310139_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit:ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vi it j2reRoutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ` Ol Departure Time: County: Region�!'�U
Farm Name: _ yV� i w [ l oct iS �r M Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative: Jbn� A.AI { -"_r Integrator:
Certified Operator:
Phone:
Certification Number: 17 3 LD
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Curren#
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La cr Dairy Cow
Wean to Feeder
11
INon-Layer I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , P,oul_ . Ca aci P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Pullets
I Beef Feeder
I Beef Brood Cow
Boars
Other
Other
Turke s
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?
❑ Yes I/1 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [3 No
❑ Yes I �"No
❑ Yes ii%No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑iNE
Page 1 of 3 21412015 Continued

Facili umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure t 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 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 JA "o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes _.LqlClo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes .EErKlo
❑ 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_L2-%o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes , No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ja'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 CAWNW?
❑ Yes �10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes `ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes _17No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ,E3"1Qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes,,E]'1Clo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes _la<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;;] do ❑ 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 �Ft< ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes eE5No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes La 'V V ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 191 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yeso
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso
the appropriate box(es) below. i,.1
❑ 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 toss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to property 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?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes _[a'l�o ❑ NA ❑ NE
❑ Yes 0 No_,E]IA ❑ NE
❑ Yes ja'Nlo ❑ NA ❑ NE
❑ Yes 2'<o ❑ NA ❑ NE
❑ Yes,�To ❑ NA ❑ NE
❑ Yes ��a<o
❑ NA
❑ NE
❑ Yes ;?(No
❑ NA
❑ NE
❑ Yes J2 No
❑ NA
❑ NE
❑ Yes ❑'flo
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
µ V.0 V9—ci(
Phone:
Date: �� !
21412015

Type of Visit: O Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: LM
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: DVPLrJ Region:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Ir1f��t_jit~ _ _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I
Certification Number:
Longitude:
Design Current
Swine Capacity-" Pop: '
Wean to Finish
Wean to Feeder
Feeder to Finish 17
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Qther
Wet Poultry.
I Layer
Non -La er
Dry P,oultr,
Layers
Non -Layers
Pullets
Turke s
-TurkeyPouits
Design
Capacity
I
Design
C•_a aci
Current
P.op.
Current
Plo
Cattle
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Design
Capacity
Current
Pop.
.FTOther
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?
❑ Yes [/No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes U�No
[—]Yes ZNo
❑ NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

aciliNumber: - Date of Inspection: I t)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
R, No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I) Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
L-A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K]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
1� 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 environm7,o
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LCJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Vf No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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. 0 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 ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili 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 dNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ElYes yNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes dNo ❑ 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 dNo ❑ 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
[7jNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F6 o
❑ 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 answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
N A(W
Phone( 1b)Iq � -:)
Reviewer/Inspector Signature:
Page 3 of 3
Date: jo (p
2/4/20I5

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: j4_,4?gL St Arrival Time: Departure Time: County: DcoRegion:"
Farm Name: A�r•'Yn Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: �C11n It�,,� Un 44— Integrator: e2ZZ 5
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design Garrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I
INon-Layer
I
Dairy Calf
Feeder to Finish -
Farrow to Wean Design
Farrow to Feeder I) . P,oult . Ca aci P.o
Farrow to Finish Layers
Dairy Heifer
Dry Cow
Nan -Dal
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Qther Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes 0] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ZNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ff No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,6 No
❑ Yes Ej No
❑ Yes &NO
❑ NA ❑ NE
❑ NA [:],NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

FaciliNumber: jDate of Inspection:
Waste Collection &'Treatment
4. h storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ef No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 Ej 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) ZO
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 )?I No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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 0 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 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?
Reauired Records & Documents
❑ Yes Z No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNo ❑ 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 _0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Inspection: Z_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PrNo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ,,ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ff No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ 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
gNo
❑ 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
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use
�drawings of facility t6better explain situations (use additional pages as necessary).
V"
gl�115- -r �, Add new o�� ���� �
f eCoca S.
ReviewerAnspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

type of Visit: t2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: JEMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date'of Visit: Arrival Time: SPih Departure Time: County: l/u Region:
Farm Name: /V 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Integrator:
n 14
Certification Number: 3�11
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
t
Swne Pop.
0C.HaNne!
Wean to Finish
Design C•urreat
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
airy Cow
Da' Calf
airy Heifer
Current
Pap.
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Design Current
Di, P,oul Ca aci $o ,
Layers
Non -La ers
Pullets
Turkeys
Turkey Pouits
Other
D Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /a No ❑ NA ❑,NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes JD -No ❑ NA ❑ NE
❑ Yes „eNo ❑ NA ONE
Page 1 of 3 21412011 Continued

i,
Faciti Number: I I - 1-11 1 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;�T No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): AD
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 VyNo
❑ 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 9-No
TP
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes KrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:)Yes VTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes VTNo
❑ 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
[ TNo
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P�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
VTNo
❑ 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 ZI No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes aN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3
214120I4 Continued

Facility Number: - I & i= I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FL-rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Zr 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
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VI No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Vj 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
PfNo ❑ 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:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�`No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ra'No [3 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes
T�No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary-).
Reviewer/Inspector Name: __&4 s4 +4 ' Da in
Reviewer/Inspector Signature: r
Page 3 of 3
Phone: .252: 946A _WbD
Date:
21412014

Division of Water Quality
Facility Number. - ® ®Division oftSoil and Water Conservation
® Other Agency
Type of Visit: compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: QrRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ;' County:
Farm NameV-_1
Owner Email:
Owner Nam,!'M�� Utz) Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: - Phone:
Onsite Representative: Integrator:
Certified Operator: S. i�►i�o+�e� Certification Number: j r7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: ilgo
Design
Current
Design
Current
Design Current
Swine
Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Pooult ,
Ca aci_
Pao ,
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[TNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ZrNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[?(No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: -5 _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[no
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
VTNo
❑ 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
CT'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
[!I -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ETlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?No
❑ NA
0 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
[!rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2tNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [([ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I", Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff 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 21412011 Continued

Facili Number: -ME Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ o
❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ETNo
❑ NA 0 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
[6 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[Zf—No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes
ETNo
❑ 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
dNo
❑ 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
ZNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[],No
❑ NA ❑ NE
Comments (refer to question ff): Explain any. YES answers and/or any additional recommendations or anyother comments:
Use drawings of facilityto better explain situations (use additional pages as necessary).
Pqew- we-ry\ tea_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ;&&Lhw�
Date: 5 c
21412011

1
(Type of Visit: )V Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: C Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: EMn
Arrival Time: ® Departure Time: ® County: Region:
Farm Name: S -4 tA FA (I lA Owner Email:
Owner Name: M I C—M iQ E C , U3AL L/-i CE Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _�CW 1_.. Atl r 1` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current Design
Pop. Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I INon-Layer
I
EE Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Di, P.oult .
Layers
Design
Ga aci
Current Cow
P,o , Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[a Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
tN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FacTY Dumber: (- Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in)
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes �,,No ❑ NA ❑ NE
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 ii No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) —C
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 A No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ee❑ Evidence of Wind Drift [�❑ Application Outside of Approved Area
12. Crap Type(s):Z�c J � t /J f1 L- A- 7 V EG pe i � a G� �iCCU
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA 0 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 j� 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?
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.
E]WUP Q Checklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes _qNo ❑ NA ❑ NE
❑ Yes j2fblo ❑ NA ❑ NE
❑ Yes
P. No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Y"
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and I" 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 N
Page 2 of 3
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
21412011 Continued

Facility Number: "k 1 - 1 3y 1 Date of Inspection: S` I
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 4
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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 9
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes _0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes rNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any -additional recommendations.or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
l.A�IAP 14AS HF1N1'_') WR I'TTEV AtAaga471 UC - ! r WAS 4zCEi� q_ece TLl� t­1C-_ rlF_C. TCI
14AVF- A TFcfW1C4L-SPEc1ALISr 5IC%,W C* ON /I
DflSJCIV 1 S OAJW I( -14 F4GE" — 'J c. f L(- CC 0"9- PILE S TO SGt, I F W r�
(4A(16� 111 .
,.).g
val o [ •�-
f I// Of
_46144LAT)OW
�. Np �„v,47lNF oN
Reviewer/Inspector Name: 1' eK foot+ GAII C- S Phone:
Reviewer/Inspector Signature: Date: 5/(F// o�
Page 3 of 3 21412011

Type of Visit: Rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: $LRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: t \T Region:
Farm Name: ��1`{11'� �}� /� Owner Email:
A59-5&l-331S(14)
Owner Name: (_� (� ,S . �� (�{L 1-}G Phone: a$o? - SL6-CoCo'a4 CW� _
Mailing Address: �- +� �� � (A1C1(� CHV(ZC l4 �L OCR7-3 , !Y C
Physical Address:
Facility Contact:
Title:
Onsite Representative: (,A
Certified Operator: W PLLACr
Phone:
Inte rator:)
� ti
erhfication Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Off]
Design C►ume�t
Swine Capacity Pop.CaN
Finish
Feeder
o Finish
o Wean
FFarrowo Feeder
Farrow to Finish
MIMID—e.s'
a er
Dr, P,oultr
Layers
Design
Ca aci
Curren#
Current
P,o
Design Current
Capacity Pap.
Dai Cow
DairyCalf
DairyHeifer
D Cow
Non-Da'ity
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes No
❑ Yes No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412071 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): .5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [DNA ❑ 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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes9:o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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
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
XNo
❑ NA
❑ NE
the appropriate box.
QWL ❑Checklists QDesign 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard • Waste Analysis ❑ Soil Analysis ❑ W/te Transfers ❑ Weather Code
Q Rainfall ❑ Stocking ❑ Cro7 Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faa`ility Number: ? I - t-t Gi I I Date of Inspection: In 74 /1
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 provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yeso
kNo
❑ NA
❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
7�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
o
❑ 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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
'E!�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
o
To
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations: or.°any other comments w ,.
Use drawings of facility to better explain situations (use additional pages as necessary).
Lf . �P ARC wH�-E FAR r� P` ►Ei� IN Cucun�43 EPS - C uLutnec-U /V0T/ At fXAX
ri: Wu1 `P5 a0.ESTI[.LI Al q e-e&tL.'o 4 14A
-- l PUMPrAvG o/c FPZA& 7r/UCE NOV '10
PLEASE PSI MT C3uT K(r EST (� A . dl- Pu7 WI
(ix_E .45 r-JIr Q t IVT pcAT '/� Sa t` (L,6?(Cl 4 (7uT t.J' �L E CO(zP '�j
0(,(9,G7-A-7))oN b (A Gam' a o
Malj / M5- r DC_ o
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q16 '-jg6-43 d T
Date: bh///
21412011

Division of Water Qua
Facility Number" f 39 0 Divvsion of Soil anii W
J.:.
:Other -Agency,
onservahon
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 ❑ Denied Access
Date of Visit: b Arrival Time: Departure Time: County: ISUpu N Region:
Farm Name: S y' l Fa�, iM Owner Email:
Owner Name: + �CNF}�L S . W ALc A C` Phone:
Mailing Address: "!-9 (.&L4M, C^aeH W 4 L Jf f q_ s�v %VC.
Physical Address:
Facility Contact: / Title:
Onsite Representative: 61
Certified Operator: + ' L S ���A CLACC
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 0303
Back-up Certification Number:
Latitude: [� e = . = .1 Longitude: = ° 0 6 = «
Design Current _'Design" Current"" n k x
Swine. Capacity✓ Population Wet Poultry "Capacty Populagon.Cattle
❑Wean to Finish 10 Layer ❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer I I
❑ Dairy Calf
u. Feeder to Finish
x X ...
El Dairy Heifer
LJ Farrow to Wean
_ "�
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
` ❑ Layers
El Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood C
ther
... ❑ Turkeys
-
0-Other
❑ Turkey Poults
❑Other
#Number:of:
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�TTr No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 —139
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Sd AA
Spillway?:
Designed Freeboard (in): jCJ, S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes
JNo
❑ NA ❑ NE
❑ Yes No
❑ NA [INE
Structure
Structure 6
❑ Yes ANo
❑ NA ❑ NE
El Yes m No ❑ NA ❑ NE
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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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? 00
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 1A No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No [I NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
$No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F No
❑ NA
❑ NE
.Comments (refer to•question #): Explain any YES answers and/or an y.recommendations or;any €ither�comments .:
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name /}IHCS b :� Phone: Clio ` (0 51-
Reviewer/Inspector Signatureel—Date: 5A9W/C)
Page 2 of 3 12128104 Continued

Facility Number: — f Date of Inspection r1 /a7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes �io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes y[! No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists 0 Design
g � Maps ❑Other
' \
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )6,No
❑ NA
❑ NE
ED Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑(Vaste Transfers ❑ ) inual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections D Monthly and V
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [XN
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes dNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
0 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
. General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
o
❑ Yes to
El NA
[I NE
33. Does facilityrequire a follow-up visit by same agency?
Cl Yes
❑ NA
❑ NE
01
Addahonal Camrnents andlor�Drar`vEn s' "`
16
,A 56
A7T/ AMAND14 CZ� /--'vEs
ivC D6NQ -D��-;�� : Amrvho>q G,a�nr• s
InCpcA--. >1,v4L- CyT G,� ��x TC J : �lU 35�,-�ooL/
j�J l LNG t n,C Tcyv, X!C
�loS
I2a8/04

Type of Visit Acompliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit .Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: iD Q9 Arrival Time: f a oo Departure Time: County: L-1 Region:
Farm Name: FACzm Owner Email:
{y� aS - 57W-331 SLh
Owner Name: I ' i 1CA AC-L , , (A"�A u-1Q c C Phone: 2Q` 5Cd0-(ob + x sYvp Cam'
Mailing Address: 479 CA,,C .Cj4 R-6 c j�QN C. O S�
Physical Address:
Facility Contact: I Title:
Onsite Representative: F LAyv►Eft Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= 0 = Longitude: E__1 o =' 0
Design=%urrett
Design Current
Design Current
Sine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑La er
❑Dai Cow
Fea Ento
Feeder
10 Non -Layer I I
❑ Dairy Calf
91 Feeder to Finish
` (P-441.
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to FinishEl
❑ Layers
Stocker
❑ Gifts
❑ Non-ts ers
ElBeef Feeder
El
❑ Boars
❑ Pullets
❑Beef Brood Co
Li Turke s
Qther
❑ Turkey Poults
❑ Other
I j
JL] Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNo
❑ NA
ElNE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L.ACCX>A/
Spillway?:
Designed Freeboard (in): R .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA [INE
(ief large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1�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
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &9 t14S C`') 522 LA3 W"
E 4ew p
(
1 u GIk-C-b
13. Soil type(s) u•
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
' ifs •rx.'fY-aa5` .4.€"�"' rM,��r r,.... 'x^� v:�i'"'%" - n., F' - s:t�w �t+=� '� -�.A',�
=Comments (refer to queshun°#) Explain any�YES answersIat d& 'any' or. any other comments...
:,Use drawtngs;of 1'ac�ty� to,better�;egplata sitnattons {use addittoRal+pages as necessary) �� a���'�"°{"��
�.
a•� `��arue.e�.� .. s� w ... �3, ��_� � . •��:� � i ,... - _: "fie" s�.� .. ° °,'r:a. � •^'r:'" � T^£*iL�rae'�a..;' .
�l�109 a_ o
11�1� 3
Reviewer/Inspector Name famaxop At CS Phone: �10`igia
Reviewer/Inspector Signature: Date: (9
Page 2 of 3 12128104 Continued

Facility Number: l — 9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropirate box.
WUP 0 Checklists D Design [D Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ V/ste Transfers
❑Xnual Certification
(] Rainfall ElStocking 0 Crop Yield El 120 Minute Inspections El Monthly and 1"
Rain Inspections E]
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
U(No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CANo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
14 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
5� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5jNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
E-T- Co pL�s o �-- log O 1 C cAa-D q �' � / 9,�s - C.Klb 2)jM S-- O1CAcw
Q U� C� {Z -fno"_3 o N 1N5 A) r- DIKC
Page 3 of 3 12128104

W Division of Water Quality
Facility Number' 39 O'Division of Soil and Water Conservation
=----
- - 0Othcr Agency
Type of Visit OCompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: (j Departure Time: County: UN Region:
Farm Name: Owner Email:
M
Owner Name: 4 t ly-f Lk_) A L L!RC_C— - Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 0 H/l/ /i J` R Integrator: `�
Certified Operator: I C-44r L �� A C Lt4 C r Operator Certification Number: ! T
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = S 0 « Longitude: = ° 0 1 = "
Design Ci
Swine Capacity Pop
Em El Wean to Finish
❑ Wean to Feeder
Feeder to Finish I SEEL
❑ Farrow to Wean
❑ Farrow to EFinishl
❑ Farrow to
❑Gilts
Other
it Design Current
on . Wet Poultry Capacity Population'
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
- Design n Cu
Cattle'`. -Capacity :=Pop
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
o !'
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 l of 3
❑ Yes W,No ❑ NA ❑ NE
❑Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Dumber: 3 1 —
Date of Inspection y Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �kNo
❑ Yes ❑ No
Structure 5
❑ NA . ❑ NE
❑ NA ❑ NE
Structure 6
❑ NE
❑ Yes
No
' `
❑ NA
❑ Yes
No
❑ NA
❑ NE,
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 I0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LKNo ❑ 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 ElNA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes jq No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CqNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
19_ GtG,T c0(�uJ t= cC)ctzA&IT ,�Vlam; W� C-0RJ
�o�C_ ,4L)C. Rn/�vu�4c sTZ)Cr �I- p'�, c,�f (Z�ca2n5
rrtou�
Reviewer/Inspector Name jq4 C N 5 {Phone:
Reviewer/Inspector Signature: Date: <1 Ot5
Page 2 of 3 12128104 Continued

Facility Number: —�,3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 19 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FNo
❑ 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
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
El 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
N 'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additional Comments and/or Drawings:
CJG01c S 0 p
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (P O Arrival Time:Departure Time: I ,1- nty: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
f— r p
Onsite Representative: Zf Integrator: T, G�l�Plfy—.L���uJ AJ
Certified Operator: _ r' L Operator Certification Number:
Baca -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = O = 9 = Longitude: = ° = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 YNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes A No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: j — Date of Inspection1'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑Y s ❑No
❑ NA ❑ NE
❑ NA ❑ NE
Str ucKure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: X-r
Spillway?: lt)19
Designed freeboard (in): _ 7e
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo
[INA
[INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes Q� No
❑ NA
ElNE
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 XNo
❑NA
El 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 YJ No
❑ NA
❑ NE
maintenance or improvement?
LCCLLL
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo
❑ 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 Soi:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El
,Application Outside of Area
12. Crop type(s) �f•%Yl!!D _ . �-�-�� �U �E P� �L.SLj . '505f'g6j4 !/G
13. Soil type(s) Ae,U , /I)o 46
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes )dNo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes X,No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes / o
18. Is there a lack of properly operating waste application equipment? ❑ Yes , ' No
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
IComments (refer to question 9): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
2-1) /V/_,40 L;o�'o,49 K,-71,co 7o
� Dry
Reviewerllnspector Name Phone: O W&--'7.3Z 7-
Reviewer/Inspector Signature: Date: / p
12128104 Continued

w
4
Facility Number. — Date of Inspection Ica//9/D j
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
��/
Z Yes
o
ElNA
El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on negation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
!!
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
XT
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
f No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Ak
GO &�)C� � S / L LZ77l�I.�� �T
12128104

Division of Water Quality
Facility. Number �,3 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit ;?r'Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visitoef Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: /b D Arrival Time: Departure Time: County:
Farm Name: - _- Owner Email:
Owner Name: 1xr_nV4,eV, Gf r4/ A &C�_ Phone: _
Mailing Address:
Physical Address:
0 Technical Assistance
0 Other ❑ Denied Access
Region:
Facility Contact: —� Title: Phone No:
Onsite Representative: c 01ii+�I LW ('O /' I/ Z4AAM ntegrator: Z�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c =, = Longitude: = ° 0 { = u
l.
Design Current Design Current,- Design Gurrenf '-
iSwine Capacity Population Wet Poultry Capacity Population Cattle Capacity Popul tia on
�U Wean to Finish
lz ❑ Wean to Feeder
Feeder to Finish
�r
`>0 Farrow to Wean
[] Farrow to Feeder
i ; ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number, of Structures
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 Id No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes El No
❑NA
❑NE
❑ Yes zzNo
❑ NA
❑ NE
❑ YesXNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — /
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA ❑NE
El NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:W1/
Spillway?: / VP
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes XNo
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 XfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10No
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I--]NA[I
NE
18. Is there a lack of properly operating waste application equipment?
El Yes
IV,]
'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):
20)/AD A&1?7.ENDn'11061Y
1 I � os ©12'I�o.S� 5oz'c �.�fs,
Si �o� f}�,� yf�s /�,✓A pGal••�1�vf ��cae,�
Reviewer/Inspector Name I
----]phone: 1%10- `?er - 9Z&0
Reviewer/Inspector Signature:
Date: 3 1
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 7fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ZYes ❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
10
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
9Yes J#No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes )2fNo
❑ 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 XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit gf,,C,,[[ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
X� Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 11,00 Departure Time: County:
Farm Name: �%cM Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0/"C4
Certified Operator: /
Back-up Operator:
Location of Farm:
Swine
r
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I Longitude: = o ❑, "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
El La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy -Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ET]
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 V(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
12128104 Continued

� t
Facility Number: ' — * Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure IIStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 15,314
Spillway?: 1410
Designed Freeboard (in):
Observed Freeboard (in): �p S
S. 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.)
r
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
El NA ❑ NE
through a waste management or closure plan?
to
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
tbLrVat, notify DWQ
7. Do any of the structures need maintenance or improvement?
9Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Z 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
[A 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
F No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drift ❑ Application
Outside of Area
12. Crop type(s) iQ�%%K1lfTLlP9sz �/ i �rJ.L`c�� �iJR�r
y/`j5 �dG'!1/�1�f�Ps
%,
f0".`l`Tf�C�Y}�
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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[XNo
❑ NA
❑ NE
IOS4"��
�+,(refer�to question #) Esplain any YES.answers and/or any�srecommendabons orgauy other Comments.drawings�oi'facihty to better=eaplam situ�ahons ,(use addmonaltpages�as'necessary)• 11
gj,5eW16 0#lte - fi"9r:� 4'1-'
21\ JtFzF �/r1�F�T5 f R / 71iS��CrZo�I.
Reviewer/inspector Name T /LPhone:
Reviewer/Inspector Signature: Date: a
12128104 Continued

Facility Number: / Date of Inspection QS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to
No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. V1 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking A Crop Yield 10 120 Minute Inspections Monthly and I" Rain Inspections P Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vj No ❑ 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?
2T 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes
(fNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
[2rNo
❑ NA
❑ NE
Addrhdi al Coninients;and/or Drawin s . ='a- W `
I2128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 31ORoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Late of Visit: i�1 Tune:
Q Not Operational O Below Threshold
ermitted Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above reshold: ,. .. .
Farm N e: ......_._ `�' _...�........ rA h L.CI........._.........._._. ___....... County: ...... �f/L!'! ....... _ ......._ ___...._.
Owner Name:
Mailing Address:
Phone No:
Facility Contact: .............................................................................. Title:.. .. _... _ Phone No:
Onsite Representative: ......... ..b... Jt...._.........._.............. .......Integrator: .. .-_ ...... ».................................• ........_---•Y-----.........
Certified Operator: .. . ................ . ............. . ......... . .. . . .......... . ................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 `6 Longitude • 4 66
Discharges & Stream Imvacts
1. Is any discharge observed from any part of the operation?
❑ Yes /No
Discharge originated at: [:]Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made?
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 gaVmin?
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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
WCV
❑ Yes
7No
❑ Yes��/o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --.,.._.1........ ...... .__...... _--
Freeboard (inches): 7 0
12112103 Continued

Facility Number: — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 13 0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes��/o
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 maintenancelimprovement? es ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes L?o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvernent? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 21,01
❑ Excessive Ponding ❑ PAN [] Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc , !
12. Crop type 3Et'a�'lvoq I N 5G%0 w Rr6 6E,d PJ cur -um 16EAS Cis w
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �<oo
b) Does the facility need a wettable acre determination? ❑ Yes �UYK9
c) This facility is pended for a wettable acre determination? El Q �o
15. Does the receiving crop need improvement? ❑ Yes ❑'l-o
16. Is there a lack of adequate waste application equipment? ❑ Yes 21,0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes To
11""
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes /No,
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1 o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 03'40
Air Quality representative immediately.
'Comments {refer to: questzo #)Exglarn4any YFS a�wers snd%r a y recoieadatioas orsny other commence �'
:Use drawee of f$ Ito better situatrons. ase addilzonal es as necessary} •} ❑Field COPY ❑Final Notes i
?) CaNrcAJVE 6 foK.k 04 694SS COtlER a F Wii O A PJICLE MU,
35� C,6r ��E� F a" opoAIV ANo TWSftcrttA J ArttE� PTAx. J
Coo�S ►�
y
Reviewer/Inspector Name
<.wr y
Reviewer/Inspector Signature: QXA Date: 19 0
12112103 1 Canknued

Facility Number: ! _ 139 Date of Inspection
v
Required Records & Document.~
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 appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keepingrcrolpYieldForm
DES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Rainfall 6rispection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes ❑ Yes r�N/o,
❑ Yes t/o
❑ Yes [�'NO
❑ Yes ISO
❑ Yes to
❑ Yes 2 o
❑ Yes Leo
[TYes ❑ No
❑ Yes 13
❑ Yes
❑Yes VNq
❑ Yes
2/yes ❑ No
12112103

IType of Visit T Compliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason for Visit >O Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility NumberEnD—E=
Date of Visit:
Permitted ;J Certified [3 Conditionally Certified 0 Registered
Farm Name:
Owner Name:
Mailing Address:
Date Last Opern)-PIZA1
r Above Threshold -
County:
Phone No:
Facility Contact: Title: Phone No:
i �
Onsite Representative: �.� - '� Integrator: ait Y
Certified Operator: Operator Certification Number:
Location of Farm:
dSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 =1 " Longitude Oo 1 Du
Wean to Feeder I 1LJ Layer
I I JEJU Dai
Feeder to Finish ❑ Non -La er
❑ Non -Dal
Farrow to Wean
❑ Farrow to Feeder
❑ Other
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
- -- _. s
Holding Ponds 1 Solid Traps
❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XN 0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches):
05103101
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
�No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
Y No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
A No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[�No
11. Is there evidence of over applicatio ? ❑ Excessive Ponding ❑ AN ❑ Hydraulic Overload
❑ Yes
/ No
12. Crop type �� S .4 5
�l%
-*1�L�/Yf
13. Do the receiving crops differ with those desfinated in the Certified Animal Waste Managemen(Plan (CAWMP).
❑ Yes
' No &0'a,,�d
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
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
jzfNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
I/J 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
PdNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
� o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
9
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
�d-No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
YfNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
["No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
/XNo
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to ;question {t):.Explaintany YES answekAand/or`aoy recomme©dattons`oc any'otl er comma Y .
al'pages
Use drawings of facility to better explain situations4use additiotias:necessar}) Field Copy ❑Final Notes
{� (.ram
rE A 040 rPz'-'q/V
C t IkAF De 7- �zivi47�o,��
r^+°
(2 7'iJ69
1 w5 (RYE) ti4lz6�L-A�� Ivor
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: IL a 2
O5103101 7 Continued

Facility Number: '3 Date of Inspection M�a
Printed on: 7/21/2000
Odor Issues XNO
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑Yes
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )ZNO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes [YNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or /
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )XNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
Aj �,� way
7/-�ZaN C /'YiI�7� yuQs�
b�e 12-V U)TzZ-&
5/00

Type of Visit .)Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Uatc of Visit: Z Q� Time:
O Not Operational Q Below Threshold
Permitted © Certified © Conditionally Certified Q Registered Date Last Operated or Above Threshold: ................:
Farm Name:
S-b M �ar1^% County: .D.f.v*.A......................
OwnerName: ......... ................ ...................................................................... Phone No:....................... .............................
FacilityContact: ..................................................................... ......... Title: ................................................................ Phone No: ................................................. ..
MailingAddress:....................................................................................................................................................... ..........................
Onsite Representative: ...... f.i,k.e.... n.�� ....................................................... Integrator:.. t1� .. 1........................................
Certified Operator:................................................................................................................ Operator Certification Number: .... ;................................. ....
Location of Farm:
Swine []Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �«
Design Current Deli Current Derr Carr�ut
>� gr
•°Swine Ganacity Ponulation
❑ Wean to Feeder
Feeder to Finish
36 Z
3(M
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Ca aci '=Po ulation -Cattle C apacity. = Po ula
❑ Layer ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total-D&i9m Capaei0
Total SSL- W
m..
Number of Lagoons ' ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area --
Holding'Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharjes & Stream Impacts
I - Is any discharge observed from any part of the operation?
❑ Yes YNo
Discharge originated at: ❑ Lagoon [3Spray Field [IOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes V No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes 19No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 5'No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes % No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................I ..................
. .................................... .... . ..........................................................................................................................................
Freeboard (inches): Z.g
5100 Continued on back

Facility Number: 3% — 1 21.1Date of Inspection 2 O1 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 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? Oyes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ;37No
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 4No
i 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN I �Hydraulic Overload []Yes ONo
12. Crop type 6G,^ r-tydq 14, y, 5;t t4 f ( &g i, r l L 3, G✓ L CA ! , wG'L!' n e [ B,-,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15- Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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?
(ic/ 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?
0;Rio yMMi6ris'oe- deficiencies mere noted- during this;visit: • ;Y;o4 will •receive it further
: rorres orideike: about: this :visit:.:::::::::::::: :::::::::::::: :
❑ Yes ;9 No
❑ Yes al No
❑ Yes ;�TNo
❑ Yes % No
❑ Yes 54No .
❑ Yes M No
❑ Yes AKI No
25Yes ❑ No
❑ Yes 4 No
❑ Yes 7rNo
❑ Yes 2fNo
❑ Yes No
❑ Yes No
❑ Yes )KNo
❑ Yes XNo
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): -
`l. ?e.sliAr iaalaa,` waf( cwmd oil fa rt, wAlb' `
i8. oar, des; h f 1/alt.,+�•e "eet i+('a, wta, hced5 �ia lay -t recore(J'.
eL sire r, - All cro s ��d �'�c[df -fit w:!! recetTtre Wash q� wrrljQ�,
1Je �( a er1 � �
i n 44e wade- p1Gv .%deed 4tvavc koe+-d gcr•cS erdo^e -FarMeWI c16Ae-cd 144d
a V-d ttet vc wot s-!e p l et "t A &%6( p f; G� d$% � 60rd s r-Vd 1'r, ek A Q,
veV-A Ii �aG1�i I� CC66rc$s ere we kpu
o y Pf
Reviewer/Inspector Name . t plc ,,.s
Reviewer/Inspector Signature: Date: Ze ZZ 4i 5100

Facility Number: 3 —1311 Date of Inspection 2 Z (]j Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '0 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 OtNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 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
5/00

UateufVisit: l�EONot
Time: 10 :08 Printed on: 7/21/2000
Facility Number
(Operational O Below Threshold
Permitted 0 Certified ❑ Conditionally Certified 0 Registered Date Last Opera r Above Threshold.
Farm Name: 1' County:..... i'L......:......................�....-.
,II
Owner Name:......a.k a L.. .L-—............ Phone No:..... 2)z a ::' .332�...
Facility Contact: rA .11(e�....... ..1ty aAAA.L�-.......... Title• ill? Phone No: �........................................
MailingAddress:..........................ti.............................................................................................................................................................................. ..........................
Onsite Representative ...... K.4.L..... VA.11k..j........ g �,.� E
.................................. Integrator
Certified Operator: ................................................... ............................................................. Operator Certification Number:............ ..........
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Curfr
S',-Cagiacity. Po uh
P
n to Feeder
er to Finish
w to Wean
w to Feeder
rl Farrow to Finish
j Gilts
Boars
Latitude 0 4 64 Longitude • 9 66
Design Current Desrgo Current
Poultry Capacity Po ulation Cattle Ca ci Po eitati-
❑ Layer ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Totai Design Capacity,'
TOW
,SSLW
Number of Lagoons- ❑ Subsurface Drains Present ❑ Lague Area ❑ Spray Field Area .-;
_ -
I Ponds L Solid Traps F77 JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JANO
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)
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
SlrUcturc t Structure 2 Structure 3 Structure 4 Structure 5
Identifier
..........................................................................................
Freeboard (inches):
5100
❑ Yes ❑ No
.. A 114 —
❑ Yes ❑ No
❑ Yes b(No
❑ Yes [6No
❑ Yes [�No
Structure 6
Continued on back

Facility Number: — Date of .Inspection"ed?
of Printed on 7/21/2000
5. Are there any imme fate threa s to the integrity of any of the structures otrees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or �[
closure plan? Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A122lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence
12. Crop type
13. Do the receiving crops di fer with t ose designated in the Certi
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?
Overload
Management Plan (CAWMP)?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0. Kd-yioaioris;or &fiderdepQl. driA this:visit.- You wii-rekhutthero
corresnoridence: aN f this :visit:: :... .
❑ Yes :No
Yeso
❑ Yes kNo
❑ Yes ONo
❑ Yes [13K'No
❑ Yes RNo
❑ Yes 2�No
❑ Yes S�*No
❑ Yes j� No
❑ Yes '�l No
❑ Yes fl�rNo
❑ Yes KNo
❑ Yes g90
❑ Yes -;IrNo
❑ Yes ro
❑ Yeso
❑ Yes j(No
❑ Yes �ro
❑ Yes o
❑ Yes o
Comments (ref& to question #}; Explain any YES answers and/or any recommendations or any other comments F
Use drawtngs,of:facility.to better explain situations fuse.addrtional;pagesas pecessary)
---� �- � ,� t �► �-�� fir- �� � � cam. �. S ��'�
U
NO n Y +0y T) >„ nAP4kV
Reviewer/Inspector Name i
Reviewer/Inspector Signature:
Date:

Facitity Number. — Date of Inspection
7/25/97

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes qNo
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 kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /j�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? VYes ❑ No
Additional Comv.pmli�a�law �v^4 al5o t�Ow at ee�c�
�r�b k_ k
�,N yl� nM4c I/��aec
(1
'Vl
5100

of Visit © Compliance Inspection O Operation Review O Lagoon Evaluation O Other
IReason for Visit O Routine Q Complaint Q Follow up O Emergency Notification OQ Other ❑ Denied Access
Facility Number 31 139 Date of Visit 223rz000 Printed on: U2312000
0 Not O erational O Below Threshold
® Permitted M Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: County: D.upli x............................................... '...[�.IR.Q.......
OwnerName: Jdf.......................................... Radall........... ....... ..._ .... ...... ..................... Phone No: 65&59.76 ...................................................................
Facility Contact: ....... ................... ...._........... Title:.. ............ _._._.. Phone No:
Mailing Address: ?.SG. IxnrntlW.K. �?iutia�x.Btla�rl............................................... Sexms'p ring-Kc.............................................. 285.78 .............
Onsite Representative: ............... Integrator: Mu. Vhy..Fam*..Farms_........................
Certified Operator: Operator Certification Number:
Location of Farm:
% Swine ❑ Poultry ❑ Cattle Latitude 35 • 09 6 29 u Longitude 77 • 51 29 K
Disehar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field [j 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
e. If discharge is observed, what is the estimated flow in gallmin?
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
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............ ... 12...............

Facility Number: 31-139 Date of Inspection 2/23/2000 printed on; 3/23rz000
5. Are there any immediate threats to the integrity of any of the structures observed? (id trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefunprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
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?
(iel discharge, freeboard problems, over application)
23. Did Reviewerllnspector 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?
N6_V, Waiibfii oir:defrEieliciei•were:rioie:d:duii'ng iiiiswiiii:: you • vilfreceiv:e:nb fiift ier: -
c'�rrpertiriwi�t�tiri* ahNi�itFii�•vci1_'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
found Mr. Padgett at home and he gaave me permission to go on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
rq•:g.
Reviewer/Inspector Name
?freer kcr:><�>•xn:::.:::�� - -

r,
© Division of Soil and Water Conservation Operation Review
_
© Division of Soil and Water Con'ser► Compliance
�'
a-t_ion Inspection
r
a ;
2
f _
Diviision of Water i Compli - �,-
Qual t]' inspect<on S x z�
�� aI1C�
©Other Agency =:Operation Review ' '� ,
r
,�Fs..•.
10 Routine Q Complaint a Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number I 13 Date of Inspection j 13 20
Time of Inspection 15Q� 24 hr. (hh:mm)
© Permitted © Certified [3 Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
�" m F rw, �v
Farm Name: l ...................... Cozen
OwnerName: l.. ........ a .! e _!_'......................................... Phone No: ....................... ......................._.................
Facility Contact:
Mailing Address:
....................... Title:
Phone No:
Onsite Representative: —j7cTf l2k� f_. Intel rator: �u!- F`','"�!! y r'�r S
..................................... J
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
_
... _
.-_
..
...........................................................................................................................................................................•_ .............._.....--.- ..........................- �
Latitude �• �� �• Longitude �' �° ��- '
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Laver ❑ Dairy
❑ Feeder to Finish JE3 Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
_ ❑ Farrow to Finish - = Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
-•- "Number of Lagoons ❑ Subsurface Drains Present [Magoon area ID Sprav Field Area
Holding Ponds / Solid Traps E� JE3 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of die State'.' (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in cal/min?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes ❑ No
Structure I Structure 2 Structure , Structure 4 S€ructur, 5 Structure 6
Identifier.
Freeboard(inches): .......... 1............. ................. I....................... .._......._................._._........................................ .....---................... .......................
S. Are there anv immediate threats to the integrity of any of the structures observed? (ic/ trees, severe.rosion. ❑yes ❑ Ni
seepage, etc_)
303/99 Continued an buck
r
t i

Facility Number: 31 —136) 1 1)ate of Inspection
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?
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes [:]No
15. Does the receiving crop need improvement?
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 itlanagement Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) V
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?
(iel discharge, freeboard problems, over application)
23. Did Reviewerflnspector 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?
0: i�fq-v�ela�toris er defcienc�es -rFere noted. du#Fng this:visit:- Y:ott will-reeeipe Rio furthe3r. •.
corresporiilehc'e:aboirtthis'visit. •. -
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J9 No
❑ Yes ❑ No
❑ Yes ❑ No
7]
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):
j q,oc 4ree_ �jas been mmove-A ��o+y► �ago0M
tl G✓ 01 b V + s4 v M f rt lryt a , ►'!f Ea yi'i o n ; +o f Irk
%ire 4�' ffgnS �� se��j ur �r�bleHls, S,r17e -gees ,54 11 ren-A)h)
1'h�. ��►d �e sq`�s had -�hcse l..ei �i �e fev"Oved elheo- woo-k
+v es4q bri A 100d Gra s S GO,r�r Q� a 1i Q� /c,�oa� C4' ke 1"411.
415e" re•hove- al/ 6rVAjwood y VeS a�aon -�r�n 01� wal(.
r•� I! Sj" o JEf eve 4 ,e 4Lber ' t4ernr &0-if l Tvy1e 1)2OPO.
Reviewer/Inspector Name
Revie-sver/lnspector Signature:
Date: 1Z112 geo I
312 = li) u

Facility Number 3 13�} Date of Inspection ? 2$ R
Time of Inspection 24 hr. (hh:mm)
®Permitted 13Certified 0 Conditionally Certified Q Registered JE3 Not O erational 1 Date Last Operated:
FarmName: .........T ..- ...+.-. .f ........................................................................ County:......fi- -�... V . �!.' 1......-....-............-�.......................
Owner Name: ... ..�e7�fC..........PAA Gj.L!................................................... Phone No: .�..,!. ...- 6159 ......5..!.../..`..........._........
FacilityContact: ........................................ ...................... Title:................................................................ Phone No:...................................................
Mailing Address: ZSL o.n G I d k o rqW sevg.'�...5 .%. 5............................. .2Bs7.8
Onsite Representative: .. v e . l k r +� Integrator 14 v r ll,
........................................................................�........................................... .......
Certified Operator: ................................................... ............................................................. Operator Certification Numbe_r:..........................................
Location of Farm:
............ ................................................ ................................................................................................ ............................. ............ ........................................ .............. I...............
Latitude 0 4 •6 Longitude 0 & °i
Swine
Design Current: Design ''`'Current Design Current
Capacity Population '. Poultry Capacity Population Cattle r Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ hilts ,
❑ Boars
Number 6U agoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon sstem'? If yes, notify DW ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 19 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes 19 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date ofInspection
.3 •
16 -i Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre detormination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge; freeboard problems, over application)
23. Did Reviewer/Inspector fait 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?
::.. yi..... ... .. ncies erc ....... .. g lthis:visit:.. . ....... +z tnti lf... . i. .
rtirres 6fidehc' e' a:b'aUA this visit. :: :: :::: :::: ..
❑ Yes [:]No
Z Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes j"N No
❑ Yes ❑ No
❑ Yes ❑ No
Cotnntents (refer fo question #) Explain any YES answers`and/or any recoiimenclahons or any'other comments:
Use.clrawing
_ ty. , p . ns {use ad�hogal;pages,as necessary) �;. s of faeilr to�better ex la�nsttuaJho
�. LG�goo►1 �,1�1CS SLIo�(�Ul � Yl?owa ot,']p[ �/'oper• otrasS I
veAL
'V4 GoVzr s�Io�C�I b�. �s ��l;f� Con e,� �F�ef' o�1a
Reviewer/Inspector Name
Reviewer/Inspector Signature:
_ x _1�
Date: V Z 9 9,1
3/23/99

Ye
Facility Number ,� Date of Inspection 7 ZZ
Time of Inspection f Z 24 hr. (hh:mm)
541�
Permitted JR Certified 0 Conditionally Certified g' 0 Not O erational Date Last Operated:
L y� ,� � �] Registered
FarmName: ........ T/..5.:.-I....... Y...�. r............................................................... County:...... ....... .................. I ......... .............
Owner Name:....... e.-q*e.Y
. r"r:'� ................. Phone No(!/..Y.-... ...1.. ...!.-1..L.................
.................................
FacilityContact:..............................................................................Title:.................................. .......... Phone No:...................................................
Mailing Address:... �..r�... �� �'1R �1......................
.....G........................,.,.J.�.... r. Ga�'�.�..l�t'p..y��., � f
Onsite Representative: ,.'"��..`Il.. f..'''� ��..�'`!e-'7�1 Integr for .......�1 �' + l...........................................
1 a �.
Certified Operator: ...................................................
Location of Farm:
.................... Operator Certification Number
Latitude 0 1 •4 Longitude • 6 «
Design Current - = Design`' Eurreht Design Current
~,
Swine Y "Capacity Population I'oult P ty,... P A .Cattle Capacity P
ry- Ca aci Po ulatton Ca act Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
w
Number of Lagoons-. ;' ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Hvldtng,°Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream ImRac
Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -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
Identifier:
Freeboard (inches):
Struclure I
3(�
❑ Yes 19'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes JX No
❑ Yes ❑ No
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
Continued on back

[�ility ?}umber: 3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
& Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23" Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd-061hti6is .or' deficiencies -were iiofed. dirrtId this;visit:' :Y:oit will-keeeiye Rio futth�r
correspondence. abouf this visit_ - ..
❑ Yes f5 No
Yes
❑ No
❑ Yes
❑ No
❑ Yes
.JK No
❑ Yes
❑ No
❑ Yes
❑ No
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
]KNo
❑ Yes
❑ No
❑ Yes
❑ No
Comments°(refer to:.question 4):' ,1?xplain.any YES answers and/or ahy recommendations of any Ether ion> in&
Use drawings of faeilrty foybetter explaun stheations (tese addiitional;pages as necessary)
7. So .rte -f-weer have beets c lVrves oh d► ke tv-i s4;11
neLA 4-o be re m zlvGd • Y v 4Qeds 40 ,be
es4q>bt;sI Z eevet be
lit! ; 11 �o 11 er.✓ U� L� � �� m ��-F�-�� � � d /� 1CG S
Reviewer/Inspector Name—
Reviewer/Inspector Signature: Date: 7 Z 4
3/23/99

--
Q'Division of Soil and-Water`Conservation =Operation Revjew
,.. -
017iv�sion of Soil aad Water`:Cvnserv_attvn :Compliance Ltspection - =
gXMision of Water Quality Compliance llnspectian 4'
:Other Agency OpeeabonReveew-
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection I ir. 1:3
Time of Inspection 6 24 hr. (hh:mm)
'Permitted 0 Certified [3 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
�(� --
FarmName: .... ..�..!..`. �................................................................................................. C.ount.. ................. �1I_................................ .......................
Owner Name:
Phone No:
FacilityContact: .............................................................................. Title:................... ............... Phone No:.............. .
MailingAddress:..............................................................................................................................................................................................._........ ..........................
Onsite Representative: ., � a4^'-._�� Integrator:..... ' j'...................................1.............
.............. ...........
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm: t % _ r 11 _ f n _ _ % 3
u�r .1.... .........r.....��...r.-{.._................................ ........ .......................................................................................................... ...... -------- I.............................
Latitude Longitude
Design
Current -- :; :' `Design
Current. - Design _Curr'ent
Swine = - Capacity
Population = Poul_try - . Capacity
. Po ulation =Cattle-, Capacity . Population ==:
❑ Wean to Feeder
❑ Layer
°'
❑ Dairy
Feeder to Finish
'�'a-
=`
❑Non -Layer
❑Non -Dairy
,_
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total-Design-Capa6ty
❑ Gilts,
❑Boars
`- = _
: ' T6ta1 SSLW
'-
- Number of",Lagoons
�, ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
Bolden ' Ponds /Solid traps
❑ No Liquid Waste Management System
.Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
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 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure; 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ................................... ................. ........... ........................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, N(Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

` Facility Number: 3 — 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
h?rNo
(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?
12KYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
mYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
WNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
j� No
H. Is there evidence of over application? Excessive Ponding ❑ PAN
❑ Yes
ZrNo
�❑
11
12. Crop type --cA' S i 4 ZS - - -
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[_'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Ml No
b) Does the facility need a wettable acre determination?
❑ Yes
(9No
c) This facility is pended for a wettable acre determination?
R'Yes
❑ No
15. Does the receiving crop need improvement?
10 Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
EE(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?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
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 KNo
Rio . i6Rtti6Fis :or Mciencies -"re opted- doting �his'visit' • :Y;oir will •i•ee6v0 fio further
correspond n' * ai,nut. this .visit
FUse.'dtwtiSngs.of
ntn(refer to question #)i Explain any YFS answers andlor any recommendattons or any`other comments:
facility ,to -better explain sifivadons..(use additional pages.as etecessaiy)
i k� V w4�� �ecl fie►-' ��e t-et,-ova - p{q�,�-
CL-c-Q Cam, W IC5:
A3 , �s �•-•��` � e. fie►-���.
3/23199

Facility. Ntimber: — [)ate of Inspection y {J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation; asphalt, ❑ Yes gNo
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 O�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 9No
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
►tional omments an or rawrngs:"
nn �
RMAS"i

0 Division of Soil and Water Conservation ❑ Other Agency
1 Division of Water Quality
Routine 0 Complaint 0 Follow-up 6f DWQ ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection �I
Facility Number 3 Time of Inspection J<')JA 124hr.(hh:mm)
D Registered M Certified © Applied for Permit 13 Permitted 10 Not Operational Date Last Operated:
FarmName: ................... `� . .....: f �....................... ....... ....................................... Coetnty: �V�l.��.............................................. .......................
OwnerName: .................... ..............�-Oj- t>................................................ Phone No: ... k(.1)4.s-..0. Z6........................................I
FacilityContact:..... ............................. Title: ................................................................ Phone No:
MailingAddress:..... ..................................... .....�:IK ...�!'C.�....A jL ........................ ..........................
Onsite Representative: ..-----..,,1"q....... G. gC ........................... ......... Integrator:........ sl! ? ......... .................................................................................
Certified Operator ................................................... ...... ....................................................... Operator Certification Number, .........................................
Location of Farm:
:.?a .... a�..... ....
Latitude =•=' �«
y... _. ..
❑ Wean to Feeder
_ ..u:.. _
...._.
Feeder to Finish
7Z
❑ Farrow to Wean
=; ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
..................................................................................................
Longitude
Design Current=
Poultry • Tapacity Population Catt
❑ Laver F El D
lI Non-L
❑ Other.
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
40
3
Subsurface Drains Present 110 Lagoon Area J❑ Spray Field Area
No Liauid Waste Management S
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 gallmin?
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 lagoonstholding ponds) require
maintenance/improvement?
ti. 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 E[No
❑ Yes P No
❑ Yes
No
❑ Yes
[ J' No
❑ Yes
No
❑ Yes [4-No
❑ Yes [RNo
RYes ❑ No
❑ Yes No
❑ Yes No
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding fonds, Flash Pits. etc.,
9. 'Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft) .............:3......
10. Is seepage observed from any of the structures'?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes M, No
❑ Yes §0 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 r 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 WIMP, or runoff entering water -,of the State, Inotify DWQ)
EN _
15. Crop typCam41�C" 4C�x-� t4� tflntl�G
❑ Yes jU No
Yes �] No
Yes ❑ No
❑ Yes M No
❑ Yes No
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement?
a
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21 _ Did Reviewerlinspector 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 AW1MP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violations or deficiencies werenote'd during this.visit.- Youmill receive no further
correspondence abort this visit.- :
® Yes ❑ No
❑ Yes ® No
Dyes ❑ No
❑ Yes PTNo
IM Yes ❑ No
❑ Yes 1No
❑ Yes M No
❑ Yes No
Comni6hts.(refer to question`#): •Explain any VES answers andlor any recommendations or any"6&r comments
Use'}drawings of facility to better.ezplain situations. (tise additional pages as;peci�ssarv).>
S. �-Ooo uric a it7r— I"o k L s, cj.!j a,5 }1o5s�t}�c 'i►� OS' cduyhtnopi? e ,
� ►�n.� ��,
�z. T`�`s w�a� �����. s���a ��.i d;[C,� t.J� .. �6v.`f7rCf ���T
OL e • l`A lit Grunry-1 (} 1 -)l f dU� 1 i S la Vla �1� t� 1ht O e� , tri fla s i O►� Qt— n V+�+�"
~3
k « c. C l 1 skou 1 � b e LW Ytst d er)
` l+ .
t � Cal C V�wv�3
ri 6 � �li�ou� � � I T_V__ z 5 �Y�o� �t) � .r4 aa���,an `�
.
dew 01 sA,Vvlr} b� �h lc ,t1 -,, ��t sw.u�,�5 slnavld be (�c}a�id,
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:

0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection .
Facility Number
Time of Inspection li0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 0 Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:.. . . ill.... a.rtirxa_................ ........ ........... ........ ..............
�.....
Land Owner Name:.. _...., e.. ..._..... ... PaA .tti..�........_...._...... .....
Facility Contact:
Title:
County: j?.a,Lf ..6.1n....... ..... ...... .....L�1 ,Q..
Phone No: .._...... ........... _(o �. �.�..� �x.__......_.......---
Phone No:
Mailing Address:... s 6 .. f.3.?� a.i ..... �.. �.sl.` % �L ea �._. s ........... tea....7....#�.... ' ..
Onsite Representative: ... .�e. .s' ..[l.. �.. t ......... .. Integrator: at...
Certified Operator: ..... _....... ................._................ �... .......W ....__..... _............. ......... _... Operator Certification Number:. f.��..�O...._ ...._ .
Location of Farm:
.�n.....s.c.u.�...s.i.d..�... .._5.�,,_IS y.......�.�.� ....Q.:..Z.�....xr.�..l.e.�.....�s.�.,t.f.....a ......�.,rs.��.:.............. 4
Latitude ®•���� Longitude ©• ©®u
Type of Operation and Design Capacity
g 4 Design Current Design Caren# ` <, Design Current
S►v�ue� _ 4.. h P_ouE Cattle w@a aci ' -Po ulateow 3 �.. C'a aci `Po tilahan �Y .y, Ca act Po 'nlattbn --
❑ Wean to Feeder❑ La er ❑ Da'
Feeder to Finish 3� ?� ❑Non -La er ❑ Nan -
Farrow to Wean f F
3
Farrow to Feeder Total Design =Capaeitty
Farrow to Finish �i S
. w: Tata S L« 77 a _
Other
$4 i _
„Y .,:<qq, t .•.v.....x "e mum,-.- Ka - F�a ,,,J5:. 1.:,, u4�W Numberof Lagoons 1 Hald�ng P nds ❑ Subsurface Drains Present
❑ Spray
❑ Lagoon Area S ra field Area a
General
I. Are there any buffers that need maintenance/improvement?
2. 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 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
4/30/9 7 maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes
® No
❑ Yes
0 No
❑ Yes
9 No
❑ Yes
®No
Continued on back

Facility Number: ,_1...... •--.. a.cl-
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 lagoons an-d/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (11): Structure I Structure 2 Structure 3 Structure 4
1 - 7<_
❑ Yes ® No
❑ Yes 14 No
0 Yes ❑ No
Structure 5 Structure 6
10, Is seepage observed from any of the structures? ❑ Yes BNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ® Yes ❑ No
12. Do any of the structures need maintenance/improvement?
(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 Iack adequate minimum or maximum liquid level markers?
WasteApplication
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 .tea! -r_ .._.— ............................... ....... 4.4. .I���, ...... ,�e.4�x �. V_A.�.......
16. Do the receiving crops differ with those designated in the Animalaste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18, Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
FQr Certirlrd Facilities
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?
E9 Yes ❑ No
❑ Yes 91 No
❑ Yes ® No
❑ Yes 129 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
& Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
❑ Yes EU No
® Yes ❑ No
Corninents (refer to cNeshon #l) Explain any YES answers' and/or;any recommendations"or any other comrnentss�
Use drawings. of faciLty to Better explain situations. (use addihonal pages as necessary) .` ,
= f
76.� k S [$ S ` 0 -p/,a 0 r- 4J IL S 1 4. St
P
1
l ; pp 1 i
p� �'�`j 11 S' �"� a 1 1 ,r-° 4 r 0. �-•�. S P +r0.y �" p p 1 c-, 0 v� v,_
I l . j 1 Z . T" - a e, s - Q, a-d.. 41 6 4, r Je.�-n ,r a� w. i u 1�e.,r 1 11 c� 0,
p
v e �a i s ►1 0 r` w a� l 1 u. V d o V% L 4Z d t-O b e c v a ti i t-r t7�n
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V r r C uJ -1 eiv-o C t d ,r. C v f`3 w e- - b G • f H .u�
t--Zd , A K-� t 1n Q.✓ b o_ rt S p o ff
�.1 a+, wo l S 1�ov
bQ rt v b-a.��- ,
Zq , '�'t il-� e O S t C-o Y Y-- F 0
Reviewer/Inspector Name
Reviewer/Inspector Signature: c,. 1..��� L)AR Date: 4 T
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number: .� ..—_I.�Z,_ .. Date of Inspection: 2
Additional. Comments and/or Drawings l a
Z -Soil
... S tl✓+� t ! Q
0 v 0. p+ c a-r d d v 1 y C bj
'C"6 $. A
S �p kC
t; p!+ G 1 V tn.. CN U i Y1 VJ d v
a v tj i a z.► fl ,,, 1 ai., ,Pi
C, --a i v. a v t i U aJ j �-u�-d
I
q. t; o v r
i Cs d i tt a ••, t C. o a l 0-{ a 'P-� t-o P e�,,, p �_ �.-, .-k , a
I"
s 40v 5pt -ILA &Vtv +�
4/30/97

•
•
„J /J �1- 'Site Requires Immediate Attention:
IFacilityNo. t -
D t
I N S ON OF ENVIRONMENT
AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2-3/ , 1995
Timer i• �
Farm Na
Mailing.
County:
Integratc
On Site 1
Physical
Type of Operation: Swine 1� Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM. Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' I Longitude: ” �l Elevation: Feet
Circleaga or
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard S.—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available _for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: -_ _ btu/a S
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ' se or No
100 Feet from Wells? Gor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or a
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ore If Yes, Please Explain.
Does the facility maintain adequate waste -management records (volumes of manure, land applied,
spray. irrigated bn'specific acreage with cover crop)? Yes or�
Additional Comments:
Inspector Name - Signature
' cc: Facility Assessment Unit Use Attachments if Needed: