310059_INSPECTIONS_20171231

'0 7Wb
NORTH CAROLINA
Department of Environmental Quality

.DIV�5rUn of Water Resources`; . k-,
Fatuity Number D�vts�on of Soil and Water Conservation x
.. IN 71.___
Other Agency � ti
Type of Visit: Co lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�Roouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � / /� Arrival Time: Departure Time:�(�/J 1 County: Region:
Farm Name: T� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
Onsite Representative: 0 r G CA.e Integrator:
Certified Operator: Certification Number: 1,(—,j
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Des n CurrentDes gn �Cur�rent �Y" = n� Current
Swore Capacity MZ:g
Ca aci Po
p ty Pop Wet Poultry Capacity Po Cattle erg. p ty p
Wean to Finish Layer Dairy
Cow
Wean to Feeder Non-Layer Dairy Calf
Feeder to Finish He
s
Dai
Farrow to Wean Design Current Cow
Farrow to Feeder D Poult P:,Ca aci Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood CowTurkeys
�.
Other ...:" Turkey Poults *' Y
Other Other
• w
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ea<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? 0 Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ ❑NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Q Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FacilityNumber: - Date of Inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes r,--Mo ❑ 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: Of-°�^ ! ��A Ls+2
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Lt 3 `
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EjNo ❑ 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 M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E:j"'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [al o ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes []"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes EjNo ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes IGl ivu ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes V Co NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes To Q NA ❑ NE
Re uired Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ONo ❑ 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 E2<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 o ❑ NA ❑ NE
23. if selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? [:] Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

[Facility Number: - -5 TI Date of lns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P' " - ❑ 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 El 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 fflNo ❑ 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?
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [3-90 ❑ 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 10 ❑ 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 FNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments(refer torquesfioa ) Egplarn ariy`YESranswers and/oi`any ada�tional,reconimendationsffo'r.�any ather�commen'ts;
3' F
edrawg e nsd sn'
s f . p � a {.0-r- r[ cpr JS gelC (�'►� ' �� 1�
Reviewer/Inspector Name: OC4 ✓/ d tJ � Phone: 2/O 7 f
Reviewer/Inspector Signature: Date: ` 72—Y l
Page 3 of 3 21412015

Division of Water Quality
Facility,Number - 0 Division of Soil and Water Conservation
I `�' 0,Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: ` ounty: Region:&/�
Farm Name:_ Owner Email:
4,
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: ich/wl (��S Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder I INon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry Capacity Pop. Non-Dairy
Farrow to Finish I I ILayers I I jBeef Stocker
Gilts I Non-Layers Beef Feeder
BoarsI Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ff�No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes eN o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of-Inspection:
Waste Collection&Treatment
4.Is,storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes jo—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 ,E:fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environment I threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes FNo ❑ 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 E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need [:] Yes C No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. [:] Yes U(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 Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes 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 [/No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes E7No ❑ 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 Tr nsfers ❑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 PA No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[facility Number: jDate of inspection:
24.Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes allo ❑ 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-No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ YesrJ2'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 [�o ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J;3"No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative? ❑ Yes J�no ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes J 'No ❑ NA ❑ NE
Comments(refer to question#)•Explain any YES answers and/or any additional recommendations or any other_comments. a
Use drawings of facility to better explain situations(use additional pages as necessary).
Reviewer/Inspector Name: i Phone: �!� `
Reviewer/Inspector Signature: Date: l
Page 3 of 3 211412011

ision of Water.Quality
aGility Number 0 Diviseon of Soil and Water;,Conservation. p
����� � lOOtherAgency. ,~�
Type of Visit: P"—&pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: feparture Time: County• Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current~-
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.;
Wean to Finish ILayer Dairy Cow "
Wean to Feeder I iNon-Layer 1 74 Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean - ,.';,Design Current Dry Cow
Farrow to Feeder D Point 'Ca aci ',4o Non-Dairy �<
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder T.
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes 2-<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes J2'No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑'No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑'No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J�No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ;I No ❑ NA ❑ NE
of the State other than from a discharge? T
Page 1 of 3 21412011 Continued

IFacHity Number: 51 - Date of Inspection: jO
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? [—] Yes ZNo ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ZfNo ❑ NA ❑ NE
Struc e l 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 j2 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 EfNo ❑ 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 00No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;3^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 JoNo ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes '2 No ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. [:) Yes ❑'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ONE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA eo'14E
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 ❑ No ❑ NAiE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ No ❑ NAZ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ❑ No ❑ NA
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 La E
❑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 [:] No ❑ NA eNE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ET�NE
Page 2 of 3 21412011 Continued

r-
[FacilityNumber: 01
Date of Ins ection: c� )
24.Did the facility fail to calibrate waste application equipment as required by the pe it? ❑ Yes ❑ No ❑ NA XNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes [] No ❑ NA ErNE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? [:] Yes ❑ No ❑ NA�TE
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",ZNE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NAE
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 91E
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 _ZNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA�E
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ❑ NA NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes J020<0 ❑ NA E
Comments(refer to question ft Explain any YES answers and/or,any additional recommendations orany other,comments:-
Use drawings,of facility to better explain situations(use additional pages as necessary).
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: CGle" 1 Z
Page 3 of 3 214120 l

rQ'Division of Water Quality j
Facility Num ber 3 tJ O Division of Soil and Water Conservation
Other Ageney
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit.'toutine O Complaint O Follow up O Referral 0 Emergency O Other ❑Denied Access
Date of Visit: 3d Arrival Time: eparture Time: County: Region:(_�-cJ
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phones No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c Longitude:
Design Current Design Current -Design Current _:;;
Swine. Capacity Population Wet Poultry., Capacity Population Cat#le Capacity Population
❑Wean to Finish ❑La er ❑ DairyCow
❑Wean to Feeder ❑Non-La er ❑Dairy Calf
`•❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry , ❑Dry Cow
-[]-Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
El Gilts ❑Non-Layers ❑Beef Feeder
❑Boars ❑ Pullets
• � ❑ ❑Beef Brood Cow
Turkeys
9thei-
Turkey Pouets 1
-
❑Other ❑Other Number of Structure's::­.ED
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ONo ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(if yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
C. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ' io ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes ;ZNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes j No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: Date of InspectionM12i54
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes PNo ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Struc�t
�/ re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes R�No ❑NA ❑NE
(iel large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed Cl Yes XNo []NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental
threat,notify DWQ
❑
7. Do any of the structures need maintenance or improvement? Yes ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes V5 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 VfNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ZNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes )'&o ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
[]PAN ❑ PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes tO No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes qNo ❑NA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes � a ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? El Yes ;No ❑NA ❑NE
Comments refer to uestion,# Ea lain an YES answers and/or an recommendations or_'an other comments r '
( Q ) p Y Y y x
UWdrawings of facility to better explain situations.(use additional`pages asmecessary): -
Reviewer/Inspector Name - Phone: r�!
Reviewer/Inspector Signature: Date: Cr
Page 2 of 3 1 /28/04 I Continued

Flcility Number: Date of Inspection 3 Qa
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes jXNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes PNo ❑NA ❑NE
the appropriate box. ❑ WUP ❑Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ZNo ❑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 PTNo ❑NA ❑NE
23. if selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes 1qo ❑NA 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 VNo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes �io ❑NA El NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? El [/�No ❑NA El NE
Other Issues f
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes VNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes VNo ❑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 Vf 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 VfNo ❑NA ❑NE
General Permit? (ie/discharge, freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes VNo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes VNo ❑NA ❑NE
Additional Comments and/or Drawings:
44&L N
~—' r
Aa
°/h/ 2. 3
r�
Page 3 of 3 12128104

Q'Sivision of Water Quality
FCi�ity Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit �,oLmpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
10<
Reason for Visit Id Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Z�
s
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /�r'C�P L�l�� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e Longitude:
r
Design Current Design -Current _ , . , ,� 'Design GurrenY,-'
ine Capacity Population Wet Poultry Capacity Population ; Cattle Capacity Po ulafio
Sw„ g n
❑Wean to Finish ❑Layer ❑Dairy Cow
❑Wean to Feeder ❑Non-Layer ❑Dairy Calf m
❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry El Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑ Layers
❑Beef Stocker
El Gilts ElNon-Layers
El Pullets ElBeef Feeder
❑Boars ❑ Beef Brood Co
❑Turkeys
Other- ElTurkey Pouets
❑Other ❑Other Number'of Structures
Discharp,es& Stream Impacts
I. is any discharge observed from any part of the operation? [:]Yes ONo ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑ Yes L-JNo ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ; "No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? [--]Yes ZrNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ;?O�o ❑NA ❑NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy-rainfall)less than adequate? ❑Yes 2fNo ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes No [I NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 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 ;dNo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes ONo El NA [I NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes VNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes dNo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes VNo ❑NA ❑NE
maintenance or improvement?
Waste Apmlication
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes �No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes Plo ❑NA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 1 O lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes VfNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes VNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes V No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes 0 No ElNA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes VNo ❑NA ❑NE
Comments Irefer to question#): Explain any,YES answers and/or any,recommendations or;any o_tbtr,eomtrients
Use drawings of facility to better explain situations.(use additional pages as necessary):
AL
ao `
G� '
w
ReviewerlInspector Name a; Phone:
Reviewer/inspector Signature: Date: Q
Page 2 of 3 121AI04 Continued

Facility Number: Date of Inspection /
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes VNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes ETNo ❑NA ❑NE
the appropriate box. ❑WUP ❑Checklists ❑Design ❑ Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes �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 e No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 5YNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes 10 No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? El Yes /A No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes VNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes )6 No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document []Yes [�40 ❑NA ❑NE
and report the mortality rates that were higher than normal? VNo
30. At the time of the inspection did the facility pose an odor or air quality concern? ElYes ❑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 E/No ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes [;VNo ❑NA ❑NE
33. Does facility require afollow-up visit by same agency? ❑Yes �No ❑NA ❑NE
Additional Comments and/or=Drawings m
Page 3 of 3 12128104

Q Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
-- Q Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: U r d Reparture Time: �� County: Region: wr'�fJ
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=o ` �" Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑Layer ❑Dairy Cow
❑ Wean to Feeder ❑Non-La et ❑Da' Calf
❑Feeder to Finish ❑Dai Heifer
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder El Non-Dairy
El Farrow to Finish ❑Layers
❑Beef Stocker
❑Non-Layers
El Gilts ❑Beef Feeder
❑Boars ❑Pullets ❑Beef Brood Co
❑Turkeys --
Other 10 urkey Poults
❑Other 10 Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes _'No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ;]'1Go ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes ,�o ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts io the Waters of the State El Yes L?IQa"'❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: Date of Inspection
Waste Collection& Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? El Yes ;[ o El NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes 6 No ❑NA ❑NE
Structure l 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 1ZNo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes VfNo ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes JZI No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes E No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes dNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ZNo ❑NA ❑NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes dNo ❑NA ❑NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes VNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes / No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes Vf No ❑NA ❑NE
11 Commentsi(refer to�questton,#} Egplam any YES:answers and/gravy r ecommendahori�sYor any other comments:
r� a�: � - -�...�. -
6Use drawings=offacrlity�to better egplam srtuatrotr`s` (use addihonaE:pages asrnecessary}
7
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: O G
Page 2 of 3 12/2810 Continued

Facility Number: — Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes 0 No ❑NA ❑NE
20. Does the facility fail to have all components of the CA WMP readily available?If yes,check ❑Yes ;7No ❑NA ❑NE
the appropirate box.
❑WUP El Checklists ❑Design El Maps ❑Other
t
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑Yes PNo ❑NA ❑NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑Annual Certification
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes Ef No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ONo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes PrNo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes PNo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes I[TNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes 0No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑yes Rl"No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes CYNo ❑NA ❑NE
General Permit? (ie/discharge, freeboard problems,over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑Yes No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes ('No ❑NA ❑NE
Additional Comments and/or Drawings:
c cam,
12128104

r
)D'bivision of Water Quality
Facility Number r Q Division of Soil and Water Conservation
_ _. _ _...... Q Other Agency
Type of Visit Q.6bmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: parture Time: County: Region:
Farm Name: roa rf Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /Z'y ( Q�� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑c ❑` ❑" Longitude: =°❑` ❑"
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La er El Da' Cow
❑Wean to Feeder 1 10 Non-Layer ❑Dairy Calf
❑ Feeder to Finish ❑Dairy Heifej
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts ❑Non-La ers
El Pullets ❑Beef Feeder
❑Soars ❑Beef Brood Cowl I
__. . ❑Turkeys
Other ❑Turkey Poults
❑Other ❑Other Number of Structures:
Discharces& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes R<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 DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes P-fio ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes_,UIqo ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: �7 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes 0 No ❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure 1 Struc re 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 0No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes �?No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? XYes ❑No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ONo ❑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 ONo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes gfNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes oNo ❑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 �TNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes dNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes KNo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes P No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes Flo ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
a
Reviewer/Inspector Name IlePhone: 0 7
Reviewer/Inspector Signature: Date: 6
12128104 Continued

Facility Number: �� —��1� Date of Inspection
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes Z,�N"o El NA El 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 El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ,_No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ;2-No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes P-No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes C'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 PkNo ❑NA ❑NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes �INo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑yes ETNo ❑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 , rNo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to no the regional office of emergency situations as required by El Yes ,D—No ❑NA El 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 1Q No ❑NA El NE
33. Does facility require a follow-up visit by same agency? [I Yes /PNI10 ❑NA ❑NE
Additional Comments and/or Drawings:
P S.cr •
s l Cf UG
/ /
X a r /'e�e,"7L irc.c
T
Page 3 of 3 12/28/04

4015ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation Loo�
0 Other Agency
Type of Visit j2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QeAoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: LI)6 Arrival Time: O t"J Departure Time: C] County: Region: C✓l
Farm Name: _ rIIG�1f�1 Tc C/�/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No-
Onsite Representative: ����cr [�C�/�s� Integrator: 1 �� f��'✓�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =u =1 Longitude: =o =g 0
As
I
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑ Layer _ �, ❑Dai Cow }
❑Wean to Feeder ❑Non-Layer ❑ Dairy Calf 1
Feeder to Finish t5­10U I
_ ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑Dry Cow ?
❑Farrow to Feeder Non-Dairy
El Farrow to Finish ElN ers El Beef Stocker
[I Gilts ❑ on-t ers ❑Beef Feeder '
ElBoars ❑Pulles
--- - — - — - El Turkeys ❑Beef Brood Cowli
Other ❑Turkey Poults
❑Other T-.- - J 0 Other - y� - Number of Structures: EIE
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes ❑No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ❑No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: _ Date of Inspection
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ❑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): 5-4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes ❑No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes ❑No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes ❑No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ❑No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes ❑No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes ❑No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑No ❑NA ❑NE
Comments(refer to question##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
' /4�Gcl� rGC CG `caooy— !dd`C G o�
Reviewer/lnspector Name — -- —�--- _ -- Phone:
Reviewer/Inspector Signature: Date: 4
Page 2 of 3 121±8104 Continued

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

ie ".
. _-f D�vrsaan of Water�Quality s
t" � Yr aka^
`Facility N11MF'er DaDtvtston of�Soiltand Water�Canservatton " EMMA
��� 1�� Q�.Other�Agencyy
Type o€Visit (>bmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit r-31-15outine 0 Complaaidint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Accpless��
Date of Visit: d Arrival Time: 7� Departure Time: County: Region lj`____�&els
r
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: / �/PJhone No:
Onsite Representative: �rGGi ( 21.� _ Integrator: / !/�iv�/�,
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish I Ik ❑Layer � ii ❑Dai Cow
❑ Wean to Feeder 1 10 Non-Layer ❑DairySalf
LLTe to Finish 009P ❑Dai Heifer
❑ Farrow to Wean ❑Dry Cow
'
El Farrow
Poultry Farrow to Feeder ❑Non-Dairyj
ElFarrow to Finish ❑Layers
❑Beef Stocker
❑Gilts , ❑Non-Layers ❑Beef Feeder
❑ ❑Pullets;s
❑Beef Brood Co
❑Turkeys - - - -
Other ❑ urkey Poults
❑Other ❑Other ; Number of Structures: �I
Dischary-es& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes .2 No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes �No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ;'No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ETNo ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yeso El NA El NE
a. If yes, is waste level into the structural freeboard? ❑Yes �o ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 2-
-Spillway?:
Designed Freeboard(in): 1q.
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes`ZNo ❑NA ❑NE
(ie/large trees,severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes [)lo ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes 4 No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ElNA ElNE
(Not applicable to roofed pits,dry stacks and/or wet stacks) 91
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 No ❑NA ❑NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes [YNo ❑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) dr�� -
13. Soil type(s) �
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes P No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes P,No ❑NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,El Yes VNo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes P No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes VNo ❑NA ❑NE
Eomments(refer to q! uest#} UK Ilia VES^answers and/or any recommendations or any other comments.
Use drawings RiaC!4wolbetter�explam(situations:t(use addthonalR ages as necessary
Reviewer/Inspector Name ' Z.
�_ r Phone:
v, vc':
Reviewer/Inspector Signature: �! Date:
12/28/04 Condnued

t___
Facility Number: 3 — Date of inspection c
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑ Yes ZNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes �& ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement'?If yes,check the appropriate box below, ❑Yes Q No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes [JIB o ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes FKo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �' o ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes 0'No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes J:�'No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes PNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes DNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �o El NA El 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 1,—a-tvo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
f
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes Vo ❑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 �3 o ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes ❑NA ❑NE
Additional.Comments and/or Drawings:
12128104

W x
°'�. � �' P r..t'�y'� -ww��s.��,.."=L r" .. '" ®.6 N, x,�•rr"""•l�.»y..::�, sue;...». _.i {a» ^?„ .'.,. �:
�� .� ;-�-_ _i(��Divisirid of Soil and Water Conservation �.�
�-
aP"4�-.--
Type of Visit Q Compliance Inspection Q Operation Review Lagoon Evaluation
Reason for Visit O Routine Q Complaint Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: c? O Time: %d>
Q Not Operational Q Below Threshold
Permitted PCerdfied ©Conditionally Certified 13 Registered Date Last Opera or Above Threshold: -------
Farm Name: ...0 a..u,�rt�....�Q,_-1!_"7�.--.-......--..._._------._..--..-..---------- County: ... ,(�YJ.................. ..... .. .... .........
OwnerName: .............................................................. Phone No: .......................................................................................
MailingAddress: ..__ ....... . _....... ._. . .... . .. _ _. .. _ ._._. . __ _ .__. ___ _. _ .. __ .. .. ...
Facility Contact: ...................................-..................................--Title: - -- - Phone No:
Onsite Representative: ._ ..- �L -.. ........... ... . .. Integrator:_...�GE!!FA. .........
.... ......
Certified Operator:. ....... . . . . ........ .......�.... - - .. _ . ._ . .... Operator Certification Number:._....,,........
Location of Farm:
A!
Y�
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� ��� Longitude �• �� ���
-� b wxt Design r Curi:"entt a DcSIgn -CnrCgn[ DCSign Current
Swine ,. ; Ca aci . Po illation `PonitrY Ca Pn alafiori Cattle Ca—aci ?Po elation
❑Wean to Feeder ❑Layer w❑DairyI lam
Feeder to Finish ❑Non-Layer 1 ,44❑Non-Dairy
Farrow to Wean
_ ,
❑Farrow to Feeder Other f'
Farrow to FinishEl
W�s � �� �Total Design£opacity'
Gilts
Boars ' Total SSLW r
'�� Number of Lagoons^` _
Y. r it-_ , x
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 gallmin?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ❑No
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ❑No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._.... . . ............. ..........�.............. .................................. ..... .................................
Freeboard(inches): 70
12112103 Continued

Facility Number:,3/— S Date of Inspection < O
5.>Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ❑No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes ❑No
closure plan?
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes ❑No
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 ❑Yes ❑No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes ❑No
❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ❑No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes ❑No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑Yes ❑No
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes ❑No
roads,building structure,and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes,contact a regional ❑Yes ❑No
Air Quality representative immediately.
Cnmreeients(refer to question#) sEzplaua'any';YFS Answers" tions,o any other cnYnirigents.
Use drawtings of faalxty to better lam situatrons (use addrtaonal pages as necessary) ❑Field Cop ❑Final Notes
.r :
�z
1,5
S/cry .Pi ca ��r c�ies
a� 7Z 1G0 4e SC C ion . e K y
477Z /Pq lr
?4 ea C7`LGr! 7L�
O r�
actor Reviewer/Insp Name
Reviewer/Inspector Signature: Date: 5-- .;7 0
12112103 Continued

2"
D,
r Conserva qqnL
3
Type of Visit 191'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit fieRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑Denied Access
Date Facility Number = I
of Visit: 4 0JT,ine.
O Nat
o
rational 0 Below Threshold
/)Zro&rmiffed ertffied 13 Conditionally Certified DRegistered Date Last Operated or Above Threshold:
Farm Name: ..... ............. County:
Owner Name: Ww� Phone No: ........
Mailing Address: —------- ---
Facility Contact. ....................... Title: Phone No: .......
Onsite Representative: Integrator: .......................................
Certified Operator Certification Number.... .............................
Location of Farm:
[I Swine [3 Poultry 0 Cattle ❑Horse Latitude Longitude
2'= Z� Design gn Design
g
f
swine -j)adt�42° 'op
tion
e,
ationj­P 'Dig Ca op
Dairy Wean to Feeder Layer
Non-Layer ❑Non-Dairy er to Finish
Wean
Farrow to Wean
Farrow to Feeder
Farrow
D&i
to Finish Uwi
Gilts
Boars
fF
gooxffP!
DiscbAgy,es&Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes No
Discharge originated at: [I Lagoon [I Spray Field [I Other
a. If discharge is observed,was the conveyance man-made? [I Yes [I 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 gaUrnin?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
n AW 2. Is there evidence of past discharge from any part of the operation? 0 Yes O
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:1 Yes
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? 0 Spillway 0 Yes 0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --------[...............
Freeboard(inches): N y
12112103 Continued

Facility Number: 3j — <C7 I Date of Inspection
T�
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes Y/Ncseepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes
closure plan?
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ) f
7. Do any of the structures need maintenancetimprovement? ❑Y s d No
8. Does any art of the waste management system other than waste structures require maintenance./improvement? Yes ❑N�To
P
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ❑Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes rZo
❑Excessive Pondding ❑PAN ❑Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop type &iC pn Jfl A ( G) S C'o U clS bJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes (PNo/
14. a)Does the facility lack adequate acreage for land application? ❑Yes
b)Does the facility need a wettable acre determination? ❑Yes No
c)This facility is pended for a wettable acre determination? ❑Yes
15. Does the receiving crop need improvement? ❑Yes Io
16. Is there a lack of adequate waste application equipment? ❑Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑Yes To
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes o
roads,building structure,and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes,contact a regional ❑Yes No
Air Quality representative immediately.
_Conuneats(infer to3quest�on) FF�cplarn any YFS answers and/or any recommendaboas ar any otizerrcomt<ients y
rtUse drawingsof fatty tojbette�r'e�cplarn sduatsna4 (ase add�honal P �3') ❑Field CaPY ❑Fufal Notes : s
(Y sAadtCN PjJ Ce N Ef D C- D ZKJ cotes P,12C A o f rX C O vV2r
ic_Ar-fi IS" ?-1
to UP N (cos r> BE Cf ANGEo s j4C,►._/XjjG, /30q< Mt/1DA A5 Naq/ a+0
GI-0 P S gC_C oa_D (-19 0�j N F �621r)
Reviewer/Inspector Name Y "�[ Ct.l.- _ ,a.,
ReviewerAnspector Signature: Date:
12112103 Continued

Facility Number: • 1 — Date of Inspection
Re uired Records&Document,;
21. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes o
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 OIN
23. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes o
❑Waste Application ❑Freeboard ❑Waste Analysis ❑Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes
25. Did the facility fail to have a actively certified operator in charge? ❑Yes o
26. Fail to notify regional DWQ of emergency situations as required by General Permit? ; w
(ie/discharge,freeboard problems,over application) ❑Yes N
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes
28. Does facility require a follow-up visit by same agency? /YesN
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit?(If no,skip questions 31-35)
3I. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes N
32. Did the facility fail to install and maintain a rain gauge? ❑Yes
33. Did the facility fail to conduct an annual sludge survey? ❑Yes
34. Did the facility fail to calibrate waste application equipment? ❑Yes No
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes ❑No
❑Stocking Form ❑Crop Yield Form ❑Rainfall ❑Inspection After 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.
dd�t►onal`Cotnments and/ar:Drawrn�s .
m
e-*-,�.'i:_P u.-"=":'i1_'=_- �.L�E.' s.1-�
12112103

Dtvtstan of Water Quaiity
�.
1 r O Drvtsion of Soil and Water LonsAq A. er�ahon - �.
QOther Agency: '
-x '.°&" s _��i§ -fl'i�`s � +.•A$'J E� .4dS' .. .�Rf .*b.m.�R S--
Type of Visit 7&Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number Date of Visit: Time: + 04rt
Not Operational 0 Below Threshold
M Permitted ®Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ✓ County: —._ Aids., _
Owner Name: Phone No:
Mailing Address:
Facility Contact: �/j�} �� Title: /Phhjone No: �[
Onsite Representative: //l'd a C l ,146e7iS _ Integrator: ,///6.CAxiiF of
/�✓/�✓h
Certified Operator: Operator Certification Number:
Location of Farm:
�l Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
®Feeder to Finish 127do I JEI Non-Layer L 10 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 11EILaLoonArea ❑Spray Field Area
Holding Ponds/Solid Traps 10 No Liquid uid 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. floes 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 YNO
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes
Waste olle lion & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes XNo
Structure 1 Structure 2 Struc 3 Struc r Structure 5 Structure 6
Identifier:
Freeboard(inches):
05103101 Continued

Facility Number: — Date of Inspection ! '
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes XNo
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? t es jw o
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 W('No
11. is there evidence of over application? El Excessive Ponding ❑PAN El Hydraulic Overload El Yes XNo
12. Crop type z
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes ko
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 o
16. Is there a lack of adequate waste application equipment? ❑Yes No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes o
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes XVNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ,I,L�J(No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes l�(J 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 review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? ❑Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes VNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a. ��Sz�;-.r .:�
n#). Explain any-U— answers and/or-any recommendahons or any other comments , Q, ,,
Comments(refer to questro .
Use•dravtangs of facility to better explstn sttuat.ans'(use additional pages�asiwneCessary):; Field Copy ❑Final Notes
eu46 /u07 �SP
eel r �I� �/�r�� �'f/y�G4��j 7-'4r-9-t/
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q
05103101 Continued

Facility Number: — Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes No
28, is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes �[J No
roads,building structure,and/or public property) /1///XNO
29. Is the land application spray system intake not located near the liquid surface of the lagoon? El Yes
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 X')
o
31. Do the animals feed storage bins fail to have appropriate cover? El Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑No
:AdditionalpG�"riiments.and/ot•D"rawrn � _
�C �1�n�f✓,p �° �� �4Ps. yoe��✓ s
Lam - /vfl� . �i✓ l�� G4C.}i�o�✓ /� S S�D�,✓��✓ �F
Z41M
05103101

` . Division of Water,Qual�tya ,
Division of.Soil and:Water Conservation _
� ��' . .�..4., r.•--f.� ,� � ' Other-Agency�� r - > �-- �` c�; �5" J ,,�Y ,�:��'.z-�..��f
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Follow up O Emergency Notification Q Other ❑Denied Access
Date aF isit: EONt
t i�ne:
Facility Number Printed on: 7/21/2t304
3
(Operational 0 Below Threshold
�Upermitted D Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ................
rp W r1 r j�
Farm Name . .............. County: ...f—I '
` J'.1.............................
OwnerName: ......L............................. F�.'. .�..... Phone No: .......................................................................................
FacilityContact: ..............................................................................Title: ................................ Phone No: -
Flailing Address:
Onsite Representative: VD Yt �' 2 t t Integrator:".., ✓"'�
p 'I. .................................................................................... g .......-p .-.......�i........................................
Certified Operator:.................................... .. ........................... Operator Certification Number:........................
Location of Farm:
dj Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �• �' �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer RNRon
DairyFeeder to Finish ❑Non-Layer -Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑soars Total SSLW
tEl
Number of Lagoons 4 ❑Subsurface Drains Present 110 Lag—ri Area JE1 Spray Field Area
Holding Ponds/Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacu;
1. Is any discharge observed from any part of the operation? ❑Yes RNO
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, Wits the conveyance man-made? ❑Yes No
b. If discharge is observed.did it reach Water of the State:'(If yes, notify DWQ) El Yes /RNo
c. If dischai-e is observed. what is the CS61TWted flow in gal/min?
d. Does discharge bypass a lagoon system''(If yes, notify DWQ) ❑Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑Yes /VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes J�'No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway []Yes P�No
Structure I Structure 2 Structure ; tructure Structure 5 Structure 6
ldcntificr: ....re ' 'r T �................... .Tea .a. ......... ...R.�H�...... l. l ........ �-..----d. .-.......-"..............................................................
Freeboard (inches)- 21 3,9 zo
5/00 Continued on back

Facility)Number: Date of Inspection d d Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes-11?fNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes )FfNo
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes (XIo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes XNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes A No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes 1P No
11. Is there evidence of over application? ❑Excessive Ponding ❑/PAN ❑Hydraulic Overload ❑Yes IffNo
12. Crop type �e-r r`► I'd`i-Cj e,�_ SjI OL 1 Lit,- I belle 4 f —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes'XNo
14. a)Does thcfacility lack adequate acreage for land application? ❑Yes ZNo
b)Does the facility need a wettable acre determination? ❑Yes gNo
c)This facility is pended for a wettable acre determination? ❑Yes No
15. Does the receiving crop need improvement? ❑Yes/XNo
16. Is there a lack of adequate waste application equipment? ❑Yes)6 No
Reguired Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes X No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes 'VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes 9No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes �0No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes VfNo
24. Does facility require a follow-up visit by same agency? ❑Yes'oNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
. :�•yiQlations;o�d�fe�encies•wire noted il�ng t�is:visit; Y:o�witi•I�eeeiye�o�u�t��r•.•:
col-ires oricience.a Uf this'visit~
Coima cents(refer to question#) m 1 'A#a any YFS answers andh any recommendst"S or'agy iber at coagqumea my
Use draw{lings 4-facility to better.explain sittEabdns_(iise aild><tional pages as neress rrp) x �4 s
t-GGi j 1� � q"t� YCGD r�'js Gy✓•Q L�g�f k��� �
Reviewer/Inspector Name a hC L�ti . - y - e
Reviewer/Inspector Signature: Date: 4Zh 1 5/00

Facilitx Number: 31 — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge;IL/or below ❑Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes fi3�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes )j�r&o
roads,building structure,and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes J!�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 ZJ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑No
Additional Comments and/orDrawings:
AL
w
5/00

IWDivision of Water.Quality
w Dwision of Soi!and Water.Conservahon
Q,OtherAgency.
E
f Visit g(Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit JK Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number
Date of Visit: l 1 Z 0 d Time: 2: S Printed on: 7/21/2000
;3 S�
0 Not Operational Q Below Threshold
a Permitted ❑Certified Q Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ...............
FarmName: .............. ...........G'.... ..... County' -�.►n. .............................. .......................
Owner Name: ........? -v.,R'.'l eT ....0.... -S............................................ Phone No: ....................................
...................................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ........................................................... ................. ......... ............. ............................. .... ........ ............................................................... ..........................
Onsite Representative-.. ...G .....N r 1':.I r...................................... Integrator. !•YJ, r'"'Zr..............................
u. V..... . ..........
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location'of Farm:
Ili
i
r
Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� �_��� Longitude �•�� ���
Design Current Design. Current Destga Current. .
Swbpte Ca acr ..-Po ulation_ Poultry Ca ci Po ulation Cattle Ca Po tiori: .
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish Q Q ❑Non-Layer ❑Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Desi Ca
Gilts pa�lt3'
Boars Tota1.SSLW
Nptipber of Lagoons ❑Subsurface Drains Present 110 Lavan Area 10 Spray Field Area
Hoitdmg Ponds/Solid Traps ❑No Liquid Waste Managerneni 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 KNo
h. If discharge is observed.did it reach Water of the State?(If yes, notify DWQ) ❑Yes M No
c. II'discharge is observed. what is the estimated flow in gal/min? i 1 !"
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑Yes W No
2. Is there evidence of past discharge from any part of the operation? ❑Yes O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes CffNo
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes No
Structure I J Structure 2 Structure 3 Str ure 4 Structure 5 Structure 6
Identifier. Brown D�U .�LagOQ>n �a7i0v"saier �'�d ................................... ............................................. .... .......... ............ ...................... .
Frechoard(inches): 3(0 43 3 3 I
5100 Continued on back

Facility Number: Date of Inspection I Ui'Z• 013 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(iel trees,severe erosion, El 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? [I Yes ❑No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes 9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes ]KNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
H. Is there evidence of over application? ❑Excessive Ponding $[PAN f3Hydrau11lic Overload Yes [-]No
12. Crop type 4�?eer-wdct G+-.Zet Small Gra;n1 �r� t �n1�CRTa erns
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? EJ Yes ❑No
15. Does the receiving crop need improvement? ❑Yes $No
16. Is there a lack of adequate waste application equipment? ❑Yes Ej No
Required Records& Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ]9.No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes No
i9. Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis& soil sample reports) lKYes ❑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 J"nj No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problerns, over application) ❑Yes ;�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes iX No
24. Does facility require a follow-up visit by same agency? ❑Yes J�j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes KNo
�ici yiolatiotis©r delici ndic s were itgted-dit-ritid Ais:visit:-Yop:will-teceive;io fuether ;
comes oridenke'abou7: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):
/V o ve,-a �i roc I?
o t•, r r e o n 2000 I?e,-"1 tdC-t 61.7d
L,�d��tv�1fL aY1erl+1'0-C'(;'I 2 9� 3to 3rt1/Inu`'re oh 91Z%o even t,
W. F�c,' J t' � rena(cd for t�,e��b(L acres �e�crr��n�-}ion .
15'. ter-,eV bL��GLdIQo,�s -Grp 7i f (,Gr�"►Vc��►�:eld5 ��+G� qp�'�J 1i+".� Gtc[ordi.�A
J'E�dt^Lm�Y1G�GOYrs,, 1
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: IL A102 5100

Facility Number: YI Date of Inspection Z CG Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AYor 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 JO'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes A No
roads,building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes 9No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e.broken fan belts,missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes No
31_ Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover? ❑Yes ❑No
Additional Comments and/orDrawings: -
I `1.. Oe sur o J'r4 seal sG,��P]es .rar g11 ;�'�df i� �lcevi ano(
be sv>'2 o des;,?nG4e �ra�ver c sot 1 sa•-itp c
3io Sure 4o V se F rop Q Y Lv at.S-te
5100

©Division of Soil and Water Conservarzon Operation-Review = "'
,
C
.Division of Soil and:V4'ater Conservation Compliance Inspection
Division of Water Quality Compliance Inspection _
Other Agency-Operation Review. -
C
Routine Q Complaint O_Follow-up of DWQ inspection Q Follow-tip of DSWC review Q Other
Facility Number f Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified [] Conditionally Certified ©Registered 0 Not O erational Date Last Operated:
FarmName: .....13X[LVII..........jr41.`!101.................................................................... County. ......... ............................ .......................
Owner Name: ..................... Phone No:
FacilityContact: ................................................. ...Title: ............... .. Phone No: ...................................................
Mailing Address: ...................... .....................
Onsite Representative: Aike.jriN57f . ........ . �. ..L�.f (4 /� Into rator
g fF.....................
Certified Operator:................................................... .......................................................... Operator Certification Number: 1'ra4�(.../1 _l..144
Location of Farm: � 5
J
..........................................................................................................................................................................................................................................
......... .
Latitude •�° Longitude • 0` `=
' Design Current Design Current'r- "= Design Current,
_ Poult - Cattle Swine =- Ca acity Population y Ca acity Po ulahon Capacity Population-:
❑Wean to Feeder e ❑Layer ❑Dairy
Feeder to Finish 17 d ❑Non-Layer JE1Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other _
❑Farrow to Finish Total Design Capacity F AP z6165
❑Gilts,
❑Boars
�Number:of:Lagoons,: Z ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
HoltLngPonds/Solid Traps ❑No Liquid Waste Management System
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑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 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�
Freeboard (inches): 3 ................ .................................... ................................... ............•...................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees, severe erosion, []Yes 9 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection .
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ( Yes �N
cF
{If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes W No
8. Does any part of the waste management system other than waste structures require main ten arce/improvement? ❑Yes LKNo
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? El Yes [ No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Yes J$No
12. Crop type ,�� s
13. Do the receiving cr s differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes P'No
14. a)Does the facility lack adequate acreage for land application? ❑Yes I$No
b) Does the facility need a wettable acre determination? ❑Yes Q'No
c)This facility is pended for a wettable acre determination? ❑Yes pirNo
15. Does the receiving crop need improvement? ❑Yes KNo
16. Is there a lack of adequate waste application equipment? ❑Yes ;XNo
Required Records&Documents
H. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes ;KNo
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes M No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ;Q 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 review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes JgNo
violatigris'oi•-dk!fieiendpi •were O ed•04ting this.visit:-Y:ou will-reeeive t7o further•-.:.
comes orideizce:about_this:visit: . . . . . . . . . . . . . . .
Cain_ments�(refer to-question#) ExpWi any Y_ES answers and/or anq recoEnmendahnns of any other comments
Usc,drawtn of facility fo_better explain sttuattons {use addr6onal'pages as necessary)Y }
'7• [c r'���~ clew ker ereg?_*s
4VAAr PX,1-d / n.
XIlkjr / i7 M is �J�i f 4` 6-e r 1 elis4 bx� . 1�/!! G/DS�r� r�corR�S
-�j"l� ague Y fe5c�- � /� is G�a�' C1D.S�aes
a� !� &VWn Wd/ hi e/dz
Reviewer/Inspector Name - i d - -,
Reviewer/Inspector Signature Date: f! Q
3/23/99
r

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 NYes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes $(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes No
roads,building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes ANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes ;SNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes WO
itiona .,.ommedit an:_-or. roiWingsr_
3/23199

P Division of Soil and Water Conservation ❑Other Agency M M.
. _Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection - 0 O 24 hr.(hh-mm)
E3 Registered ©Certified [3 Applied for Permit U Permitted 113Notpperational Date Last Operated: ..
Farm Name: .... ..L�C`C ...................... County .'- \\, .. ........
Owner Name:..... r ... !' Phone No. S�' \79 A..................................
v
Facility Contact: ........ ." Title: .. Phone No:
Mailing Address: ...}..C�.. G?�.. ..........'. �? .. ... ... �C vo..............................................
Onsite Representative:....- ��� Integrator:..... .....................................................
Certified Operator;.................................................. ............................................................ Operator Certification Number,.............................
Location of Farm:
.09
.... ............................... ...........1..... ........... .............................................
.............
............. . ---...... ..............----.....
Latitude �•0°�'� Longitude �• �� �"
Design Gurrent Design Current w Design Current
$wore „ Capaetty'Population Poultry .Capacity Population. Gaftle _ "Capacity Popy tton
❑Wean to Feeder Layer ❑Dairy
Feeder to Finish JJEI
Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑ Other
Farrow to Feeder `
P
❑Farrow to Finish '
Total Design Cap0 Gilts
acity
❑BoarsA '.Total SSLW x
NumBet•of LagQpns I Holdrng PondsV ,❑Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes t No
2. Is any discharge observed from any part of the operation? ❑Yes MNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes KNo
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑Yes JgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes OR,*No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes 1ANo
maintenance/improvement?
6. 1s facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes (9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes r.No
7/25/97

FacMty Number:,3
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑No
Structures(LaQoonsAolding Ponds,Flush Pits,etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes ❑No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
�................ ...... ........ ............
.,0.....&....... ...................3............
...
.[........0 .q.----- .............3...?......... ........
Freeboard(ft): ..............r�' ......... ...........�------................. .............. I..................:i ....... ..........a.2........... ...................................
10. Is seepage observed from any of the structures? ❑Yes (N No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ` Yes ❑No
12. Do any of the structures need maintenancelimprovement? OYes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes %No
Waste Application.
14. Is there physical evidence of over application? ❑Yes I%No
(If in excess of WNW,or runoff entering waters of the State,notify DWQ)
15. Crop" ..��...'. `..1..............5�...........L'�.4 L - ........................-----------.---.--.....------......---------•--..-----................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes M No
17, Does the facility have a lack of adequate acreage for land application? OrYes O(No
18. Does the receiving crop need improvement? KYes ❑No
19. Is there a lack of available waste application equipment? ❑Yes O No
20. Does facility require a follow-up visit by same agency? ❑Yes b�No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes No
22. Does record keeping need improvement? Yes ❑No
For Certified or Permitted Facilities Onl
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 KNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes IkNo
13-No.violations•o ' deficiencies.we're-nated-dtiritig this,visit.•.Y..ou:will receive 'no, further,
cti&OPOudehO A oid this:visit: : .'. : : . : . . . . : : . : . . : ; : : : : ; : : : . . .
COrtS r@fEI t0; 11E5tlonF. 1�1n`:an k da 2 d x "
answers}and/or�any reeommendattons or any-other comtnents.�`� �
[ls�dcaw�rtgs o#'Witty wtbetter explain.sttuations,(use additional,pages as necesssr'y) ��� � � �
�Al iz_� V\" -�M
g alb, �,�� +�ee�. �, . ����.d �►-��� -� sE���s ass�ble.
L
�L A43
k tt�'Ic� �Fsr` tc,CSC . M1cG� +- i3 �is '�SSv o+v►�s
Gam•_e� �k� 7/25/97
sm �,,, axi�r. ,fir*, r'r , x �s� ' f'E ems'
Reviewer/Inspector Name fl ., I � „xk z > p
ReviewerAnspector Signature: 1 bD"
ater �0

[]DSWC Animal Pera iow
Reviews
�,� � _ ®DWQ��An><mal Feedlot Operatlon S1te�Inspect><on �� � Y,�r� Y `�
Q Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 'I
Time of Inspection 24 hr.(hh:mm)
Total Time (in fraction of hours
Farm Status: .Registered ❑Applied for Permit (ex:1.25 for 1 hr 15 min))Spent on Review
❑Certified ❑Permitted I or Inspection includes travel andprocessing)
❑Not Operational Date Last Operated
Farm Name: .. rakI mi- ,� .... _ —.... _ _._. r... ... ... County:
Land Owner k�'ame: .Q ?1t�3.-L�.... .�.7. .�. s<� ............... Phone No:
Facility Conctact: ...- s S_r. .... �.S_.... . .... . _ Title: _._- Phone No:
MailingAddress:_...... _ ..... ................__.............._........._...................._................. ..............._................ ....._....._......._.....__.....__.... ....... .....__......
Onsite Representative: ..T—t--.�—r.�:^ 1 Integrator: �. sr.-g.. . ...._....._........ .... _.
Certified Operator. .....�l.�n,�a . ...L:..._..... .�^^� ......__..... ..... .. Operator Certification Number:
Location of Farm:
O _._k,ar... _ #.... s.i.d..z ... --..� ..i..Gl ��.......a. ... :-a. ..rx....!� _.�_ ... __.w►�..tt__�...........
__..... ..4
Latitude 0.0`0" Longitude �•�� ���
Type of Operation and Design Capacity
r 4,
a Design Current Design Current n � Design Current
Sw�iie 4 C aci ,.po ulatian� Poultry Ca aci � Po` ulahon battle g
.<„ Ca aci P.o ulahon
n ❑Wean to Feeder ❑ er ❑D k`
Feeder to Finish 5 d ❑Non-Layer �T❑Non Da
Farrow to Wean `
Farrow to Feeder I Total Desh!W0 unviq'�
Farrow to Finish
�.
❑Other Ta a SLW x
r'NumberafLagoons`I Holding fonds M ❑Subsurface Drains Present
` x F ,! ❑Lagoon Area ❑Spray Field Area
Q x ,
General
I. Are there any buffers that need maintenance/improvement? ❑Yes No
2. Is any discharge observed from any part of the operation? ❑Yes R No
Discharge originated at: ❑Lagoon ❑Spray field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes E�No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes R No
c. If discharge is observed,what is the estimated flow in gal/min? ra
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 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes No
S. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes 7 No
maintenance/improvement?
4/30/97 Continued on back

Facility Number ... .�.., _—..,?..�..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes 0 No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes KNo
8. Are there lagoons or storage ponds on site which need to be properly closed? 9-Yes ❑No
Structures ,a oon an Holding. Ponds
9, Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes E.No.
Freeboard(ft). Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑Yes allo
11. Is erosion,or any other threats to the integrity of any of the structures observed? ($Yes ❑No
12. Do any of the structures need maintenance/improvement? ®Yes ❑No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes [RNo
Waste Appligation
14. Is there physical evidence of over application? ❑Yes R.No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type ..... ..... _....... ........ .... _.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes RNo
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ONo
18. Does the receiving crop need improvement? &Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes ®No
20. Does facility require a follow-up visit by same agency? ❑Yes KNo
21, Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes Eallo
FQr Certified Fgciljtie5
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes 0 No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes J@ No
24. Does record keeping need improvement? iaYes ❑No
Comments{refer to oestion�# in)-':Expla any YES answers and/or any recommendations or any other 65mments'
Use drawings of facility to better✓explam situations (use adilrttonaI pages as necessary) '' - . µ ,*A
ts. ,
t'3 o o►% i i ce m Lift L iV o a �► ii 1 S l^.v Ld I�.e C_(,c LXd $v t o r 4?
a� P^'�r ri �
=a�
�. C?t-� t.a.+rr�.�✓►{ SQ� C i s r S �^a ���^ � f V
Reviewer/Inspector Name m wIMPRINT-
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
�. Time:
Farm Name/Owner: Y �_ ?�� ��q
Mailing Address: �D�P �21*4-bG 1'j W S9("j
County: 0V 0 )1 n
Integrator. AA urt')hPhone:
On Site Representative: / G le- Phone: r0— ZN�5-4(P70
Physical Address/Location: kja i 0 U S ' 'N m► on S R /70
I n trz Z� �' �-► p t
Type of Operation: Swine Poultry Cattle Cn,
Design Capacity: S(0 0 Number of Animals on Site:
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: ~ " Elevation: Feet
Circle Yes or No (�1�f�
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +25 year 24 hour storm event
(approximately 1 Foot+7 inches) Ye or No Actual Freeboard; Ft. Inches
Was any seepage observed from the lagoon(s)? Yes of To Was any erosion observed? Yes or No
Is adequate land available for spray? es r No Is the cover crop adequate? es or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orb
Is animal waste discharged into waters of the state by man-made ditph, flushing system, or other
similar man-made devices? Yes o No If Yes,Please Explain. `
.'
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?( "'r No
Additional Comments: _-- 2- sf2. � C�C�i� Sf z /2
L ►'s �-
• Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.