310105_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

O Division of Water Resources
Facility Number - rjf O Division of Soil and Water Conservation
O Other Agency
Type of Visit: acomp ' e Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 011outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ( Arrival Time: Departure Time: l{4a County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Integrator:
Phone:
Certification Number: % 71` 7 04 9--14-2 6
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
j 2D
5-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Non-]_;
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharp,es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EfNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: jDate of Inspection: H777 /
Waste Collection & Treatment
f4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-lqo'�❑ 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: IV 6,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E2rNo ❑ 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 7 rNo❑ 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 ET—
'�Nc'NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 21 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 P40 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes l4�"o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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
[2'lgo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E? —oo
❑ 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
❑.#m
[3 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C]-Ncr— ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 31 - 19 S' IDate of Inspection: 1( /7 Itif
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes !_I 1 " ❑ NA ❑ NE
'k
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []'T_o ^ ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑'No' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ i�A _❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ENo ❑ 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 F71-No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes L_d"No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�N^o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
D"1 0�❑ NA
❑ NE
Comments (refer -to duestion #): Explain any-YES>answers�andlor�ati y additionaLrecommendations'or,any other coi invents"
Use drawings offacilEty to better explam situation (use additiona I pages as`aecessary).
F_( y (,emu 5 o c,c �_ e c "4 S e
n-.-P (_- 1, ft-c- r.__V (KS zz S r-e-Cde �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Ctrl'�%�Q —C
Phone: T14 7 W 'may
Date: 1f 11r 7 /6
21412015

_ s ("ivision of Water Resources f
~ Facility Number I� - 10 O Division of Soil and Water Conservation J
O Other Agency
Type of Visit: Compli ce Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: pna County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Latitude:
Phone:
Integrator:
Certification Number: 1 $ O01(
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
We -to Feeder
eeder to Finish
4 20
7 !�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry CapaCity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo
N- ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: [Date of Inspection: t 9 y1/ r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fo ❑ 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): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E f r o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ' No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes [T No [:DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Fj"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 0"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
r] 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 C3 N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 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 0No
❑ 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 es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6"N - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

R
Facility �umber: - 0 Date of Inspection: IL i
24. Did the facility fail to calibrate' waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA �] NE
RN o ❑ NA ❑ NE
❑ Yes ❑,No ❑ NSA ❑ NE
❑ Yes ❑ No ❑'NA ❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
Q "" ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes��N�NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
Comments (refer to question #} ;®Explain any.=YES answersand/or-any, additional recommendations or any other'comments.
Used rawings of facility to better explain situatioos:(i se additional page's as pecessary).
CCU
Reviewer/Inspector Name: (, iV I U"'&( I ^^�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [ l 7 It 73
Date: to 11
21412015

Division of Water Quality
Facility Number , - O Division of Soil and Water Conservation
O Other Agency
type of visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Beason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: {TI'% Region:
Farm Name: nd Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other ..
Other
La erI I -::]
Non -La er
on -
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is thereeevidence of a past discharge from any part of the operation?
3. Were th' re any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle.
Design Current
Capacity. To
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ,D?No [] NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes JVo ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
[:]Yes ONo [DNA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
allo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
6 No
❑ NA ❑ NE
Structure I 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
Z 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
6 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 P� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes YJ 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 dFTNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6 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 A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,3 No ' ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 6 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes f2'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Cq'lqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ S Judge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes PNo
25. Is the €acility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o No
'Ithe 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question,#):,Explain any.YES answers and/or any,,additional recommet
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes E]-No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
ons,or any.othercomments.�
Use drawings of facility to better explain situations (use additional pages as necessary): 3
12-1211,3
61 70
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J
1516(� v LctS"
Phone: 7
Date: z2h 4,&
2/4/2014

it '.
Division of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
type of visit: Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
2eason for Visit: outine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: 1 ! 3� Arrival Time: _ (n =�� Departure Time: County: Region: w
Farm Name: ` i7a��'"']]``'' t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: V jf4u-� A ` B =1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry " Capacity Pop.
Layer
Design Current
Dry Poultry Capacity Pon.
La ers
Non -Layers
Pullets
Turkeys
Poults
,,Turkey
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Y3 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes JfNo ❑ NA ❑ NE .
❑ Yes Fe No ❑ NA ❑ NE
Page I of 3 21412011 Continued

■
Facility Number: 6 1 i (F� Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;�rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: L,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,n 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 J�!f`No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes P No ❑ NA
❑ NE
(not•applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �2 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )?TNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes P?rNo ❑ 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 ;2!rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes Z[ No ❑ NA ❑ NE
Reuired_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �rNo ❑ 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 o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste ransfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z:fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 N'
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

is
(Facility Number: 3>1_I (Date of Inspection: 11 / /)1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F Jtno ❑ 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 ,�TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Vf No 0 NA ❑ NE
❑ Yes fi!rNti ❑ NA ❑ NE
❑ Yes �ffNo ❑ NA ❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinzs of facility to better exnlain situations (use additional Dazes as necessarv).
Reviewer/Inspector Name: %A�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p[
Date:
21412011

r Division of Water Quality
FatilityNumber 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q o`er Arrival Time: )Q Departure Time: / County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: J4'- Roxr-)
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: '-
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Longitude:
Design - Current Design. Current Design.. Current,., -
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop:
Layer
Non -La er
Design, Current
Dry Poultry, Ca aci ° Pop.,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA 0 NE
of the State other than from a discharge?
i
Page 1 of 3 21412011 Continued

Facility Number: - ZU Date of Inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�ANo
❑ 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): )9, 5
Observed Freeboard (in): -33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? J�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 [3 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. crop Type(s): C QQ
13. Soil Type(s): F A
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 Wo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑i WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes Z
No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
YesANo
No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �4 No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑,Vaste Transfers
© Rainfall ❑ Stocking ❑+ Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
"M No
❑ NA
❑ NE
❑ Yes
7❑� No
'] NA
❑ NE
❑ Yes j No
❑ Yes , No
❑ Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
0 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? 0 Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain ;any YES answers and/or any additional p recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
4- a) gsc�.CJ�� S�•2uE�
r" 0uM.a-7)C JN taur 90)a
UJ)oy�`3,1�
)ajo)/j D.Va
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: )](> --47 6-"3or'+'
Date: o� %
21412011

%Division of Water Quality
Facility tN, umber 1 - JCS O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: OLRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: `.. i-- — Arrival Time:
Departure Time: County: �C� N Region:
Farm Name: �( A-Delq 1e OJV Q C`1gQ 1y✓ Owner Email: T
Owner Name: �jQ ()��/ H . &N � Phone: q IC) - QFS-4GE S
Mailing Address: �ol (A__Nq5/4 OUi L )V Ck_]AC _C-40E , /V C 9F / (Db
Physical Address:
Facility Contact:
Title:
Onsite Representative: _�) eq_"�-\ \ �N p
Certified Operator: V PA) Cam 14 , tr /V Q
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
'qG 1 1
Certification Number:
Certification Number:
Longitude:
I `_+ 1-46
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy
H
Pullets
Poults
Other
Turkeys
[]Yes
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Cow
❑ Yes 'No[:) NA ❑ NE
[:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/20II Continued

Facility Number: j - d 5 Date of Inspection: U l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tNo
o ❑NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LKOCY
Spillway?:
Designed Freeboard (in): 8.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 0,No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 7 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) Pq
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes] No
❑ NA
❑ NE
maintenance or improvement?
i (1
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc..))
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): C0QW QeGz- Sl_-�
13. Soil Type(s):
W Q A (-�a A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes V(
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 21 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 6No ❑ 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 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes Po ❑ NA ❑ NE
E] Waste Application 0 Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ 1�ste Transfers 0 Weather Code
Q Rainfall [:]Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and I" Rainfall Inspections 0 Sludge Survey
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 I
No ❑ NA [] NE
Page 2 of 3 21412011 Continued

L
[Facility Number: - jQ Date of Inspection: it 3v ll
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9
No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
1A NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.other comments
Use drawings of facilityto better explain situations (use additional pages as necessary).1.1­1
1­1;;_''�"`
w'A•
IM 01 ] .
910, ] .
�U �3GZ,A Ti 4►� bU�� Da 1 0�
S LLkDG
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
riall"A f k! "WW I A& 2
r
ti
Phone: /�1 1 (_7_� `�-7
Date: I _ 1-3011
21412011

Divislon-of Water Quality - -,
Facility. Number f US Q Division of Soiland Water Conservation
0 Other Agency, -�
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: L I N Region:
Farm Name: lVA N ��� CrA�m Owner Email:
Y Owner Name: Az�c,,,l _ _ i�a�/� Phone: 9jd'0R5`L4911
Mailing Address: _ 1 Sla LA_->AS;4 U�(2)LL ACE / 2, 0 EC-66
Physical Address:
Facility Contact: Title:
Onsite Representative: 1✓`Y PA
Certified Operator: Ox o
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
o-d 1 o
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ { Longitude: ❑ ° = 1
.mow � �a w
Design Current" Design Current ; N uDesrgn�Current
Swine Capacity, Population Wet Poultry Capacity ,Population t Cattle;Capacity P pulahon
❑ Wean to Finish
[:]Wean to Feeder
Feeder to Finish /
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
'Dry Poultry
Nan-L
Pullets
Other ❑ Turkey Pou Its
❑ Other ❑ Other
J77777777
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder .
Beef Brood C
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
-0 No
❑ NA
❑ NE
❑ Yes *o ❑ NA ❑ NE
12128104 Continued

facility Number:3 1 - i?5 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6(t4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ✓✓✓✓✓91 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L4Goon!
Spillway?:
Designed Freeboard (in): �.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes $No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JRNo ❑ 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 g,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes KNo ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes A 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 ❑ Evidence of Wind ❑ Application Outside
12.
+Wiin�dow
_o�f.,Arrea
{Driri�ft
Crop type(s) COQ.jCa! C-) S _ '{ G�l.(ZL I + IILLETT(P� � egy_Q)�_
13.
Soil type(s) �_(]Il11 j(yci f2S ►� _- —
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
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
FNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
o No ❑ NA
❑ NE
Comments (refer to question ft Explain any,YES answers.andlor any -recommendations..or'any other eotriments
Use drawrings,of facility to better explain situations. (use additional pages as necessary) s ,
Reviewer/Inspector Name I 614AMD4S " I Phone: y /Q - � 76
Reviewer/Inspector Signature: Date: !Q ro
Page 2 of 3 12128104 Continued

Facility Number: 3 J — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists Design [] Maps ❑Other
21. Does,record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 14No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ /aste Transfers ❑ f/nual Certification
0 Rainfall ❑ Stocking ❑ /op Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
XNo
El NA
El NE
❑ Yes
I No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[(No
❑ NA
❑ NE
Additional Comments and/or Drawln s
9 a
y133110 I
VO-C,
IC*1 �# D-
�
Page 3 of 3 12128104

�Division of Water QualEty
Facility Number `3 Dtvtsion of Sotl and Water Conservation
Other'Agency_
Type of Visit 4Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit MLRoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `3 69 Arrival Time: QoC Departure Time: County: A' Region:
Farm Name: V � %V BOND f�_� Owner Email:
Owner Name: �Ayy� ''1�.. •`` �QN Q r \ Phone: 1� roil 1�LD� 1O—Sj ,, _
Mailing Address: I5 OL W�SH �l � IJVAL-LPCE � A/C (QO "t (V Lc
Physical Address:
Facility Contact: ����77 Title:
Onsite Representative: ezeM
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: l TO
Back-up Certification Number:
Latitude: [ o [ = Longitude: [� o [= d
Design: Current ^Design Current - Design'Current�`�
<. _p... . .. . obuhAk o {
Swine Capacity. Population WetPoultry,fonlahon Cattle CapactyPopularion
❑ Wean to Finish
❑ Wean to Feeder
ZI Feeder to Finish
1 'V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
J'
Other -
❑ Other
❑ Layer ❑ Dairy Cow
❑ Non -La er " ❑ Dairy Calf
`' RDariHeifer
Dry Poultry Cow
tJ Layers
❑ Non-L
❑ Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Beef Stocker
Beef Feeder
Beef Brood C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
%No
❑ NA
❑ NE
❑ Yes X No ❑ NA ❑ NE
12128104 Continued

Facility Number:j OS Date of Inspection PAM
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A 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: S_A-GooN _
Spillway?:
Designed Freeboard (in): 1 q . S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 9 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 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 [ (No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ElNE
(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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 1*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 ❑ Evidence ofWindDrift ❑ Application Outside of Area
12.
+Window
Crop type(s) Coa'$'
13.
Soil type(s) _T—D
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[(No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No
❑ 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
X No
❑ NA
❑ NE
comments
Comments (refer to question=#): Explain aiyYES answers and/or any r commendatins or any otherZZQ
Use drawings of facility to better explain situations. (use additional pages. as;.necessary)
AL
00
�[ 1 voq
Reviewer/Inspector Name
�= Phone: 1tfJ`TWO 30
Reviewer/Inspector Signature:
Date:
12128104 Continued

.w
Facility Number: 3 — Q Date of Inspection �oG
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ElNA ❑ NE
0 Design ❑Maps ❑Otherthe appropriate box. 0 WUp ❑ Checklists 0,No
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0' Soil Analysis ❑ haste Transfers ❑/nnual Certification
El Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections E] Monthly and 1" Rain Inspections O Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
*o
❑ 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 *. ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 0 NA ❑ NE
Other Issues
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
CA 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
Jo" No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
12128104

Division of Water Quality
Facility NumberDivision of Soil and Water Conservation M-1 M-0
Q Other Agency
Type of Visit XCompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit %Routine Q Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: j /0/93 Arrival Time: Departure Time: County: w N Region:
Farm Name: Owner Email:
Owner Name: V 14�+r/u t . Z.-3%V Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: '� e Luy) (_k
Certified Operator: VAL�EN H • �a��
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
L
gC3d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone No:
Integrator:
Operator Certification Number: f� +-4 C)
Back-up Certification Number:
Latitude: =]' Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
QjLayer I
�I
� on-
❑ Non -Layer er �
Other
❑ Other - - - — —
Dry Poultry
Non-L,
Pullets
U Turkey Poults
❑ Other
Discharges & Stream Imgacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 j has Date of Inspection �O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
A No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: CS Oo)v
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[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 NNo ❑ 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 .0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes OkNo ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy 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 XNo
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C ET CaOpL.S oP L%CC - cN bES j C n1 �- qLA L I Cj S
(_ eA-SE (49LCUJVZ�� (._ AC- cC-1)'"
Reviewer/Inspector Name QA- L . [ l Phone: ` f/0 r T'Aa--4 01-4
Reviewer/Inspector Signature: _LiDate:
Page 2 of 3 12128104 Continued

.t
Facility Number: 1 — /C>Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? - ❑ Yes j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'V 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
4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ 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
r-71 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
121,rNo
❑ 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
1�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
4No
❑ 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
EkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
t&ljo
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

Facility Number 3 1p 5
IV Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit KJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: A V Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
01
Onsite Representative: SCQ._A-_ P.A__f (3,00 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
_❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Latitude: FJ 0
Phone No:
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = ° ❑ ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I 10 La er
❑ Non -La er3
Other
❑ Other — - --- -- — -
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
!
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑Yes
El No
❑NA
❑NE
El Yes
❑No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
ElNA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
12128104 Continued

FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: M ('&�
Spillway?:
rI
Designed Freeboard (in):
Observed Freeboard (in): 3 '2-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes En"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? El Yes LI 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 El Yes L7o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El 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 Bate Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S C O C.103
13. Soil type(s) ['OIZE 3To/J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Flo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
2-*'No ❑ NA ❑ NE
L—,✓1N/o ❑NA [3 NE
2<o ❑ 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) tAC oa;J Ot*SsGjU &A66 bS vPl1RrG-0 . Pis ,vT 6A.4- 4:6R- Izoa AJat%! -/ko .
Jgr6XA1 A A10 rCAI-0 Te Orw &
08 rfi_Uj S 70kc rdV Cam- Cory FA-'r Pk^- Z 0 Ttr61ZATJ A-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Paee 2 of 3
Phone: L91a 79b - 7.3 KY
Date: iu /2 _C— Li (.
12128104" Continued

Date of Inspection �a o
Facility Number: ( — /Qi
OL
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Y
No
El NA
❑ NE
20.
Does the facility fail to have all components of the CA P readily available? If yes, check
Yes
❑ No
❑ NA
El NE
the appropriate box.
ElWUP El Checklists Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
6 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
LJ N
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El❑
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes;7No'
❑NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2<
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes�3�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 CA WMP? ❑ Yes 05o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ko ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
LJ N El NA
MI
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

�� ._ _, Division orWater.Qua[ity
Fak�l�ty Number 3 I Z C?S" Division of Soil and Water Conservation '
`Q Other Agency
Type of Visit (rcZutineliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I 3o Departure Time: Count': DUPL2 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5&—L—c- t 1 ]a tJ P
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [= , [= Longitude: 0 ° ❑ 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1 413a-0
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
ElLa er
❑ Non -La et
Dry Poultry
Nan-L;
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection Id -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6oLr )
Spillway?:
Designed Freeboard (in): ?
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [I Yes
,,��,d//
LNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
eNo ❑ 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 environ
tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
ElNA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
,❑�No
u 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
dNNo ❑ 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
Li -No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) f36%*,,%U D R jf S G O
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo ❑ 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
I.4 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
r001
I NA
❑ NE
�tr� 13 n-OSR o Q3�u< a OEkcs. �.., at_.� s, .
aa,) CLAVL-C.FK WA`t' �F iZAW CRAP .W wtaP. VPOAiE L-AGOO N
a t {ZEE P Lo i' �' o ANN��C CL-Tt�-17 S CAT La� !�N 1� S�GtLT��, wzTR ►1.0 CO(R-03,
ReviewerJuspector Name roHl j aQ_,) E-- Phone: ^0)
Reviewer/Inspector Signature: 9A= Date: e
I2128104 Continued

acility Number: j — (pS Date of Inspection to a4
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 haWwlucrri
oponents of the CA readily available? if yes, check Yes ❑ No ❑ NA El NE
the appropirate box. p El Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. es ❑ No ❑ NA ❑ NE
❑ Waste Ap7stocking
ion ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ 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 13 o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes E-d'1vo ❑ NA ❑ NE
❑ Yes `) o ElNA ElNE
ElYes Ei o ❑ NA ❑ NE
❑ Yes ld"No ❑ NA ❑ NE
❑ Yes ;No ❑ NA ❑ NE
❑ Yes
? O
❑ NA
❑ NE
❑ Yes
,L
Li lo
❑ NA
❑ NE
❑ Yes
-}J No
❑ NA
❑ NE
❑ Yes
LJ"No
❑ NA
❑ NE
❑ Yes
2<
❑ NA
❑ NE
❑ Yes
I o
❑ NA
❑ NE
AddihdnalkConiments`aadJor`Drawin s :
g
2 a r
£ 1 f , i`�
12128104

Type of Visit T Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O hollow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: �1 r� WdUTime:
Not erational O Below Threshold .
Permitted Certiined JO Conditionally Certified r] Registered Date Last _.
OP or A ve Threshold:
--7 C� /h
Farm Name: _1Ct. -Ply %?�% .. County: ._ ._» ..._ .. _.
Owner Name: _ _ _ _ _ _ _ _ _ ,. _ . , _. 'Phone No:
Mading Address;
Facility Contact: _ . _._ . ._.. __ tie:.____ __ _ _ ._ .. Phone No:
Onsite Representative: ,,,;,r,Z,���• _,.,,,,,.,.,._- ---_-- - -• Integrator. S /''
Certified Operator.
Location of Farm:
Operator Certification Number:
Os —wine QPoultry ❑ Cattle ❑ Horse Latitude • fi Longitude • 9'
Desk �£nrre t � xDe: giii 'Current :s vl
gn Current
S�vi:iePo bon >P, Catttlit:po
-Po
an:., a
txan ,
Wean to Feeder ;' ❑ Layer
Dairy
Feeder to Finish c1a 0 Non -Layer I-
Non -Dairy
Farrow to Wean :.
r
Farrow to Feeder
Farrow to Finish Tottat
Gilts
Boars
Total'SSLWu'.'
TP
Discharges $ Stream
1. Is any discharge observed from any part of the operation? ❑ Yes o
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 b 1vo
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:
Freeboard (inches):
12 I2103 Continued

[FacilityNumber-
3z= Date of Inspection G
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑Yes LAN
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 maintenancefunprovement? Yes 0
0NNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 7No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level❑ YCs
elevation markings?
Waste Application
10. Are there any buffers that need maintenanmrimprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Prozen 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 O3No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes L'I No
b) Does the facility need a wettable acre determination? ❑ Yes do
c) This facility is pended for a wettable acre determination? ❑ Yes 121�0
15. Does the receiving crop need improvement? ❑ Yes Of4o
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 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 �o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 °
Air Quality representative immediately.
_� � ta��= f ..-_-�.:,Alty'El�E%tS�...
�_ ���'�{����._ �
�t{r
♦�,� ���y►� I_l p�
❑Final
r �.
tJ EW l.0 U N LE^ N 1 � fZJ d5T-
WEP coe 'r' A►J bJ V AL- C t%:5 l v (LA mtJFN LL..
3s��PT� L(L,Q
a3) "Pa`CA
EGO
ReviewerAluVector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: O j
Date of Inspection 7
li uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appro te box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis Ef Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (if no, skip questions 31-35)
31_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for ES required forms need imprq�ement? if yes, check the appropriate box below.
❑ Stocking Form Crop Yiel Form ❑ Rainfall ['1] Inspection After V Rain
❑ 120 Minute Inspections Annual Certification Form
❑ Yes [�No
❑ Y s No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes NV
❑ Yes 1ff,_,, ,Noo
Yes r1o
Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
0 Yeses
z
r
❑ No
12112103

I r r
Type of Visit /11 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ._J Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: s Time: 1C_t_
d Not Operational O Below Threshold
E3Permitted 4 Ce "cried [3 JConddiittiona�ljv Certified [3Registered Date Last Operated Above Threshold:
Farm Name: ......... County:...._! ............. ... ..- ............... ...
Owner Name:D r"� Phone No:- .................................. ......
,....__r ..M............ ......................
Mailing Address:
Facility Contact: ................................... ............... ............... ....... Title: ......................... ..................
Phone No:..............................................N' / ----- -Onsite Representativeh&..�rnIntebrator:
h>.D..........................................
Certified Operator : ......................... ......... ............... ............ Operator Certification Number:
Location of Farm:
[swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 " ` u L°naitude 0
Wean to Feeder
[] Layer
Feeder to Finish
❑ Non -Layer
❑ Farrow to Wean
<` ❑ Other
REM.............:.
❑ Farrow to Feeder
❑ Farrow to Finis
Boars
Discharges & Stream II PaCtS
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from. a discharge?
Waste Collection &_Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
/No
No
0 Yes
❑ Yes INo
Structure 6
Identifier:..............•......--•--•................................•-•--•..................._............................_................__.. ....................-._..... -..............................
Freeboard (inches): ...........0 ............. ..

Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Yes /No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? • If any of questions 4-6 was ai�wered yes, and the situation poses an
El Yes INo
immediate public hcA& or environmental threat, notify DWQ)
7. Do any of the struenn-es: need maintenancehimprovement?
Yes No
9- Does any part of the waste management system other than waste structures require maintenanceTunprovement?
1:1 Yes /ZINO
9- Do any stu - ctures lack adequate, gauged markers with required maximum and minimum liquid level'
m
elevation markings?.'
El Yes A"No
Waste. Anglication
10. Are there any buffers that need maintcnanc:61mipr6vcment?may0
Yes No
11. L- there evidence of over application? F] Excessive Pon PAN ❑ Hydraulic Overload
Yes No
12. Crop type
13. Do the receiving crops differ with those designated'in the CcRified Animal Waste Management Plan (qAW1.4P)?
Yes No
14. a) Doeg'the facility lack adequate acreage for land application?
Yes j No
b) Does the facility need a wettable acre determination?
F-1 Yes [I No
G) This facility is pended for a wettable acre determmation?
El Yes 0 No
I S. Does the receiving crop need improvement?
Yes D No
16. Is there a lark of adequate waste application equipment?
0 Yes El No
-Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
0 Yes 3dNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
"El
(ie/ WLJP, checklists, -design, maps, etc.)
Yes /No
19. Does record keeping need m4Tmmment? (iel irrigation, freeboard, waste analysis & sod sample reports)
El yes No
20. Is facility not in compliance with any applif-able setback criteria in effect at the time of design?
0 Yes No
21. Did the facility fail to'have a actively =tified operator -in charge? r
n Yes No
-22, Fail to notify regional DWQ of emergeticy-situations as required by General Permit?
(ie/ discharge, freeboard problems, over. application)
"EI-Yes No
.23- Did Reviewerfinspectorfail to discuss remewfuLspection with on -site representative?
1:1 -Yes No
'24. Does facility require a follow-up visit by same I agency?
Yes No
25. Were any additional problem noted winch cause noncompliance of the Certified AVINT?
.[J'Yes No
no.further.corres ondence about this visit.
10 No violations or.dd-wiencies-were-noted-during.tlijs visit. You wilIxeceive p

J .
Facility Number: 3 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes UNo
❑ Yes XNo
❑ Yes XNo
Cl Yes 10"No
❑ Yes X(2'No
Cl Yes ONO
❑ Yes ❑ No
Ailditiarial Coi®tnentsaeid/orl)rawirigs:iyc= v -;
5 11'}ALG Rl4z,�1 Qv�RS�� Qn17� eRmao6 ,6rEOS Qr-,gk
6c"""y
-Po 0 o-r L� ( C n1©(kC�)i
�QWc PIYt�I�.
r 60tQER � LC�oRr, �� E7 C F-s -r
L,kTH CoflPF6Tr�rvr �-r
��L (ems WEPo0T
LEFT lam �� a m ��►''� (�-�� F A
DR 6CCr D/Q40-65
r� r�
�s`cAN ��NDDrt}
K R —r i- 5a 15-0
70
TQ F T L lJ /-s �r� .0 E,e ._
05103101

Facility Number / D S Date of Visit: Time:
Q Not Operational Q Below Threshold
© Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..........:.........W.
Farm Name: ..............��...``.. va d e''?Q.. �,o,�'fl �... ��£ �' ... County: „7 V �i,�1.......................................
OwnerName: ............Y..a.'-?......f."." 1................................................................... Phone No: ............................ ........................................_..»... �.
FacilityContact: ............................................................................... Title: .................... I ............ I .............................. Phone No:.............................................. _
MailingAddress:................•-•---..................................---•--•-----...........................-•-------•...............................................................................
OnsiteRepresentative: CJ'"?- �r7'i� vgp�Ch �anA ..... Integrator: AMB'�
Certified Operator: .................. Operator Certification Number:,...........
Location of Farm:
wine [3 Poultry ❑ Cattle [3Horse Latitude • 6 66 Longitude • & «
Design, Current
Wean to Feeder
-Rfeeder
to Finish
2
-`
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Design Current
Poultr Ca aci Po elation . Cattle
❑ Layer ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total°Design Capacity
TotalsstW
'Number of.LMbons ❑ Subsurface Drains Present ❑Lagoon Area
Holding Ponds. / Solid Tt-ttps. ❑ No Liquid Waste Management System
Dischamees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
-Design_Cat
Spray Field Area
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:..................................................................................................................................
Freeboard (inches): ?-D
5100
❑ YesjdNo
❑ Yes'O"No
❑ Yes-
",,eNo
� rQ
❑ Yes ZfNo
❑ Yes �Vo
❑ Yes two
❑ Yes
,ZNo
Structure b
Continued on hack

)Facility Number: 3 h — r BS Date of Inspection Z4 D Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes/EfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
. closure plan? El Yes,'ETNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type rt,ft,,,.0rv4q ffA.l„ lv;dc, A1nVA
cry ,Soy be -an,
13. Do the receiving crops differ with thost designated in the Certified Animai Waste Management Pla� (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes _IZNo
❑ Yes P'No
❑ Yes )❑'NO
❑ Yes 'No
❑ Yes ONo
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ONO
❑ Yes PNo
❑ Yes E(No
❑ Yes ❑lqo
❑ Yes WO
❑ Yes ❑'No
❑ Yes rNo
❑ Yes-101f4o
❑ Yes�No
❑ Ye�o
0: o yiolaiioris:or d�fcienc�es Were notes diWiitg this'visit:- YoO Will-i'eceiye Rio
corres o6dence: about: this 'Ash-'-'.
,Comkents (refer to question #) . Explain any -YES answers and/or any recommendations or;.any^other Comments:_' _:4
Use drawins:of facility to betterexaiin pisituations. (use,additioial pages as niecessary)--
�.
IS L►/of /0 e1;"1Jnq'(1C n+' rvs dam bermvdr, Acle(, 9
jy- I die Gvt�a6(c �.Gre1 q►p�er✓rt,'��i,`o+'� �ds -�o �,e, redon@
Jo hew 9.r0Lr-r rv.r► fs,
Q✓era[l) +f e sae:01 vivid Yvcordf Otre We// ke(4,
Reviewer/Impector Name
Reviewer/inspector Signature:
Date:
5100

Facility Number: 31 — Q5 Date of Inspection Ol
•
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
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 -PV0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J2TNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
I -Additional, Comments an or rawings• _
LI
J
5100

DDrvrsion of Soil and .Water Conservation - Operation Review '>
O'Drvision-of Soil and: -Water Conservation-- Compliance Inspection
ivision off Water Quality'=.C6inplia' ce`Inspection
D.Other.Agency Operation Review-
lilRoutine O Com laint O Follow-u of DWQ ins ection O Follow-u of DSWC E•eview Q Other
Facility Number
Date of Inspection � 03—
� UT
Time of Inspection l3 : OO 24 hr. (hh:mm)
Permitted ©CIIert/rtified 0 ConditionaIly Certified © Registered 0 Not Operational Date Last Operated:
Farm Name: .........Y... lR, ..!n............. �!J... 7 oct „ _ County:...........1a(I.L�F�i..............................:.
....,n.... ��
OwnerName: ............... ...... Phone No:.......................................................................
Facility Contact: .......--. Title:......- Phone No: g� ..�$�
.. .....
MailingAddress: c...............................................................................................................................U..........................&­.;
3 ..................................................
..........................
Onsite Represent<ttivc:.... .... L 1d� 1........................................... IntE� rator ....r..l..................................................
Certified Operator: ................................................... ........................................... 11 ................ Operator Certification Number:..........................................
Location of Farm:
Latitude 0 4 •4 Longitude ' 6 "
Swine Capacity Population
❑ Wean to Feeder
91 Feeder to Finish
LyfZO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area JE1 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Dischantes & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)•?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts -to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure :3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ..........................
❑ Yes qNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ER' No
❑ Yes 'VNo
9—Yes ❑ No
Structure 6
1/6/99 Continued on back

Facility,Numbzr: — 1t>s Date of Inspection �p Q
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [%_No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9] No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes O-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [� No
Waste APRlication "
10. Are there any buffers that need maintenancelimprovement? ❑ Yes I%No .
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes PQ No
12. Crop type 2 -S
—4e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [,gNo
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 RNo
t6. Is there a tack of adequate waste application equipment? ❑ Yes 'JA No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑Yes
jkNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22• Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) wyes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Qfio
24. Does facility require a follow-up visit by same agency? ❑ Yes [2No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes O�qo
0: Rio viblaiioris ;or def ciericie5 vtfere pa ted dtWii)g this;visit: • Xoii will •ree&ive do fuirth�r • ;
: correspondence: about: this viisit * :: .
C©mments(refer to question #} iJxplain any YES a4swers and/or any. recommenda ons or any_ottiec,comments = "
zUse drawings of-facilityWbetter explain situations (use ii c"onal_pages as�necessary)=
1 xv ar 1 ",- tr&�t r� i •z +�' .,� l� ►ram a�,. w -v _ y tn1,.� - �� v -A
t g,� N,t cd� ca py p_� c kw{�1► s-E- i 1a�gt�a,� AA-s 6`3 - ou s ► (c �� spry r ig r 1
F""`T'� >ti { e.��--�-c�ioa tee( ��.v'p fS do s ��e- . �.bw-�e�1�- � � sir. Gf � c-•� a �O d r,, �
J
:tea � ., - g;.-: -•t
Reviewer/Inspector Name 9, �,� �;+/ �.d/ `�.�y)
Reviewer/Inspector Signature: Date: U3 OQ

i
Facility Number: 3 ! — /cDate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
kNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
JErNo
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
E'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
RNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
% Yes
❑ No
Additional -Comments. anor Drawings =�
nCtn ! WAS
'_/ � 1'S`�
� ��� !^a���✓)i -t I G[ml
ei' � 1a�
Al
R,14 - .e
bPam-( al"' r► V"
3/23/99

10 Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 4P Other
Facility Number 31 105 Date of Inspection 2/15/2000
Time of Inspection 16:10 24 hr. (hh:mm}
® Permitted M Certified O Conditionally Certified C] Registered [ Not O erational Date Last Operated:
:
Farm Name: Y.at14.n�.Blacrid.�'alCloa...................................................................................... County: Ruplin............................................... WI1i.0.........
OwnerName: Paden ..................................... Rond ............................................................ Phone No: 2.1D-28,5 4f1#5..........................................................
Facility Contact:
Title:
... Phone No:
Mailing Address: L Pllaah.Q&Lane......................................................•---..........------. }R'.a,ILace--N.......................................................... 28466.............
Onsite Representative-------------........--..................................................................................... Integrator: Gat1 11'.IaQQiL9.ilalC.................. ............................
Certified Operator. ..Y.adcm &.............................. Band.................
Location of Farm:
Operator Certification Number:.17.170 .............................
........................................................................................................................................................................................................................................................................E
F.ta Pin Ha�ktal�e Rk.1827.aat.tur2_�onnilea.aturn.Rt...Qn.Batrher.Bz�y.Rd..an�dgs�..0�.mile.nn.the-right......................................
............................................................................... ... .....................
Latitude 34 *r 44 00 u Longitude 77 • 45 15
❑ Wean to Feeder
® Feeder to Finish
4120
❑ Farrow to Wean
[I Farrow to Feeder-
0 Farrow to Finish
❑ Gilts
❑ Boars
Discharees & Stream ][impacts
1. Is any discharge observed from any part of the operation?
Discharge originated af: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............. ............................................................................................... ........ ................ ......
Freeboard (inches):................19..........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
0 Yes
❑ No
Structure 6
..............................
...............................
❑ Yes
❑ No
Continued on back

Facility Number: 31-105 Date of Inspection
_ P
z/1512000
�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
❑ No
12. Crop type
11 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
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W17P, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis &. soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
l�io ir%olatiions ar:t ficiericics vve�e:noteii:duiriikg this visit:: tau Ofriieiv- ito fiirNies•: :
• • •l`oI'i'@SiiO�a�CC' alN11iI •Ii1�$•ViSrli::' • - - - - - - - - - � - - - - - - -
idom freeboard check. Although dithes did appear to look somewhat suspicious in color but did not have an odor. Ditches around
facility have recently been cleaned out and this suspicious color could possibly just be turbid water due to the cleaning out of ditches
and farm. I was unable to contact Mr. Bond. Dean Hunkele and I will re -visit facility the next morning for further investigating. Mr.
id also met usDWQ) at farm. It was determined by DWQ to be turbid water due to the cleaning out
Reviewer/Inspector Name
�:.
��`
Reviewer/Inspector Signature: Date:

Revised April 20,1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number M — Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: Part 1l eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP: Ili 144
Annual farm PAN deficit: 4r pounds
Operation not required to secure WA
' determination at this time based on
exemption E1 E2 E3 E4
�piiiration pended for wettable a e
determination based on P1 C P3
- r "
Irrigation System(s) - circle bard -hose traveler; 2: center _pivot system; 3. linear -move system;
4. stationary sprinkler system w permanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlpartable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Par I exemption_)
E1 Adequate irrigation design, including map depicting"wettable acres, is complete
and sioned by an I or PE.
E2 Adequate D, and D)D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART I1.75% Rule.Eliaibility Checklist and Documentation of WA Determination
Requirements. WA Determination required .because operation fails one of the eligibility
requirements listed below:
_F1 Lack ofecreaaewhichTesultedinnver:applicationmfwastewater_(PAN) on:spray.
f eld(s) zccordino to farm'slast two -years nfamaatiomxecords.-.
F2 UndearjIlegible, or lack of information/map.
F3 Obvious -field limitations -(numerous itches;failure�o:deductTequired... _
bufferlsetback�acreage;-or25%:oftotal -acreaaeadenimed:.in-CAWMP.]ncludes
small ;-irrecularly-shaped.fields-fields -less -than-5acresfor. travel ers-or.Iessthan 4=
2 acres for stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acre -ace in excess

Revised April 20, 1999
� Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD I TYPE of TOTAL CAWMP FIELD I COMMENTS'
NUMBER NUMBER'-2 IRRIGATION ACRES ACRES %
SYSTEM
I i3��1 Ix.Y
�vH
II II II III
�
I I I
fl
I I I I I I I
r1=L`U JXUIYLQ=M - IiYUl Cl IL, PUII,(-UI I=, UI -PULL it I1UI I IWr-.Z IIMY UM UJC:1 Ill JJLCLC UI 11CIU IIUIiiUC:J Ut-Ut:lUML; UIi k i-kYV1V1r-
end type of irrigation system. - If pulls, etc. cross more than one field, inspectorlreviewer will have to combine fe!ds to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMEER2 - must be clearly delineated on rricp.
COMMENTS' - back-up yields with CAWMP acreage -exceeding '75% of its total acres end having received less than 50%
of its annual PAN as documented in the farm's -previous-two years' (1 g97 & 1998) of irrigation records, -cannot serve as the
sole basisfor requirina a WA Determination.hack-upfields -must,be noted inthe-comment -seMaon and must be accessibie
by irrigation system.
Part IV. Pending WA Determinations
P ; Plan -lacks .following -information:
_. ,e!,"P2 Plan -revision may:satisy75% rule based on adequate overaii PAN deficit and by
adjusting all field acre2geto below 75% use rate
P3 Other (ielin process of installing new irrigation system):

s[3 Division of Soil anil=Water 'ConservatEon - Operation Review
13 Division of Soil attd-Water Conservation' ;Compliance Inspeet.an f
rz,Ao of Water Quality Compliance Inspectiop : s -
{] Other Agency_ Operation Review ;.-� _ e�
.- i t -
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Q Date of Inspection
Time of Inspection f 24 hr. (hh:mm)
Permitted 1_-] Certified 0 Conditionally Certified 13 Registered 113 Not O erational Date Last Operated:
FarmName: .......... VP- .......an1 ..... r............................................................ County:..... .L1p�i.............................................................
Owner Name:..........................4.fl ......-.... Phone No:..�gl..� i ,8 -- .�. �....-.-..-.-...-..........................
FacilityContact: ................................................................... ..... Title: ................................................................ Phone No:.....
MailingAddress: .............ki`.1...W.......... Lrt............................................... ........... LA)&L1a4&,F .NCB..................
Onsite Representative:....... ............ q}...................................................... Integrator: ...... yyp 1�.S............
Certified Operator: ......................................
Location of Farm:
.............................. I............................. Operator Certification Number:
................................................................. ..............1-7
Latitude �� 0` �•� Longitude
Design Current Design Current Design Current=
Swine Capacity Population Poultry,= ,,.. Capacity Po ulatiot Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
® Feeder to Finish tip ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
[IFarrow to Feeder _ ❑Other
❑ Farrow to Finish To tal Design Capacity y(zo
❑ Giltsr -
❑ Boars 'Tota1,.SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
Holding Ponds / Solid.Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: El Lagoon [I Spray Field ❑ Other r
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (d No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches) : .............
........... 2<......................................................................................................... I ...... .... .............. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IP No
seepage, etc.)
3/23/99 Continued on hack

•r
Facility Number: 31 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 0 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 V9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 2 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes [2 No
12. Crop type �ev,m
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
15 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
AS 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
QjNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
(� Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
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
(p 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
O No
0; c1< yi6lafi6ris;et-deficiencies were noted• during phis;visit; Yoit will•i'eeeive Diu fui-thgr
comes oricience a�oti this visit.... . . . ............ .
Corn ments (refer uestion ( q #}:.:Explarn.anyYES answers andlorany recommendations of any"other coinments-
Use,drawings of facilityrvto better explain srtuatioas.,s(use additional:pages:as.neces"sary) `
13. '�6" _ '" O" �c i �� t'U'�.tt� 1 r` �r+2� �S w f Cosy►_ a-Lsa_ G"QS t rLpw I'le W .16
fF. �-c-�oor ae5i9r. S11c.�1�t� � i^ 'i�- �r►,� U`�co�-d�.
{o WQSkt NV61� i s 1
�i n� ShW IC� �Q a.?)f3 Ae Stol (�(ids accod ivy �d 56 � ( {�-►f
Reviewer/Inspector Name s ,. � z
r ] 9`iG uv
Reviewer/Inspector Signature: v Date:
3/23/99

r -
f Facility Number: — 01- Date of Inspection [ I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 [4 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 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes P No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes / No
Xdditional Comments and/or, Drawings.
1
3/23/99

P=Vs--d April 20, t g09
JUSTIFICATION & DOCUMENTATION FOR MANDATURY_ViIA DETERMINATION
Facility Number_-
Farm game:.
.On -Site Representative: (1
InspectorlReAewai's Name: -wi
bate of site visit:
Operation is flagged for a wettable
acre determination due to failure of
Part ll eligibility ifem(s) Fl F2 F3 F4
Operation not required to secure W,4 == -
deterrninaaan at this time based on
exemption El E2 E3 E4
Efate of most recent WUP: _Iz4perativn-Pended for wettable a
�d,�4 - t dog, buf ,�►ae -� determination teased on Pl Pl a P3
Annual "arm. PAN defier pounds �S
r:J
irrigation System(s) - t rL1¢ _ "I..izard-fiasairarre .. , cent r�iv©t sys erm 3. finearYmave syst-m;
4_ stationary sprinkldr'sy�m w/pem-ane . , . anary sprinkler system wfporiable pipe;, .
'6. stEto'naygun system wiperrranantpipe; 7. stationary gun syst-am wlportabla:pip_
.PAr� ii i_ � A Determination Exemptions (EilgiD4Tity i9flure, Part 11, ovenides Part .f exempubn-)
E1 Adequate 'irri5aiion design, inducting rr►ap depicting wettable ames, is comp}aie
and signed by an .1 or RE.
E2 -Adequate D, and D20 Iniganon operating parameter sheets, including map
depicting wefiabie arms, is compiete and signed by an ].or PE.
z3 Adequate D, irricaufln aperaiing pararneier shert, including crap depicting
wettable acres, is complate and s anad by a VVUP;
E4 75m rule examption as -verified in :-art 111_ tNOTE 5 a o exernp Dn -cannM be
armlied io fa=t ai ;ail ine ailaibitiiy-Ch-a .kiis'Lin P3ri.11_ Complete -eiigiiaurty
cnecdist, Part II - -1.F2 F3, b-_ior-_camplsting conznir1a1ional amble in Par 111�
'ART 11. 7S%.s'.islasiigiaiiity-Cbez:I isi�ndDig :urrteniation a; VIfA Deiermira�it�n
.egriuetmanis_ _-WA Dew .aIlonzegiiirad b =ause nprnavan J'ailszane otfne eugib-ity
-field(s) i _ w' ia�i3wC]ai�L� [GaIUII3r�U%d.
_ 2 Undearjliegible,-m racF �; irittsrrr ani�z- p= :..
_F3 ODViai:sldimiiananurrai^s�iics��lieducgvid -
bucer}setbacl�::rn—X l- A MP, mciudes__' =
small, jrregd1'arly:Shap✓djla1ds 4aidsd�._.�- ;ar ,:rrs velar
' 1 aa-i-s bi-sta onaryznrinkiars)
F4 WA daterminabon-reQuin~d because CAVE D- r�r eldts�'s a� eage ii excess
o; f 5°F ai ihe respective fiaid's iotal acraage as noted in able in Part Ill.

racilitty Number
Part Stf. Field by Field Determinaban vt
75Dlo E.xernpbDn KUM ror WA Determination
TRACT
NUMBER
FIELD
NUMBEW;z
'TYPE or
IRS �� N
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
C4MMENTSP
FI-
I
I
I
I
i
I'
-i I I-MUE= r" rry� rr,�s�t,-rar ,. n rnzr a y 0-'-' v-- - - nurrDt-,:rbpc-mmnq on C:AWM?
nd iy� 1f irra ian�} �. r_- le nuns, : cre 7nara 'fin •ona ilald,`msr rir viswar will have id cvrnibine-�l^s to
airy �a 75% ii--ld byi--ld d�igtrnar a cn r ..r.8trtmgnrr,-Dh--rwisao ars will be srsbjeY iQ WAS tr *mfim-L
DMIl�T+t"T�3- L "li1ii3321f`5]FYi1T3 �ip.Wil�l�" ��LTn '3Sfi� 75% aF I*S%Tsmlz=---z-a d ,#_....stmn 5Do
` h.-.a1mL-.-1 PAN (19 7&:1Q9B).ttr�ri�iinrr�"..nrds;�nrlrai�ar+re�s
3rr IV. Pan c ing WA eterrz" a rs
�"� �:3r��3:.�a3D�lisWIF3�3iiiClif�.3i]flT= " -
,42 ;an-rrvsiDn=ovBAN drfir-fi:and:by
Ral u n alfiteidacri:a ici�eiaw{y
1� �je�c n� •t. +d ` `' 'o r c.wz ��w ,ti "�- n Lzi4 " �-Sfo
F3 Dmar- (ieiin process j; irrstM ing nmw irrioabon s,tstem):

Longitude �• ��"
Design Current
Poultry Capacity Population , 'C
IwAli
3 Division of Soil and Water Conservation ❑Other Agency
Division of Water Quality
® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 3 c
Facility Number
Time of Inspection i -op 24 hr. (hh:mm)
© Registered ® Certified 14Applied for Permit O Permitted IDNotOcerational Date Last Operated:.-
Farm Name: ....... &1*........... b ......... r` 1*........... .�.d .......................... ............. County:...... EGA..................
... ............................................
Owner Name: \1jj.tz .r...............•---........%?41j......................................................... Phone No:.....l.gl0...?aT ". *..i........................................
FacilityContact:.............................................................................. Title:......----.----.....------...----.---.------.................... Phone No:...................................................
MailingAddress: ......�.aY�............. ....... ............................................ .....w ........................................... -44..........
Onsite Representative:.......... �.�.�t.�,.:......:�'................................................................ Integrator: .......4.�K#.I a..............
Certified Operator................................................................................................................ Operator Certification Number:. ......... i ..I.a... V
..........
Location of Farm:
Latitude • 6 44
.Swine � J Cap:
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
;
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ( No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [11 No
❑ Yes
No
❑ Yes
( No
❑ Yes
No
❑ Yes &No
❑ Yes [i) No
❑ Yes [P No
❑ Yes 9No
Continued on back

Facility Number: g I — f
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I ay_oons,Holding Ponds, Flush Pits, etc:
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4
Identifier:
Freeboard(It):............:.................................................................................... ..... .................................... ...
10. Is seepage observed from any of the structures?
l I. Is erosion, or any other threats to the integrity of any of the structures, observed?
❑ Yes [ No
00 Yes ❑ No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement'?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) '
13. Do any of the structures lack adequate minimum or maximum liquid level mari<ers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ...............e.kmul.!t................... ...... Ir
ik.......................... ... Lo.�'h...............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
17. Does the facility have a lack of adequate acreage for land application?
w
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2t. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a.copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25. Were any additional problems noted which cause noncompliance of the Permit"
0 No.violations or deticiencies.were noted -during this:visit. Youmill receive no further
correspondence about this.visit.
❑ Yes No
❑ Yes No
X Yes ❑ No
❑ Yes
fR No
❑ Yes
M No
......... ..............................
❑ Yes
EANo
❑ Yes
U No
❑ Yes No
❑ Yes No
f Yes ❑ No
❑ Yes W No
Yes ❑ No
❑ Yes No
X Yes ❑ No
❑ Yes ❑ No
Comments (refer to, question #): Explain any YES answers and/or atiy recormnendations•or any other ibmments
Usedrawings of -facility to better explain situation5.`(ase addiiio>ial pages as necessary},
�_ I-�l�oow ��e Ch3J �it�e► +rstctiaoatd• �Qao:. �Ye� r-),OuV be 644 4,-J!
%-2 -, & -CC GOC_ k a h 6,Aw 1oi+ d c t. W c.J t c_ yw l o �e imi. e,44 1
[[�ec,��,..
14, usc- $V fbs/ac- V" '# � � "ram SV-01a.� �.�0>1 tad` smatf O�Ykrr`' i5j0FrS Niirb51M.
7/25/97
Reviewer/Inspector Name �crCd�. L: �1n r�`�
Reviewer/Inspector Signature: IAJ,----- Date:

® Routine O Complaint O Follow-up of DWQ inspection O Follow-ut of DSNVC review O Other
Date of Inspection c
Facility Number
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
0 Certified ❑ Permitted I or Inspect -ion includes travel andprocessing)
❑ Not Operational Date Last Operated:._. .._ _ _.
Farm Name: ��-a... .0 ._ ,o �r_w?.W_._..._... County: _Dst.?..� i►� _..........__........
.� _.. _W...... _...
Land Owner Name:Phone No:
Facility Conctact:. _ .... .. Title: _ Phone No _. ... ....... _.... _..._ .....� ....91 S.�....
Mailing Address:.._ Z ....L�1a S .Sr► ...Q.�.> ....1 0...� ........... .........j,11 .[. �...a. t... ...... _ ........... .fig. .�..
Onsite Representative:.... ... Integrator:
Certified Operator: .... ]LA s ..... , ... Operator Certification Number:
Location of Farm:
..... !... �..... _ ..1 _... .( ._.. ...0 i .L_....__........_..... .......... _-.... .__.....
_-_....` _ _......... -- a
_-.
Latitude FW Z711 Longitude 4
Type of Operation and Design Capacity
Des tueCa gactnCtirrent�� lDesign
SwCurrent ❑ ttle E:Des�gn z PaCuurreauaaCa act ❑r Dairy,❑ Wean to Feeder ttnot
n
Feeder to Finish ❑ Non -La er I Non -Dairy
Farrow to Wean s «a
n
Farrow to Feeder Total DesignL�Capae�ty
Farrow to Finish .. «w;;... _._ ....... Total SSCW `
. Other .
, -,x, �
r =.
l�tuml a Mfk4agoonsl/ Noldtng P ads ❑Subsurface Drains Present
��k ` ❑Lagoon Area k ❑ Spray Field Area
•'3 @€ rxx
:u
encral
I . Are there any buffers that need maintenance/improvement? ❑ Yes ®'No
2. Is any discharge observed from any part of the operation? ❑ Yes [ No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes KNo
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 ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
4/30/47 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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ffia oons and/or If olding Po d
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
z.5
❑ Yes 9 No
❑ Yes RNo
❑ Yes B_No
Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes ®.No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes R No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ±� e r �^-�
................_..at....�......... .... 4m5c..Ya...........................5xar.�..c��:
16. Do the receiving crops differ with those designated in the Animal Waste Managemei
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement? .
K Yes ❑ No
❑ Yes allo
❑ Yes E9No
Plan (AWMP)? ❑ Yes RNo
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
For!Certified ertified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes RNo
❑ Yes RNo
❑ Yes KNo
❑ Yes EZNo
❑ Yes 9 No
❑ Yes P.No
❑ Yes O No
® Yes ❑ No
Coiriments. (refer to question #� Exp. atwany YES answers an or any recomrnendatrons or an Y. other commerits.�
y
Use drawin gs of fddifi to better, ez lain situation, use additional. a es as neces
. ; �' p (.. P g �Y)'.
5
apt i i s u iro'Ja'd S ; e-L L.
C v, a 't to w a.r-cl i d t c I, �.
4
12 Fii1 ,-eSeervL er-a1i9v% or2�q n�.. La�v+e.w o� ov��.� to 00
w a l l, R &V 4- e, w e a w a t ►^ae.v- 10 a "e-
`3 1
p
Z-4 µ CL IC- _ S V r-� a l` t G t f� �' ► ✓v� �R�?iv-,S ti •-� V Y m a. Env+. `�
rV
V'-F�r+•�
g i o- vc o ,rr V­ P.- S p o v'_eL w' t L, 'Yr e t i.. V w� is *ti 5 ire " r`�4
i
�
Reviewer/Inspector Name':
Reviewer/Inspector Signature: Ca_ (� r j,;� Date: S
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: AJ(,)_
Facility No. 3 , / D S"
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANUVIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: r , 1995
Time: a S3
Farm Name/Owner: -_y �: 4 D_ D
Mailing Address: bor t.r*' w Ftl,Lvvc€ 1, p3c
County: Duel i
Integrator: ^ C �r�-S Phone:
On Site Representative: V P D e"'r '3 a r4 n _ Phone: S 91Q) 2_S S- 4 0 8 S
Physical Address/Location: `'J � S, --) o = S �; c3 44- aip iJ
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: D_ "a . Number of Animals. on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 +° _ :0 " Longitude: "77 ° 446 ' 5 Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon hVorNo
fficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Actual Freeboard: '3" Ft. Inches
+� Was any seepage observed from the lagoon(s)? Yes o<Dowas any erosion observed? Yes o No
Is adequate land available for spray?('�E)or No Is the cover crop adequate? Yes or No
•
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es o
100 Feet from Wells? No F n w`
� c
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 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)? Ye No
Additional Comments r C- D � { G +�� 3' l ` rx +-G- � E c ot2 r7 -5
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERHTIQNS BRRNCN - WQ Fax=919-715-6048 Jul 20 '95 12:57 P. 05/09
3ILv t\���1LiZS I�2u�1���1 (�" �i. �i]IlOfl it
Facility Nulub r:
SITE VISITATION hLCC)M
DA n:. 7 b `1 1995
owner: occr`� %, � •� _ Faun Name: �'•�� r3p.,c1 ! -�
Co uilvv: r
Agent Visidng Site, o n _--- T Thane: = 6 -
Operator: Phone_ -- On Site Representative: _-- � Phone:
Yhysica! Adures5: _' „�4 �r2Y 0. it
Nlailir.G Address:
Type of Operation: Swint _ Y' _ PotAtry - carr-16
Design Capacity: I- ±' Q Number of Animals on Site: I .a- c,
Latitude:. --- - -n --- _ Longitude: -A
Type of Enspection, Ground X Aa ial _ -- --
C4<-Ie Yes ar INo
Does the Animal Waste Lagoon hava sufFciont freeboat'd of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ycs oX Nc, Actual Freeboard: �- .Feet --a_ inches
For faci'.itres with more- than one lagoon, please address the other lagoons' freeboard wider the
cofmnents section.
w as any seepage observcd from the Ia,goor.(s)? Yes or No Was there erosion of the darn?: Yes or No
Is adequate land availalub: for land application" Yes or No Is the cover crop adequ`[eP Yes or No
Additional Cornm-nts: -te p 12
1�n n /i i , r� r�F' i 3.1�7 ��'-•,- ;1 � j� � r
l Fa.x to (919) 71.5`iq �;i :lattli ct AgerIt

•
•
Site Requires Immediate Attention ✓
c} .
(1) Facility Number: 3 l"
SITE VISITATION RECORD
DATE: D f,11 , 1995
Owner: Vadat on cL--, Farm Name: Wa4 %30,►r4 Lf
County: LI A ;
Agent Visiting Site: ov a Phone: Q to. —2A6 -.0.1-Zo
Operator: Phone:
On Site Representative: Phone:
Physical Address: O•A —O Sv✓ of Al or
Mailing Address:
Type of Operation: Swine mac_ Poultry Cattle
Design Capacity: 4IN _ Number of Animals on Site:
Latitude: 0 Longitude: O "
Type of Inspection: Ground �� Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: _I Feet 3 Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate Iand available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: ee ar
Fax to [phone]
ignature of Agent