
Reviewer/Inspector Name:
Phone: (*) (f B --
Reviewer/Inspector Signature:
Date:
Page 3 of 3 / 21412011

S` Division of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: C pliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint p Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: o1i Arrival Time: '!� Departure Time: / p County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 43aj&J + M=rc 1aj' ' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 1-716 2_Z___
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
—A
}G
Feeder to Finish
D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Design Current
Non-L.
Pullets
Other
Poults
-Design Current.'
Capacity Pop -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
a What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: 3 - K f Date of Inspection: SZ 21 ram.
Waste Collection & Treatment 1 F'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2r 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: kA(;,nr001 4&cuo��/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a []Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [ZNo
❑ 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 Ef No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes 6No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes O/No
❑ 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 N/o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
—
❑ Yes y<0
❑ NA
❑ NE
the appropriate box.
TT
❑ WUP ❑ Checklists ❑ Design [] Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes o ❑ 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 to ❑ 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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit,
❑ Yes LJ 1" ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes o ❑ 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 E21No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes EKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes EJ/No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes To ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes L N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ NA ❑ NE
❑ Yes ;OXNo
34. Does the facility require a follow-up visit by the same agency?
CD Yes ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers°and/or any additional, recommendations or, any. other. comments...
Use drawings of facility to better explain situations (use additional pages as necessary).
wo R-lL Doti E a r.1 013-E WA t- s'
i j, ) r.iC.Lr_>S lvLl-D '-�C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
7300

(D Division of Water Quality ./_
Facility Number 31 - ® 0 Division of Soil and Water Conservation
0 Other Agency
ype of Visit: 0 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit: QRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emersencv 0 Other 0 Denied Access
Date of Visit: r Arrival Time:® Departure Time: i S a County: tk)PUW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: D8C JC "T W 1.TC u c j l Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish p r27,6b
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
Other
Certification Number:
Latitude: Longitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Capacity
Poo.
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?
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
Cow
—.Dry
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes VNy
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes [Io ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: q
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D4 ❑ 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: L uA&0�0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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 envi nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes VN
❑ 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 ApplicationINjo10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ❑ 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
F2/Yes
Q No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ NA
❑�No
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
jNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKO ❑ 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 13<0 ❑ 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 to ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31- 5 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
<_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑YesV❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ErNo ❑ NA ❑ NE
Other Issues
WNo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes To ❑ 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 CD4o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes El"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes g
XNo
❑ NA ❑NE
34. Does the facility require a follow-up visit by the same agency? ❑Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments: •:.,
Use.drawtngs of facility to better explain situations (use additional pages as necessary):: , ,
Is, ) L JD/14(I Nk60E_P af VVIO✓6 S G- O
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �
21412011
i

Division of Water Quality
14�Facility Number iI_ 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: ® Departure Time: C� County: DypL11� Region:
Owner Email:
Title:
Phone:
Onsite Representative: M-rtc-Rc _u Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e [= ; Longitude: [= ° = ` =
Design, Current ..Design Current Design Current'- ;
Swine Capacity Population WetPoultzy. 'Capacity ty Population attleCalationyPopucit,-�
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
[,0
D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:.'-�
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
❑ Yes
�❑No
LQ N
❑ NA
❑ NE
❑ Yes
L"J No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

acility Number: Date of Inspection r1 a
1; Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Cs6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes [/NNo ❑ NA ❑ NE
❑ Yes ❑ No Cl NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P�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
E No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? OYes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
,❑l
L''J No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
u No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
hTo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
IJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. 'Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[177NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1'J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E/No
ElNA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Comments {refer to question #}: Explain any YES answers and/or anyrecommendations or any other cowmen#s.
Use drawings of facility to better explain situations.(use additibnai"pages as�necessary) -'
`l) CONTmOk to PORK- 0 5-PdrS ZtO U&-CA-(C 0 13`C' S4-dJ Z5JSP6t i
Reviewer/Inspector Name AAJ Phone:(
Reviewer/Inspector Signature: Date: Z2
Page 2 of 3 1 12128104 Continued

Y
Facility Number: -S7 Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes VNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
[2 No-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
l4 N
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
'No
[ 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
9NIO
❑ 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
L� N
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
11
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a�
Page 3 of 3 12128104

Facllity�Number'
3 S
Dtvision-of Water Quality
Q Division Soil and Water
of Conservatiow-,
. .
Other -Agency
type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
CZRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: OUPLrAL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 430k,,ic'7i r� L _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = ° 0 d 0
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I L:::d
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
57(.0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ 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:
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
ElNE
❑ Yes
❑l No
ElE Yes
No
❑ NA
❑ NE
❑ Yes Q40 ❑ NA ❑ NE
12128104 Continued

`
Date of Inspection if L v
Facility Number:
' 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: L16&"O 1 LA&mokj L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 1 a2 (0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2 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
ental threat, notify DWQ
envir7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L,d,No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ICENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
DIN o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[7No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recomniendations or an, other comments ti '
s�
Use drawings of:facilify to better:explain situations: (use additional: pages as necess'.. ,y
r
7.) DXke_ wAL is sr Ok�t, LJOAX . TWIS T-TVO f 'MV—e f ZC_ 7,," 0(' L>0 "<- Da
-r,r 0=6-&-mL, M140. F-ri%cU (c-6_ r1C_Mq; I.&*-+ r
1$) �raSru�cE- 1 t.Wb comPACTIED �e_ow_ Gc2arvt3t;-. MUNW,
Reviewer/Inspector Name v ��tn��LL Phone7qG 3g9
ReviewerAnspector Signature: Date: o
rage Z of .3 11r1kVfV'r a v,...rrucu

! Facility Number: Date of Inspection +t.
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes L3"No ❑ 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 0No ❑ 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 PI�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0,1\ o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[]-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ErNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
8-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q'&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
B 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
[moo
❑ 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
Lj too
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Mo
❑ NA
❑ NE
Additional Comments. and/or Drawings: `
Page 3 of 3 12128104

d Division of W.ater,Quality ;.
Factlity Numbe� ( S Q'Division of Soil and:Water Conservation
Q thee; Agency
( Type of Visit (FrRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: db Departure Time: County: P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: e 0' 0 Longitude: 000
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E,l No El NA ❑ NE
❑ Yes L�J"No ❑ NA El NE
El Yes L�'No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
I.
Date of Inspectiion
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: (A&C0'j
❑ Yes [(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): E
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 3No ❑ 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 environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ei Igo ❑ 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 Cl NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 [] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FJ No ❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑'No ❑ NA ❑ NE
❑YN.
No El NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
} L-)4c C- tAJ A LA-S Si rout_ z tit (too v G- 4 SHAPE. AC_ -16 ,,j S
-rA1uE�J To C.n n-9 -C- ur w xT R F-L L.E. S' g6,j y)
cbfy To DOU?.
Reviewer/Inspector Name �� fZ Phone: 91 3 r�
Reviewer/Inspector Signature: Date: q L , a
0 12128104 Continued

Facility Number: 3 — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain inspection�No
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?
El Yes
�
ldNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 N�o
❑ 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
Q-Ko
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EVo
❑ 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
/
[�'N o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElC Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[1,1�o
❑ NA
❑ NE
Page 3 of 3 12128104

Faeility Number 3
a Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f; outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: SI �!s"/,,7 I Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Q 2.ENT AZT CA tu- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
�o
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ on -Layer
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
S'I tao
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non-L;
Pullets
LJ 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?
Region:
Longitude: 0 ° = ` = "
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,b No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RrNNo
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
12128104 Continued

-Facility Number: 3 — S� Date of Inspection
'Waste Collection & Treatment
/No
4. Is storage capacity (structural plus stonn 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 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LAGQnnJ I _ L.AGv.�1 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo ❑ 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?
E- I es
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
eNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
,�,/
L� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElE Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
4�,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
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,l"No
o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Ye
,l��,, /'
IJ NN
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L?'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):
7,) MjjCA ntiork wgr?44 au DZKP— uwt.cs 06CO .n L50M& +ate
L.D� E 6nCn a nl r-r"f ,
o� SEW) Co P Y ° F d,LC LZ-CErrI�f 7a ,D w a
Reviewer/InspectorName '3dgl v AeowL_ Phone..(eN 796 —73
Reviewer/Inspector Signature: Date: S1 S o?
12128104 Continued

a
Facility Number: 3 I — Sl Date of Inspection u "1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes E No ❑ 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
f 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?
ElYes
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gb�k
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[? Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�o
❑ NA
❑ NE
Other Issues �,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElL7 Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
/
B 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
ElYes
�
O 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
,,,,_,,//
93
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
L"J Zo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number 3 - Z
0 Division of Soil and Water Conservation 0 Other Agency
Type of Visit Corgpliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: —7 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 62k.&_rr �LxyC'1 NU,( .
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = ' a u Longitude: = ° 0 ` 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
')%6
,Sr7(vo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other — - — -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
Dischames & 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
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes /No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
❑NE
El NA
El NE
❑Yes
El No
❑ Yes CI No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 —
Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: CT l (T L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3v
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 1Lj No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Zo
❑ NA El NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm ntal 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 PNo ❑ 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 El Yes 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/NNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) R C—MA%"Li1 OA Cc:,.) S G c7
13. Soil type(s) A tJ 6 �_ OA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fNo ❑ NA ❑ NE
Pr/No El NA" El NE
7l_� ❑ NA El NE
L� 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):
ZGQ Srt LE-t�'Eit_ SE�s To D WQ o t-0 I,J 4I0'-V iZE PAYtL.S fl N D o k-VE z
wad DoWt to aA&6, ?P-6�WA"S D) 2mbio.
SuGCCST cn�i2�C
I
�7�.►��G
bars J sr R-Tn.l G.. 206
Reviewer/Inspector Name '�UH t j L.,
Phone:«1d�796 --7d45
Reviewer/Inspector Signature:
Date: % p
Page 2 of 12128104 Continued

Facility Number: 3 1 — ) Date of Inspection J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ Wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes d
❑ Yes 7No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�<o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ElNA [INE
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 ENo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��
[I No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 3/ ,S/
rivision of Water Quality
Division of Soil and Water Conservationeel
0 Other Agency k P
Type of Visit X Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: PJ n Arrival Time: Departure Time: County: 0�G44 Region: W! �Q
� l 7
Farm Name: lllsZ /—D Lf1 '}�O-s _ R�Owner Email:
Owner Name: ,. �. czgAi Y Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
,G{R Onsite Representative: v /e'oT ���L' — 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
Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ S ❑ Longitude: ❑ ° ❑ 6 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
j ❑ Non -La ei
Other
❑ Other
_ _ E
Dry Poultry
❑ La ers
❑ Non -Layers
❑ 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 Heife3
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: 2D
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ONO
❑ NA
❑ NE
❑ Yes ylNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — ,j Date of Inspection (v
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: 14�/ Z
Spillway?: o dek
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
P
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
PfNo
❑ 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?
ZYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[,2No
❑ 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
VrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
YINo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) el'�jV0,4
13. Soil type(s) — �Q u j fl A A. ! O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�ZNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[YNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
[ dNo
❑ NA ❑ NE
�. sue ! �G od,J t f�fF A a,J �.e c L ©,✓ �.t15z o,E ,D�.�
o� z.✓� '9'
Reviewer/Inspector NameF.
Phone: Q/D —7��/ — Z�
Reviewer/Inspector Signature: Date: lO O
12128104 Continued

Facility Number: % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �YNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Y,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JV No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
2T
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
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
P
❑ NA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
;ZNo
❑ NA
❑ NE
32.
General Permit? (iel discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,_,{
E No
/
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Al��I_Icc ot 4�ro"_IeZD 5 ��
Q2.OF_2 SF�VFzF_G.OS
12128104

(Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: O Timer
Q Not Operational Q Below Threshold
Permitted © Certifiedd © Conditionally Certified 0 Registered Date Last Operat r Above Threshold:
Farm Name: ....!!l.,1�1��iC%� County: yJ ...._...__..._ ...___....
OwnerName.... _. ......... Phone No: ........................ .... .......... ............ ........... ................. ....
Mailing Address:
Facility Contact : ............ _.................... ..........._ Title:.. _...._.. _._....... ._...__ Phone No: _.. —
Onsite Representative: /Q /�%,� 1' t ! � "` k''`rntegrator: ���DS D
Certified Operator:._............ „..... �.__.. - ...._. Operator Certification Number:
Location of Farm:
Vf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • 4 64
Wean to Feeder
Feeder to Finish
Farrow to Wean
13 Farrow to Feeder
El Farrow to Finish
El Gilts
Boars
Discharges & Stream Impacts
LJ Non -I
yn Other
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes/ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... �................. ........... b�....... .... ........................... ....-- -
Freeboard (inches):
12112103 Continued

7Facility Number: Date of Inspection SI /
IF
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
PrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
to
(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?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
;eNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
;Z(No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
12. Crop type _ i Ste,
it y'QA 1610,9 7�F_)
1001"Al) SX-40
13. Do the receiving crops differ with those designated in the Certified Animal Waste anagement PIan (CAWW)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P'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
X,o
16. Is there a lack of adequate waste application equipment?
❑ Yes
A No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [(No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 0
Air Quality representative immediately.
Cam nt`; (refer io quesfion #} Explain any YES:answers and/or any reoamrr�eudat�bius or sing otixer comrmeuts -'
P - r _
Use drsirviags of lhcrLty to betier explain sttnatEons. (use sirldstrdnl pages as necessary): Field Co ❑Final Notes M"
w W = -� -
rv` � _ ,� -
�FGE T/�T�✓F v� ��`_�'D5 � P,Pov6�r+�7
SpnF off ��,✓ G�r�'�S
f� ....�
Avo Aoczt f/, ��R �4 �/ FaF_c.,o s ;5j �voo
'
T
Reviewer for Name
Reviewer/inspector Signature: Date: ,5 / W10
12112103 `� Continued

Facility Number: —j Date of .inspection /
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes f .No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;ZNo
[IWaste Application [IFreeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes FfNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ,&No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
28. Does facility require a follow-up visit by same agency?
❑ Yes Q No
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
NPDES Permitted Facilities QC
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ONo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes No
32, Did the facility fail to install and maintain a rain gauge? ❑ Yes No
33_ Did the facility fail to conduct an annual sludge survey? ❑ Yes /[A No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes gNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JDRoutine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit:
1
© Permitted E3 Ce ' le [3 Conditionally Certified [3 Registered
Farm Name: ...........__.....!!._L_...v.--._...... ._......_.—......... ......
Owner Name. ...r..N--Z .. .�.
Mailing Address:
Facility Contact: ............ .......................... ............ ......- .. Title:..........................
Onsite Representative:.. 4F�.d q-..-M7�_r_L.............................
Certified Operator:
Location of Farm:
'Pane:
❑ Denied Access
IO Not Operational O Below Threshold
Date Last Operated PF Above Threshold: .... .� ....._
County:........ ......
PhoneNo: .... ................. ---.......... -............. ....
— ...... ..... .....
.............. .I................ Phone No:...................................................
Integrator:.... ? ® ......... I.....................
Operator Certification Number: ............ ....... ............ ...
05wlne []Poultry ❑ Cattle [:]Horse Latitude • 4 Longitude • _ u
Wean to Feeder ❑LayerI - I='
Feeder to Finish ❑ Non -Layer Non
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish ,.a i....,..,+�...;
Subsurface Drains Present ❑ Lagoon Area 113 Spray Field Area
No Liquid Waste Manazement Svstem
s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon [ISpray 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 X111
0
- . 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:...............I........... ....... -
------
_..............................----..........-----••---•..._...-.........----..__..---*-----...
Freeboard(inches): ,F...! ............................ ........................................ ....................... ............

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of qEl Yes �No
'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 maintenancefunprovement? X Yes ] No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes U No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes yNo
Waste Application
10. Are there any buffers that need maintenancefiimprovement? ❑ Yes - VfNo
11. Is there evidence of over application?? ❑ Excessive Ponding ❑ PAN ❑ draulic Ov oad 0 Yes No
}
12" Crop type .Aral& q,O �11 -tQl�y_1 �n l�C QpiZ� �li}�/1_ (r�i�Z� V`
13. Do the receiving crops differ with those designatedin the Certified Animal Waste Management Plan (CAWMP)? •
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No'
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
18. Does the facility fait 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
No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss reviewfmspection 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? -
❑ YesNo
© No violations or deficiencieswere noted during this visit. You will receive no further correspondence about this visit.
:.:.-...h - �(��y, p��'{y� .0 .:v,"ii:O�iy�:-:= C.. :i: S; s}• �iiv5:{
,i-Se �{�y�4; _ a� iYLLa-CF�IYi`:•�':d:�{:V3I�l�R1i137kti{Ilii 4 ':`{iCl„L ::iellial�:v}:t�C it.`:•" > G:ii$:�
..--. x-.Ti. ` .....�:v _ `i-'tk- __«{'.: ::aa` `}2c: .t:°i:• {{L2:
y,Y.:..-..-.-.: v: n.�: :,:,w3. :..."u.- • .-3i�i ^`},
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4.:.3:.:.... ...:....:. �: :: :�.,-:e.:.-i:::::: i_T:: �n� ;: �::::::,.::::.� -iw: .:cc•3: :•:orax?eti- - - or..--- __- :cxtts}s: ,..:..r::33:•;;...,-. ........ ;:, . ..cam::.:::
'ewe -
Revs runs ectorName ....:.' ..... ..:.:::::.. ..".::::::" - - -
P -
Reviewer/Inspector Signature: Date:
U�

P .
Facility Number: 3 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Y
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 QNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes /❑ No
j JfIRE R EA5 kROuoa L-Pr"ot3 O P�Eo -(D 9,9 VEOErAT1
ff-ka sz,;Ok), �QoER —i�o 4"L' '(-#J
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C—G)C)Dt R,moORDS
05103101

of Visit compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date or visit:
Permitted © Certified ❑ Conditionally Certified [3 Registered
Farm Narne:..... .C`. ............... ! lJhw........................
Time:I //.'
❑ Denied Access
IO Not Operational O Belo►f Threshold 1
Date Last Operate or Above Threshold:....Z.. .........
County:....... /..�.......................s.......
OwnerName: ................................................... ....................................................................... Phone No:
Facility Contact:
Title:
Phone No:..,.
MailingAddress: .................;..........................................................................................0-*."i
Y,9
............... + ..�................
`jjL i
Onsite Representative:................................................ K.l•L...__.............................. Integrator:...........l`.._._...u..........!..........'............
Certified Operator:.,,.. ................. .... Operator Certification Number:......
Location of Farm:
kwine [I Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• ��=
Design Current Design Current Design Current
Swine Caipacity Population Poultry CapacityCap4city Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I❑Nan-Dairy
❑ arrow to Wean
Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
71.
"Jo Boars ..A
Number 'f Lagoons ❑ Subsurface Drains Present ❑ Lagoon ❑Spray F 1.
4.. 1
n Area field Area
Holding PondsE/^Solid Traps a ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ 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, notifv DWQ) El Yes El No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
01/01/01 Continued

Facility Number: —
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Sigucture 1 St tune 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ........TWX
.... .. .. ............................................................................................................................................
... ... . .......... ...........
Freeboard(inches): ...._..............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Ll� 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? XYes TO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNO
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
IL
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Croptype` �� 1
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
o
b) Does the facility need a wettable acre determination?
❑ Yes
No
INO
c) This facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
016.
Is there a lack of adequate waste application equipment?
❑ Yes
;:,0
wt in ee
Required
Records & Documents
,
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
21.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
ElYes
. No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
25. Did Reviewerlinspector fail to discuss review/inspection with on -site representative? ❑ Yes No
26. Does facility require a follow-up visit by same agency? ❑ Yes , o
27_ Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ! No
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? �[
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ICI No
01/01/01 Continued

Faolity N mber: Date of Inspection Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O(No
roads, building structure, and/or public property) .
31. Is the land application spray system intake not Iocated near the liquid surface of the lagoon? ❑ Yes *0
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes *No
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes too
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0To
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. VV
' Field Co Final Notes
RIT& iot'" 1-11-�
NOV, I hJW �U Lt (arr�
jar l�
. lA G-
Y
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gy
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
01/01/01

m w��
I
nt O Follow-up of
I Facility Number I
Follow-up of DSWC review O Other
Date of Inspection
Time of Inspection
Permitted E31tertified [3 Conditionally Certified © Registered r
Farm Name: �.....�`'... ...�.... r,�...............�'r..�-�_......�..... �77� ,� 1l.
OwnerName :............. ................................... ........................._...::............. ..............
Facility Contact: ... ]............. Title:..�lh,G
Mailing Address:
Onsite Representative:
Certified Operator:
Location of Farm:
24 hr. (hh:mm)
t O erational Date Last Operated: .........-.
County:........D.. / �eq�.................... .............
Phone No:..............
Phone No:
............................................................................................................................................................. ..........................
Integrator: dlq
a c'P..............:r ...........................1.....h;...c.....................................
............... :.............................................................. Operator Certification Number:..........................................
Latitude ���� �" Longitude
.Design" Current- Design Current .: _" Design. ': Current _.
Swine -Capacity - Population Poultry Capacity Population- Cattle Ca acity '= Po ulatiou
❑ Wean to Feeder ❑ Layer JE3 Dairy
eeder to Finish GD ❑ Non Layer ❑ Non -Dairy
Farrow to Wean _
❑ Farrow to Feeder ❑Other
< ❑Farrow to Finish Total -Design: Capacity
❑ Gilts =
❑ Boars °' Tota1'SSLW_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the convevance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system'? (If'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): `�
..............yip.................. �...�...............:....................................................................................................... .......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back
❑ Yes Xfi10
❑ Yes ❑ No
❑ Yes ❑ No
_N-
❑ Yes ❑ No
❑ Yes [No
❑ Yes Ro
❑ Yes (YNo
Structure 6

Facility Number: — Bate of Inspection D
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 maintenancelimprovement?
❑ Yes
V3 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[�'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
qNo
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
�No
12. Crop type
13. Do the receiving crops differ tth those designated in the Certified Animal Waste Management Plan (CAWMP) 7
❑ Yes
j(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This "facility is pended for a wettable acre determination?
❑ Yes
OfNo
15. Does the receiving crop need improvement?
,-Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JK'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
XYe
(ie/ checklists, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ANo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
/qNo
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
;I(NO
0: %j yiola>ioris' r defCiCrtcies mere notpo r�Xtririg #his'visit; You will >reeeive fiti further:
. - correspondence. about this visit: ..... . ....... • . • . • . - . • . • . • ........ • ... • ..... • .
Comments (refer #o question #) Explatn:any-YES answersand/or:any recommendL aons or any other comments
Use:drawings of facility to;better explain situations (use; ad[hhonal pages as4netessary) , ;�' "
A.
l� �oas�,� . t oti-f'•/►,—� �s/��
}}� [ tlt C /� fAT{;) VV r G Y [� S J V S t.%fL ,L/� Ir14 Z , �Y
11A Cmw 1i i _& J4y�
WIA 0 a— At( slnrr�tv��
h.�.�-- ��"'�`' t�-aw')t/L � nirn�.Vtt✓�\e k �n�rt�-.�,.- S��L►^t�.g� o-„—�.s�• l� v}►
Reviewer/Inspector Name` FT
Reviewer/Inspector Signature: S me -1 &, ')/f//� // Y 11A Date:
a-

Facility Number: — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
N0
liquid level of lagoon or storage pond with no agitation?
'C�
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
)dNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;to
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
XTo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
P?lNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
'VNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Vio
Additional Comments and/or Drawrn
Y�trti �L talcar
es j
1
JA
k-tl�
�.re b o�� recv,�ats l�I
-z-0-P Mr.. C1101d 61�5 Kvw
i V'NJ-d —r-O 6to S S hi twl&,r
� S• � fix- vw�-�
Q�- CO-(
3/23/99

E_Division of Soil and Water Conservation=Operation=Review
13 Division of Soil and Water.Conservation - Compliance Inspection
Division of Water Quality Complilnce'Inspection -
3 Other -Agency - Operation Review. -
Routine Com plaint O Follow -tip of DWQ inspection O Follo,*%--up of DSWC review 0 Other
Facility Number Date of Inspection )
r 1 inte ol' Inspection 24 hr. (hh.mm)
Vilpermitted ❑ Certified 13 Conditionally Certified 0 Registered JE3 Not O crational Date Last Operated:
Farm Name: ...�....... ................. •5....Y County: ......
.....
.............. .......... .............................
OwnerName : ....................... ............................ ........................................................................ Phone No:..............._......................................................._...............
Facility Contact: .............. ... Title................................ _ ................_..... Phone No:................
MailingAddress: ..............................[[...................................................................I.............................................................. ........
Onsite Representative:.1.''Z............................................... Integrator:...............................................
Certified Operator: ................................................... ................. ........................................... Operator Certification Number:..........................................
Location of Farm:
r...... ......... .......................................................... ............................................................... ................... ................................. ......... ................... ............. .............. .......................
i -
Latitude Longitude'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
can to Feeder ❑ Layer JE1 Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 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 (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nnan-made?
1). If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in talhnin?
d. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is stora;e capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches)................................_...............................
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes NfNo
❑ Yes R No
❑ Yes VNo
Structure 6
1/6/94 Continued on back

Facility Number: 3t — Date of Inspection
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?
S. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evident of over application? 07�
❑]Ponding ❑ Nitrogen
12. Crop type `- .."..".................................................................................................................
0
❑ Yes brNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0: N�a'VWa'tions'tir. deficiencies1­1 .were noted during xhis.visit:. Ytiu wil, receive nor further .. ;
correspondence; about; this visit.;
Comments (refer to question #): Explain any YES answers and/or any,recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)
I" _T" .
V
MD
Reviewer/Inspector Name
Le t-etA4
❑ Yes A J No
74 Yes ❑ No
❑ Yes [JrNo
❑ Yes ONo
❑ Yes L�No
❑ Yes WNo
❑ Yes NNo
❑ Yes No
XYes ❑ No
❑ Yes No
❑ Yes N No
❑ Yes ,l No
tf Yes ❑ No
❑ Yes NJ No
[-]Yes (00
❑ Yes P4 No
❑ Yes Jbvu(No
❑ Yes tffNo
Reviewer/Inspector Signature- } Date: .51 `7 f -[ 1 11/6/99

❑ Division of Soil and Water Conservation
[3 Other Agency
x..�=
�Dtvtsion of Water Quality
3
Y.
Routine O Cum Taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of inspection
Facility Number
Time of Inspection . : 3 24 hr. (hh:mm)
0 Registered 13 Certified [3 Applied for Permit Pf Permitted 13 Not O erati .nal Date Last Operated:
11--,,1�;AFarm Name:..-. ?" Count
............................ y:.............. \)11-1
.............................................................................
OwnerName:.... ............................. ..... Phone No:...................................................................................
FacilityContact:......................................................................•--..... Title:..........................
Mailing Address: ed { ..
.......................................... ........ ............... ............V...............
Ousite Representative:.a� Q........✓....1.!s.......
Certified Operator. .................................................
PhoneNo:..... ...................................................
....... d;�„ ;..�.�........... .............. ....... ....,
j............
Integrator:-....."..-.... 11 ........ '.......•T�!'�3'
.................... Operator Certification Number,------------........
Lpcatioij of Fa
Laa.......... K..... L!.............................G'^...................� .................�f1 ''a...� ......Q'1...... +
....................
. .�........ .. '-1..._. .i• •arc....�........ ............. .....� ...3..............................................................................................................................
Latitude • 0' 0" Longitude • 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes (XNo
2. Is any discharge observed from any part of the operation? ❑ Yes ,M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes t(No
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ) ❑ Yes 0 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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ONO
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 10 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0,No
7/25/97

1
Facility Nu; ber:'31 - S
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
V1 No
Structures (Lagoons,Iiolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Cq No
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 5
Identifier: A I?'
Freeboard(ft). ........... :. ........................ Q............ ....................................................................
.............--.------................................
10. Is seepage observed from any of the structures?
❑ Yes
CgNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
F7 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 puhlic health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
0No
Waste ADDliCation
14. Is there physical evidence of over application? ❑ Yes 10 No
(If in excess of WMP r runoff entering waters of the State, notify DWQ)
15.
Crop type .- ......� ....
lb.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? .
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
51.Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
0 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
$] No
22.
Does record keeping need improvement?
O'Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fait to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
NNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
,Yes
[l No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
04 No
❑• No.violations°ar deficiencies were'iaoted-durik this:visit: You:wriil recei�e•i o'-ft rther
: correspQridence about this:visit:
'�lnil off- �ic� Go i-� , 7j
Nw Saul S°` � 1 `-. �-'te tom` `{Y '2 r�c3 �G5$ f U.11- Sc J V-k-1
1���`�. 'p��:a-.�i c..: � .`}���-. ��-v�� � (�L�� Iy� I .�e w,Qx�• �.c�-- 15 s`"�5�� ��4
1� �iYeS� •.f l \ ►- �-� ��I f �tLl TG i ZQ
4k NIl.�li � c�� � t a`►-r�c3- l�
z�rl, kip. 7/25/97 �

Facility Number: Date of inspection:1 CT11.9 07Y-7
Additi6nal Cqmm&nts And/6r- DraWings:
--kpe��4vu., J�V-411L-j ccl�
���1� ����G�. s�s� s��`,� -��.� 3,�-� Cho �.s� �
�- � pP
cl\
-� l `�-� C`t�' � '� 1�1[ �q r dc� � � 131�18; se�- -�-�� s Epp it ��� o�
4/30/97

❑ DSWC Animal Feedlot Operation Review '
® DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number ��
Time of Inspection Ll.J 24 hr. (hh:mm)
0 Registered OLClertified ®} Applied for Permit E3 Permitted 0 Not Operational Date Last Operated: .
Farm Name: ........ j6kr1 ........ ..Q.W...G as........s.n ..................... County:....... .. �� r........................................ .......................
Owner flame:..... Ari....... =wit dxC.........................................................:.............. Phone No: ... �Qjrl.�.�.5�:..��G............ .41..ewi
Facility Contact J&tti..... Title: .. Phone No:
Mailing Address: ....... Rd ....... 1)cdu,ltr......4-s'.7............................................
Onsite Representative: ..._.�2e......... C�tnOe/wry........................................
Certified Operator ........... 1Q fN........ R ........ C:416,4S.... t...... r..............
Location of Farm.
........ ..... 1+:...... 01S.W..M.c............ ............................ 2xus'�.........
........ Integrator ...... i5P.1&6s.a...... ............................................
Operator Certification HumbertLd
..... ?. .....................
T�J4....'�..1Q...crx�....... ... t4v.saw.:......!�rr... �.......ar......1.r?�.,.... rx...,r.�g. ... an...C..l...7't�rn......�. a+..
....i3a.I.:...Fc�.rr>,......'....�1.,..z-...A.Ats....�f...Si~.�34�0..Qir....�i�....�.ati�n.���...-�i[�,e.....�.�t.�f�............................................
Latitude ' bZ ` �fL �" longitude ®s ®` ®44
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish S (
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer JEJ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity I C.
Total SSLW
Number of Lagoons l Holding Ponds {� ❑Subsurface Drains PresentLZ
❑Lagoon Area ©Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes QA No
2. Is any discharge observed from any part of the operation? ❑ Yes Od No
Discharge orioinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, wac 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 VaUniin? �
d. Does discharge bypass a lagoon systein? (If yes, notify DWQ) ❑ Yes 59 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes (A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 4No
4 maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25197
Continued on back

Facility Number: — ,r
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes P)�No
Structures (Lagoons,llolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes tR No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: . ...............................---...............-....---.....................I..............................................................
...................................
Freeboard (fty ........... ..;........... 3
10.
Is seepage observed from any of the structures? N
❑ Yes
(A No
H.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
ANo
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)
H.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14..Is
there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type 6ev'+u+wC1/- ................................................................................
......................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
D4 Yes
❑ No '
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[V No
18. Does the receiving crop need improvement? (g Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a follow-up visit by same agency? Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes "0 No
22. Does record keeping need improvement? KLYes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes, ® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes tA No
25, Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes &No
0-No.violations or deficiencie's.were-noted during this:visit.-No'U"Will receive -'no' ftirther
correspondence about this.visif.
Comments (refer to question #) ;.Explain any YES answers and/or any recommendations�or any,dther jacomments.
[use drawings of facility to better explairt'situations (use addrtii►nal page`s �as necessary) � � `
c` 'I 1 °si+r 1 � �n�.
12. gore AMOS bti h04Y _ (ayor.y Si I() �c ttc- C -r�e,li- GroS�r+ (�0a, an 1a.�Cari Snovlfl �e �l�t� y
W G�a(n! �,Ctr►a fft S Lt�t�, ]Ac { j rrr. Skould Stle_ 6i I"r (�-`tfiun� yM: ctr brt �GSdbc1 1 (- F
w�.lM s 01� 1(34k �,Oyco%-SkOj6 � G w1atied._y1c�� # ? �� �'KWL �iS+Cd 'c h i�af�• L[Nv T �Ja; � a i � Dr Ulsborol
IT.3ainuh- e_tap Avvla to �v►� �ittm 'r c
ZZ. WG>k �Ay yz 5ko�r� �,° a�, s�� ��5 ikcuO � 14 t y
t(� �umbe� rnx�d ia'500A ia�e�e sho�ft? �e i� plan•
7/25/97
Reviewer/Inspector Name,
Reviewer/Inspector Signature:
:�.
Date:

Site Requires Immediate Attention:
' Facility No.- J - Sl
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: ---<W t-33 S,
Farm Name/Owner: �y�,
Mailing Address: T
County: �,401� N
Integrator: ('2:jUj&'0 � to _ Phone:
On Site Representative: Phone:
Physical Address/Location: NCO2 l30 ,A.oR,wX a,7 vrKtlff - 6 �M.
Type of Operation: Swine f Poultry Cattle
Design Capacity: 10CDO -try: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW_
Latitude: 3 b u`� Longitude: `� �° ' �i Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or(9 Actual Freeboard: L___�__Ft.- Inches
Was any seepage observed from the lagoon(s)?. Yes or No Was any erosion observed?S5Por No
Is adequate land available for spray? e�r No Is the cover crop adequate? Yes or No
Crop(s) tieing utilized: ( '4r1k I AM74f'/h
Does the facility meet SCS minimum setback criteria? 200 Feet from .Dwellings 66 or No
100 Feet from Wells?(9 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated -within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? gor No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with coven crop)? Yes or No
Additional Comments: llpo bAKi t,w'j v'-_ r— ; S
kC)
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention
Facility Number: 1
SITE VISITATION RECORD
DATE: _ f�`7� 11995
Owner: J CA D r Farm Name:
County: -
Agent Visiting Site: a.n Phone: 19 C. - Z `U
Operator: phone:
On Site Representative: _._ _ Phone:
Physical Address c2la T2
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: 7 Number of Animals on Site:
Latitude: o Longitude: -- - a '
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or (ED Actual Freeboard: Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application`.' Yes or No Is the cover crop adequate? Yes or No
l _
Additionm 'Vp 41114jec-,�
Additional Coments: / � dk-
•
Fax to [phone]
Ir
Signa+tge of Anent

OPE 'HTION',- BRWCH - WQ Fax :919-715--Gu4?, Hug 1 795 10 :23 P. 0?/08
Site Requi_=es Irnmediate Atteritton -
•
SITE VISITATION RECORD
DATE: —� 7 � ---• I9�)5
Owner; �h J!1 i.<.� _-- Farm dame: _
Agent Visiting bite. s.�- _ ..� Z,
Operator: --�-- — -- Pbone:
On Sil[e, Revre,SBIitative,- Phorle:
PizvyicaJ Address:'/ '- �.. '-r� per, a_'
N-fail.ltt,; Address:
Type of Operat.iOn. Swim Poultry - Cattle -- ---
Design Capaciry: ;urnbcr of Atiirlials on SiEe --
Lacitui : Lonnirude:
Type of Inspection.- Ground _ _ Aerial
r
i,cte Yes or No
Does the A.nirr:al Waste Lagoon have sufficient freeboard of 1 Foot + 25 yt-a: 24 hour stronr-z e% 'rJ
(apor s_ mately 1 Foot +? inches; Yes or o Actual Freeboard: __— Fret
For facilities witl-1 more than one la,pon, plcfvse address t11 other lagoons' freekxrd wn,'tr the
comments section.
Was any seepage observed from the lagnon(s)? Yfs of No Was there erosiorl of the 7rr
Is adequate la d available for land oPplication' Yi:s or'No Is t s;: corer clop a&gwte" z er n; N )
V
V/ !� --i � i,,- - - , ) 7 15.3 5 59

Cj
Site Requires Immediate Attention: 0_
' Facility No. I /
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ? v , 1995
Time:
Farm Name/Owner:
Mailing Address: P o_�7 —� Y 3 .- X-k- -, 4�,
County:
Integrator.
vf-t,
Phone:
On Site Representative: Tub '&f — Lcf-4w " Phone: 13 5_0 V '%
Physical Address/Location: �� 13o i a _ 7 •-r, ; /.e r ��� 4:: ::2_
_ivwi� Pn-I f= _ ate- S_ �Z, °% .+.�'�� ► u t
Type of Operation: Swine. Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 b Z 7 Longitude: _71'_° b�-' 7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon hav icient freeboard of 1 Foot + 25 year 24 hour storm event
{approximately 1 Foot + 7 inches) ' es or No Actual Freeboard: -Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? IC�'r No
Is adequate land available for spray? D or No Is the cover crop adequate`. or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?O or No
100 Feet from Wefls?Cesc& No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6a If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
- {t-L
Inspector Name S ignature
cc: Facility Assessment Unit Use Attachments if Needed.